Sport Sciences for Health

, Volume 13, Issue 3, pp 607–613 | Cite as

Long-term endurance training improves general health perception in multiple sclerosis patients with fatigue: results of an exploratory study

  • Marc Wonneberger
  • Stephan SchmidtEmail author
Original Article



To determine if long-term endurance exercise improves quality of life (QOL) in patients with multiple sclerosis (MS).


89 patients with relapsing–remitting MS and an EDSS of <3.5 participated in a prospective non-randomized controlled exploratory trial. The exercise program comprised a walking exercise three times weekly for 30 min (“interval training” twice weekly, “endurance training” once weekly) for 12 months. Participants were tested every 3 months on a treadmill according to a modified Naughton protocol. Fatigue was assessed by the Fatigue Severity Scale (FSS) and QOL by a German version of the Short Form Health Survey (SF-36). Data were analyzed using analysis of variance (ANOVA) with repeated measurements.


20 patients without and 24 with fatigue completed the program. QOL was reduced in several subscales of the SF-36 in MS patients with fatigue at baseline: physical functioning (p < 0.001), physical role functioning (p < 0.002), bodily pain (p ≤ 0.04), vitality (p ≤ 0.001), social role functioning (p ≤ 0.004), emotional role functioning (p ≤ 0.03), mental health (p ≤ 0.006). Exercise training resulted in a significant improvement of the subscale general health perceptions (p ≤ 0.01).


Fatigue contributes significantly to QOL in MS patients. A significant improvement in the subscale general health perceptions was demonstrated by a 12-month endurance walking program in MS patients with fatigue.


Multiple sclerosis Fatigue Quality of life Endurance exercise 



Quality of life


Multiple sclerosis


American College of Sports Medicine


Relapsing–remitting MS


Expanded Disability Status Scale


Peak oxygen consumption


Fatigue Severity Scale

SF-36 Health Survey

Short Form Health Survey


Physical functioning


Physical role functioning


Bodily pain


General health perceptions




Social role functioning


Emotional role functioning


Mental health


Analysis of variance


Compliance with ethical standards


This study was funded by Bayer Vital (Grant Number PB05).

