Exercise and MS – A PCORI Study

Interview with Dr. Jeffrey Hebert, Associate Professor, Physical Medicine & Rehabilitation-Physical Therapy Program

RMMSC: Could you please give us a brief overview of the PCORI study on MS and exercise?

Dr. Jeffrey Hebert: With this study, we are examining the comparative effectiveness between a supervised, facility-based exercise program and a tele-rehabilitation approach for patients with MS. We’re looking at two approaches to exercise interventions to compare which one is more effective, more efficient, and any other effects the approaches may have for stakeholders. This will be one of the largest MS exercise trials ever conducted.

RMMSC: How will this study be structured?

Dr. Hebert: Our goal is to include 500 participants across the five study sites. This will be a randomized study which means participants will be randomly placed into either the supervised, facility-based exercise program or the tele-rehabilitation program. The primary research site is the Shephard Center in Atlanta and the secondary site is the University of Alabama in Birmingham. The University of Alabama is providing the tele-rehabilitation program which includes coaching. Here at the University of Colorado, we’re partnering with our health and wellness center to deliver the supervised portion of the exercise program. We have a very strong infrastructure for the primary treatment and the outcome measures and screening that will be conducted at the wellness center. The exercise program will include endurance exercises conducted primarily on the treadmill or walking track, and some resistance exercises for legs and arms.

Participating in this trial is a commitment of one year of involvement. While that is a significant time commitment, it is also a rare opportunity. We’ll be able to follow people for a much longer time than a typical study and that will enable us to better understand the factors involved in maintaining a longer term exercise program.

RMMSC: Could you please tell us more about what questions you are seeking to answer with the study?

Dr. Hebert: A typical study might be seeking to answer the question of whether one approach is more effective than the other in terms of physiological outcomes and patient reported outcomes. However, our questions and hypotheses are a bit more open-ended. We hypothesize that both the in-person and tele-rehab exercise programs will be similarly effective in terms of standard outcome measurements. Therefore, we are very interested in examining other key metrics of effectiveness, such as feasibility, efficiency, and acceptability. These types of comparisons could have direct impacts on patients with MS, family members, health care providers and possibly third party payers, in terms of the efficiency of delivering one effective treatment vs another.

RMMSC: What do we already know about exercise and MS?

Dr. Hebert: There is a very strong direct correlation between a healthier heart and a healthier brain. If you are living with MS, it is important to know that if you want to protect and or improve your brain, exercise is probably the best thing you can do. While brain games like crossword puzzles are great if you like doing them, it’s been shown recently in multiple ways and multiple populations that those brain games are really not effective for overall brain health. It is much more effective to be more physically active, engaged in social and family activities, and problem solving real-life situations in your daily life.

When you exercise, your heart beats higher than at rest and you truly release certain hormones. Your brain uses those hormones to maintain and potentially grow new neurons in your brain. Over the last 20 years in MS, there has been an evolution in our understanding the importance of exercise for people living with MS – we are truly thinking about exercise as a critical front line strategy instead of an afterthought.

RMMSC: Building awareness about the important role exercise plays in maximizing brain health for people with MS is essential. But, this study is going beyond that and seeking to improve our understanding of how we can more effectively ensure that people living with MS can more readily implement and maintain a regular exercise program. Can you talk a little bit more about the challenges people face in adopting an exercise program?

Dr. Hebert: Yes, absolutely. As clinicians and researchers, we tell you that exercise is important and that you should do it. But, collectively we all have to understand that there are many significant barriers to initiating an exercise program and to maintaining a lifelong exercise and active lifestyle. The number one barrier that patients with MS face on a regular basis is access: access to the proper equipment, proper supervision/coaching, and the proper environment.

Right now, participation at fitness center facilities with exercise coaches is not routinely covered by insurance providers. Tele-rehabilitation is one potential solution to help address those access barriers. If we find that the tele-rehab program and in-person exercise program are equally effective, acceptable and feasible for people living with MS, we can continue to make the case that third-party payers should cover both of those programs and that patients should have that choice.