Themes From Exercise Trials in Multiple Sclerosis Improves Quality of Future Research


A recent review from the National MS Society revealed eight themes based on previous clinical trials focused on exercise and physical activity in MS.

Robert W. Motl, PhD, professor of Kinesiology and Nutrition, University of Illinois Chicago

Robert W. Motl, PhD

Findings from a recent review on clinical trials assessing physical activity in people with multiple sclerosis (MS) conducted by the National MS Society observed 8 themes to advance future studies.1 The findings may be used as a resource to conduct high-quality randomized controlled trials using healthy movement in MS.

There were several limitations in the current research on exercise in MS, such as few resources, few applications, and lack of consideration for the stages of research and the design. Notably, there was still a broad concern pertaining to the safety for physical activity for patients with MS. A lack of diversity in the selection of patients was also observed along with insufficient research in more community settings. Additionally, although not considered the same, the terms of exercise and physical activity were reported as synonymous throughout clinical trials.

Lead author Robert W. Motl, PhD, professor of Kinesiology and Nutrition, University of Illinois Chicago, and colleagues wrote, “These 8 themes have direct relevance for the greater vision of supporting exercise and physical activity in the management of MS as a disease as well as its biological, functional, symptomatic, and quality of life outcomes, but we do not consider our paper as providing consensus recommendations.”1

Members of the National MS Society, including Motl, collectively pooled their experiences in research to identify the challenges and complexities in the design of interventions regarding the behavior of exercise and physical activity among individuals with MS. The investigators had several virtual meetings over the span of 2 years to discuss the lessons they have learned in the field of healthy movement in MS. During the meetings, the researchers participated in voting rounds until there was a group consensus made for the themes.

The main themes of focus in this area of research were the behavior of interest, the study design features, stage of research, study setting, safety, sample selection, implementation of randomized controlled trials, and treatment or intervention fidelity. Based on the themes that were identified from the content of research conducted, a possible strategy was recommended for future studies. The content was reviewed by two researchers outside of the organization who were able to help with clarification and elaboration before the final publication.

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Motl et al noted, “We recognize that research involving exercise and physical activity in MS is an evolving field and that our perspectives identify current issues through our experience and knowledge of the literature, and we hope that, as additional studies are completed, these themes will be continually refined by investigators in the MS community.”1

The strategies that were recommended to address the recurrent themes from previous clinical trial research included future researchers having a clear definition of the behavior the aligns with the intervention. Investigators should also consider the trial designs and have a more inclusion sample,such as having a more detailed recruitment plan. Another plan noted by the authors should be to keep a record of any adverse events that occur within the trials. Additionally, there should be educational material based on exercise and physical activity in MS including training workshops and best-practice manuals for investigators to be more informed.

All told, funding studies in this area would help broaden and build a stronger body of research on movement in MS for healthcare providers. Using the recommended strategies that address the themes in future research and then using the evidence from the findings in clinical care would help with applying evidence-based practice for individuals impacted by MS in their lives.

“We recommend that investigators consider and address the themes we outlined herein with the awareness that each study, with positive or negative findings, provides more information to better understand the impact of exercise and physical activity among people in MS,” Motl et noted.1

1. Motl RW, Fernhall B, McCully KK, et al. Lessons learned from clinical trials of exercise and physical activity in people with MS - guidance for improving the quality of future research. Mult Scler Relat Disord. 2022;68:104088. doi:10.1016/j.msard.2022.104088
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