Home-Based DVD May Motivate Seniors With MS to Exercise

NATIONAL HARBOR, Md. -- A DVD-based home exercise program adapted for older patients with multiple sclerosis (MS) may help them keep up their physical activity levels, researchers reported here.

In a small study of 21 patients who were interviewed after watching the "FlexToBa" -- which stands for flexibility, toning, and balance -- DVD for 6 months, the majority said their health and self-confidence improved, Elizabeth Hubbard, a PhD candidate at the University of Illinois Urbana-Champaign, and colleagues reported at the Consortium of Multiple Sclerosis Centers meeting.

"Patients had improvements in physical fitness levels, as well as improvements in walking and physical functioning," Hubbard told MedPage Today. "They also felt more confident about exercising."

The FlexToBa program was originally developed by Edward McAuley, PhD, of the University of Illinois, as an exercise program for healthy older adults, involving exercises focused on flexibility, toning, and balance such as yoga and resistance training.

Hubbard's group adapted the program for older patients with MS. They produced the DVD along the lines of other commercial exercise videos, and incorporated three different levels of difficulty for patients with MS. The program is for research only at the moment, and is supported by an NIH grant.

An earlier study in healthy older adults found improved physical functioning for those who watched the FlexToBa DVD compared with those who watched a standard exercise DVD.

Hubbard said outcomes from the trial of the adapted DVD in an older MS population will be published soon, and that her group reported on in-depth interviews conducted with 21 of the participants.

"We saw positive results quantitatively in physical functioning and quality-of-life scores, but we wanted to dig deeper so we conducted interviews with participants," Hubbard said.

Patients were motivated to participate by being able to increase their health and activity levels, and by being able to contribute to MS research.

They said the primary benefits were improvement in health and fitness, as well as in their attitude about exercise and their self-confidence, Hubbard reported.

"For many of them, it changed their views about exercise," she said. "In the beginning, they might have questioned it, but by the end, they would be excited about exercise."

They said they appreciated the modifications and being able to participate at their own level -- although some did say that they didn't feel any of the exercises matched their capabilities, Hubbard acknowledged: "Some felt they would have liked more modalities to be included in the video."

She said her group may add additional levels or modifications to enable more MS patients who are older to participate.

Francois Bethoux, MD, of the Cleveland Clinic, who was not involved in the study but focuses on the rehabilitation aspects of MS care, said the study covers a population that's not yet well understood.

"Older patients with MS often have higher levels of disability from their disease, and that is combined with problems of aging such as arthritis, sensory problems, and cognitive issues," Bethoux told MedPage Today. "They are also less likely to be able to go to a facility two or three times a week to get rehabilitation, so this is really an underserved population in MS."

He said there's a need for more targeted home-based exercise interventions, as well as ways to validate that these programs do get patients moving more.

And in-person therapy is a must to start with, he said.

"I strongly believe that in-person training is needed in the beginning," he said. "It's been shown again and again that starting exercise is a struggle for MS patients, and they're likely to not follow through for a long time. But to continue with the help of a personalized intervention at home could enable them to keep up their exercises between [therapy] sessions."

Comment