High-intensity Resistance Training May Help MS Patients With Fatigue

Three months of once-weekly sessions of high-intensity resistance training — consisting of strength exercises followed by a short recovery between sets — effectively eased fatigue in multiple sclerosis (MS) patients experiencing low energy and tiredness, a trial in Sweden shows.

This intervention also lessened feelings of depression and anxiety, and improved health-related quality of life. A twice-weekly program resulted in greater effects only in anxiety and psychological aspects of health-related quality of life.

These findings support recommending high-intensity resistance training when fatigue is already present, the researchers noted. Most people with MS experience fatigue early on in the course of the disease.

The study, “High-intensity resistance training in people with multiple sclerosis experiencing fatigue: A randomized controlled trial,” was published in the journal Multiple Sclerosis and Related Disorders.

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Fatigue, a sense of tiredness and exhaustion, is a very common MS symptom. It can affect both body and mind, and make it difficult for patients to take part in daily activities.

The causes of fatigue in people with MS are unclear, but increasing evidence suggests regular exercise may help control it. However, few studies have been conducted on already fatigued patients to determine what type of exercise is best.

In a previous pilot study, a team of researchers at the Karolinska Institute in Sweden showed three months of high-intensity resistance training led to clinically meaningful reductions in fatigue among people with relapsing-remitting MS (RRMS). The program also lessened feelings of anxiety or depression and boosted health-related quality of life.

Now, the researchers wanted to test the same type of exercise, with two different frequencies, in already fatigued patients.

Trial included 71 MS patients experiencing at least moderate fatigue

The trial (NCT04562376) included 71 adults with MS (62 women and nine men) who were experiencing at least moderate fatigue, classified as a score of 53 or higher in the Fatigue Scale for Motor and Cognitive Functions (FSMC). The scale’s scores range from 20 to 100 points, with higher scores indicating worse fatigue.

All but one patient (who had primary progressive MS) had RRMS. Their mean age was 42.1 years, and they had received a diagnosis of MS a mean of 8.6 years prior. More than half (57.7%) reported practicing 150 minutes or more of aerobic physical activity per week.

More than a quarter of the participants (26.8%) received pharmacological treatment for fatigue within the previous year and 16 had been prescribed antidepressants.

Participants were randomly assigned to undergo either once-weekly sessions (36 patients) or twice-weekly sessions (35 patients) of supervised high-intensity resistance training for 12 weeks (about three months).

Each session lasted 60 minutes. It started with a 5- to 10-minute warmup on a stationary bicycle followed by four upper body exercises and three lower body exercises on training machines. Then there was a whole-body exercise (plank position) before a final 5- to 10-minute cooldown of stretching exercises.

Each exercise was repeated 15 times (in weeks 1–2), 10 times (weeks 3–4), or seven times (weeks 5–12), with no rest in between repetitions. There were three sets, with 1–3 minutes of rest between sets.

“Participants were provided with different options for HIRT [high-intensity resistance training] sessions to increase adherence and they trained alone or in groups of maximum five persons/session,” the team wrote.

Eleven (15.5%) of the patients dropped out of the study at some point. They experienced worse fatigue and stronger feelings of anxiety or depression at the start of the study than those who completed the program.

More than two-thirds (70.4%) of patients attended at least 75% of the sessions, and 52 (73.2%) increased their muscle strength by a mean of 10% or more.

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Training programs led to reduced fatigue in participants

Results showed that both programs led to clinically meaningful reductions in fatigue, classified as a drop of at least 10 points in the FSMC score, with no significant differences between the groups.

A total of 28 participants (13 in the once-weekly group and 15 in the twice-weekly group) saw their FSMC score fall by 10 points or more. The number of patients with severe fatigue dropped from 66 at the study’s start to 43 after the training program, at which point five patients showed only mild fatigue, and four no longer reported fatigue.

The team then compared the combined groups with an external control group of 69 MS patients with FSMC-assessed moderate fatigue who participated in a previous trial, called COMBAT-MS (NCT03193866), that did not involve exercise programs.

They found that while the FSMC score dropped by a mean of 10.3 points among patients undergoing high-intensity resistance training, it increased by a mean of 1.3 points in the control group after three months.

This highlighted the beneficial effects of the training program in fatigued MS patients.

Both interventions were also associated with significant reductions in another measure of fatigue — the Fatigue Severity Scale — and in anxiety and depression, as assessed with the Hospital Anxiety and Depression Scale.

Significant improvements in two measures of health-related quality of life — the Multiple Sclerosis Impact Scale-29 (MSIS-29) and the EuroQol Visual Analogue Scale — were also observed after the three-month training program.

Only anxiety and a psychological component of the MSIS-29 showed significant group differences, which favored the twice-a-week intervention.

When the researchers looked at the blood levels of certain inflammatory proteins in the combined groups, they found that some were significantly increased at a median of five days after the last session. These inflammatory proteins are involved in how muscles recover and grow new blood vessels after resistance training.

These results highlight that “participation in once or twice weekly HIRT is associated with a clinically relevant reduction in self-reported fatigue scores among fatigued [people with MS], with relevant improvements also in other patient-reported outcomes,” the researchers wrote.

“In addition, improved fatigue scores were associated with changes in inflammatory protein levels in [blood],” they added.

These findings provide evidence for recommending high-intensity resistance training for fatigued MS patients, the team concluded.