Conflict of interest

Both authors have received speaker honoraria from Bayer Vital.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Hermann BP, Vickrey B, Hays RD, Cramer J, Devinsky O, Meador K et al (1996) A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Res 25:113–118CrossRefPubMedGoogle Scholar
  2. 2.
    Klevan G, Jacobsen CO, Aarseth JH, Myhr K, Nyland H, Glad S et al (2014) Health related quality of life in patients recently diagnosed with multiple sclerosis. Acta Neurol Scand 129:21–26CrossRefPubMedGoogle Scholar
  3. 3.
    Rudick RA, Miller D, Clough JD, Gragg LA, Farmer RG (1992) Quality of life in multiple sclerosis: comparison with inflammatory bowel disease and rheumatoid arthritis. Arch Neurol 49:1237–1242CrossRefPubMedGoogle Scholar
  4. 4.
    The Canadian Burden of Illness Study Group (1998) Burden of illness of multiple sclerosis: part II: quality of life. Can J Neurol Sci 25:31–38CrossRefGoogle Scholar
  5. 5.
    Chen K, Fan Y, Hu R, Yang T, Li K (2013) Impact of depression, fatigue and disability on quality of life in Chinese patients with multiple sclerosis. Stress Health 29:108–112CrossRefPubMedGoogle Scholar
  6. 6.
    Janardhan V, Bakshi R (2002) Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 205:51–58CrossRefPubMedGoogle Scholar
  7. 7.
    Heine M, van de Port I, Rietberg M, van Wegen E, Kwakkel G (2015) Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 11(9):CD009956. doi: 10.1002/14651858.CD009956.pub2 Google Scholar
  8. 8.
    Latimer-Cheung A, Pilutti L, Hicks A, Ginis K, Fenuta A, MacKibbon K et al (2013) Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil 94:1800–1828CrossRefPubMedGoogle Scholar
  9. 9.
    Schmidt S, Wonneberger M (2014) Long-term endurance exercise improves aerobic capacity in patients with relapsing-remitting multiple sclerosis: impact of baseline fatigue. J Neurol Sci 336:29–35CrossRefPubMedGoogle Scholar
  10. 10.
    Bansi J, Bloch W, Gamper U, Riedel S, Kesselring J (2013) Endurance training in MS: short-term immune responses and their relation to cardiorespiratory fitness, health-related quality of life, and fatigue. J Neurol 260:2993–3001CrossRefPubMedGoogle Scholar
  11. 11.
    Bjarnadottir O, Konradsdottir A, Reynisdottir K, Olafsson E (2007) Multiple sclerosis and brief moderate exercise. A randomised study. Mult Scler J 13:776–782CrossRefGoogle Scholar
  12. 12.
    McCullagh R, Fitzgerald AP, Murphy RP, Cooke G (2008) Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study. Clin Rehabil 22:206–214CrossRefPubMedGoogle Scholar
  13. 13.
    Motl RW, Gosney JL (2008) Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis. Mult Scler J 14:129–135CrossRefGoogle Scholar
  14. 14.
    Sutherland G, Andersen MB (2001) Exercise and multiple sclerosis: physiological, psychological, and quality of life issues. J Sports Med Phys Fit 41:421–432Google Scholar
  15. 15.
    Motl RW, Pilutti LA (2012) The benefits of exercise training in multiple sclerosis. Nat Rev Neurol 8:487–497CrossRefPubMedGoogle Scholar
  16. 16.
    Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C et al (2010) Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Mult Scler J 16:480–490CrossRefGoogle Scholar
  17. 17.
    Dettmers C, Sulzmann M, Ruchay-Plössl A, Gütler R, Vieten M (2009) Endurance exercise improves walking distance in MS patients with fatigue. Acta Neurol Scand 120:251–257CrossRefPubMedGoogle Scholar
  18. 18.
    Mostert S, Kesselring J (2002) Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler J 8:161–168CrossRefGoogle Scholar
  19. 19.
    Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M (2010) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302CrossRefGoogle Scholar
  20. 20.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 33:1444–1452CrossRefPubMedGoogle Scholar
  21. 21.
    Naughton JP, Haider R (1973) Methods of exercise testing. In: Naughton J, Hellerstein HK (eds) Exercise testing and exercise training in coronary heart disease. Academic Press, New York, pp 79–91Google Scholar
  22. 22.
    Patterson JA, Naughton J, Pietras RJ, Gunnar RM (1972) Treadmill exercise in assessment of the functional capacity of patients with cardiac disease. Am J Cardiol 30:757–762CrossRefPubMedGoogle Scholar
  23. 23.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I et al (2011) Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. Med Sci Sports Exerc 43:1334–1359CrossRefPubMedGoogle Scholar
  24. 24.
    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematodes. Arch Neurol 46:1121–1123CrossRefPubMedGoogle Scholar
  25. 25.
    Johansson S, Ytterberg C, Hillert J, Widen HL, von Koch LA (2008) A longitudinal study of variations in and predictors of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 79:454–457CrossRefPubMedGoogle Scholar
  26. 26.
    Lerdal A, Wahl A, Rustøen T, Hanestad B, Moum T (2005) Fatigue in the general population: a translation and test of the psychometric properties of the Norwegian version of the Fatigue Severity Scale. Scand J Public Health 33:123–130CrossRefPubMedGoogle Scholar
  27. 27.
    Keller SD, Ware JE Jr, Gandek B, Aaronson NK, Alonso J, Apolone G et al (1998) Testing the equivalence of translations of widely used response choice labels: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:933–944CrossRefPubMedGoogle Scholar
  28. 28.
    Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  29. 29.
    Busch MA, Maske UE, Ryl L, Schlack R, Hapke U (2013) Prevalence of depressive symptoms and diagnosed depression among adults in Germany. Results of the German Health Interview and Examination Survey for adults [DEGS1]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:733–739CrossRefPubMedGoogle Scholar
  30. 30.
    Gupta S (2011) Intention-to-treat concept: a review. Perspect Clin Res 2:109–112CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Pittion-Vouyovitch S, Debouverie M, Guillemin F, Vandenberghe N, Anxionnat R, Vespignani H (2006) Fatigue in multiple sclerosis is related to disability, depression and quality of life. J Neurol Sci 243:39–45CrossRefPubMedGoogle Scholar
  32. 32.
    Papuć E, Stelmasiak Z (2012) Factors predicting quality of life in a group of Polish subjects with multiple sclerosis: accounting for functional state, socio-demographic and clinical factors. Clin Neurol Neurosurg 114:341–346CrossRefPubMedGoogle Scholar
  33. 33.
    Gobbi E, Carraro A (2016) Effects of a combined aerobic and resistance exercise program in people with multiple sclerosis: a pilot study. Sport Sci Health 12:437–442CrossRefGoogle Scholar
  34. 34.
    Romberg A, Virtanen A, Ruutiainen J (2005) Long-term exercise improves functional impairment but not quality of life in multiple sclerosis. J Neurol 252:839–845CrossRefPubMedGoogle Scholar
  35. 35.
    Bakshi R, Shaikh ZA, Miletich RS, Czarnecki D, Dmochowski J, Henschel K et al (2000) Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler J 6:181–185CrossRefGoogle Scholar
  36. 36.
    Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW (1995) A health-related quality of life measure for multiple sclerosis. Qual Life Res 4:187–206CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l. 2017

Authors and Affiliations

  1. 1.Schule für Physiotherapie Gummersbach, DAA Gesundheit und SozialesGummersbachGermany
  2. 2.Neurologische Gemeinschaftspraxis Bonn, Gesundheitszentrum St. JohannesBonnGermany
  3. 3.Department of Neurology, Knappschafts-Krankenhaus LangendreerRuhr-University of BochumBochumGermany

Personalised recommendations