A Pilot Study of an Exercise-Based Patient Education Program in People with Multiple Sclerosis

Hindawi Publishing Corporation Multiple Sclerosis International Volume 2014, Article ID 306878, 11 pages http://dx.doi.org/10.1155/2014/306878 Research Article A Pilot Study of an Exercise-Based Patient Education Program in People with Multiple Sclerosis Stephanie Kersten,1 Mohammed Mahli,2 Julia Drosselmeyer,3 Christina Lutz,3,4 Magnus Liebherr,3 Patric Schubert,3 and Christian T. Haas3 1 Faculty of Health & Social Sciences, Institute for Complex Health Research, Hochschule Fresenius, University of Applied Sciences, Limburger Street 2, 65510 Idstein, Germany 2 BAG, Federal Institute for Human Posture and Movement Development, 65207 Wiesbaden, Germany 3 Hochschule Fresenius, University of Applied Sciences, 65510 Idstein, Germany 4 Sports Science Institute, Saarland University, 66123 Saarbrücken, Germany Correspondence should be addressed to Stephanie Kersten; Received 3 October 2014; Revised 1 December 2014; Accepted 1 December 2014; Published 21 December 2014 Academic Editor: Francesco Patti Copyright © 2014 Stephanie Kersten et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There is increasing evidence that physical exercise leads to numerous positive effects in PwMS. However, long-term effects of exercise may only be achievable if training is implemented in daily routine. Enabling patients to exercise regularly, we developed a patient education program focused on evidence-based information of training. PwMS were educated in neurophysiological effects of physical exercise, exercise-induced benefits for PwMS, and risk factors (e.g., weather). Fifteen PwMS were analyzed before (𝑇0 ) and after (𝑇1 ) a 12-week patient education. Afterwards, participants performed their exercises autonomously for 32 weeks and were tested in sustainability tests (𝑇2 ). Guided interviews were carried out, additionally. Significant improvements from 𝑇0 to 𝑇1 were found in 6MWT, gait velocity, TUG, fatigue, and quality of life. Significant results of TUG and gait velocity from 𝑇1 to 𝑇2 demonstrated that participants kept few effects after the 32-week training phase. Qualitative analyses showed improved selfconfidence and identified training strategies and barriers. This pilot study provides evidence that PwMS are able to acquire good knowledge about physical exercise and apply this knowledge successfully in training management. One might conclude that this exercise-based patient education seems to be a feasible option to maintain or improve patients’ integral constitution concerning physical and mental health. 1. Introduction Multiple sclerosis (MS) is defined as a chronic inflammatory neurodegenerative disease of the central nervous system [1]. It is characterized by a large variety of symptoms, psychiatric problems, and motor control disorders [1, 2]. In Germany, about 120,000–140,000 people are affected by this disease, frequently diagnosed and manifested between the age of 20 and 40 [3]. Due to the unforeseen disease progress, in many cases the MS diagnosis means a huge psychological and physiological burden both upon the individual person, their careers, and family. The pharmaceutical treatment still represents the key strategy in MS therapy. However, physical exercise is increasingly considered to be an important symptomatic and supportive intervention for PwMS in the therapeutic context. Numerous well-controlled studies were published examining the effects of physical exercise in PwMS and a variety of different exercise interventions have been tried (aerobic training, resistance training, combined programs, etc.). In general, there is strong evidence that PwMS who do exercise regularly perform better in terms of muscle power function, exercise tolerance functions, and mobilityrelated activities compared to patients who do not [1, 4, 5]. Furthermore, physical exercise seems to be a feasible option to improve not only in aerobic capacity and muscle strength, but also in fatigue, gait, balance, and quality of life [6–17]. Both endurance and resistance training are well tolerated by 2 PwMS [18]. Additionally, endurance training seems to have a possible beneficial effect beneath physiological factors on the psychological profile of PwMS [1, 7, 9, 19, 20]. With respect to these positive findings, one might expect that PwMS generally know physical exercise as a therapy option, perform exercises autonomously, and participate in exercise therapy interventions. In contrast, there are indications that PwMS show reduced physical activity, a nescience and uncertainty about physical exercise in MS disease— possibly due to missing exercise recommendations [7, 21, 22]. As a consequence, there is an increasing risk in developing secondary diseases. Therefore, PwMS suffer more often from obesity, diabetes mellitus, osteoporosis, and cardiovascular diseases [7, 21, 23]. Further investigations in animal models show that decreasing mobility may accelerate neurodegenerative processes, in both neurotraumatic disorders like spinal cord injury and neurodegenerative diseases like multiple sclerosis and Parkinson’s disease [24–31]. Enabling PwMS to implement regular physical exercise in their everyday life, we developed an exercise-based patient education program. Because of the individual character and adaptation processes of exercise-induced effects per se, there is a strong need for an autonomous performance of physical exercise especially in persons with neurological disorders. It is highly important that the patient education program relies on strong evidence-based information about the effects, interactions, and risks of physical exercise in MS disease. Until now, patient education is established especially in chronic diseases like diabetes mellitus, rheumatism, chronic obstructive pulmonary disease (COPD), and asthma [32– 35]. Regularly offered exercise groups, mostly cofinanced by health insurances, have already been integrated in the longterm rehabilitation for persons with heart diseases (e.g., after heart attack) and lung diseases. But standardized therapeutic education programs for PwMS are rare. Furthermore, existing self-care programs focus primarily on symptom and disease management (e.g., pain, fatigue), not on exercise recommendations and behavioral interventions to increase physical activity [36]. The development and evaluation of an exercise-based patient education for PwMS is more problematic and complicated due to many factors: symptom variety, different disability status, conflicting interaction with physical effort needed for activities of daily living (e.g., house cleaning, cooking), local dependency of patients, and methodical approaches for empirical examinations. Therefore, only few previous studies focusing on concepts of exercise-based patient education or therapeutic education have been published. Conside (...truncated)