title: Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial.
abstract: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (PwMS).
  
  
  
  The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up.
  
  
  
  We conducted a parallel-arm, randomised controlled trial: 120 PwMS (Expanded Disability Status Scale (EDSS) 1.0-6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1-6) were followed by one supervised and two home-exercise sessions (weeks 7-12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL).
  
  
  
  The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue (p < 0.0001) and many HRQoL domains (p ≤ 0.03) at three months. The improvements in emotional well-being (p = 0.01), social function (p = 0.004) and overall quality of life (p = 0.001) were sustained for nine months.
  
  
  
  This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS.
authors.affiliation: Centre for Sport and Exercise Science, Sheffield Hallam University, UK.
authors.forename: A
authors.initials: A
authors.lastname: Carter
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Daley
authors.affiliation: Centre for Sport and Exercise Science, Sheffield Hallam University, UK.
authors.forename: L
authors.initials: L
authors.lastname: Humphreys
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: N
authors.initials: N
authors.lastname: Snowdon
authors.affiliation: Biomedical Research Centre, Sheffield Hallam University, UK.
authors.forename: N
authors.initials: N
authors.lastname: Woodroofe
authors.affiliation: Multiple Sclerosis Society, UK.
authors.forename: J
authors.initials: J
authors.lastname: Petty
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Roalfe
authors.affiliation: School of Health and Related Research, University of Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Tosh
authors.affiliation: Neurology Department, Sheffield Teaching Hospitals Foundation Trust, UK.
authors.forename: B
authors.initials: B
authors.lastname: Sharrack
authors.affiliation: School of Rehabilitation Sciences, University of East Anglia, UK john.saxton@uea.ac.uk.
authors.forename: J M
authors.initials: JM
authors.lastname: Saxton
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D004644:Emotions; D004739:England; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D012919:Social Behavior; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Pragmatic exercise; cognitive behavioural; fatigue; health-related quality of life