Exercise Training for Managing Major Depressive Disorder in Multiple Sclerosis
Abstract
Objectives and Rationale: The proposed research aligns with the Treatment of Multiple Sclerosis Symptoms focus area. We propose a behavioral/lifestyle intervention (i.e., standardized, home-based exercise training program supported by remote behavioral coaching) for treatment of depression severity in persons with multiple sclerosis (MS) who have major depressive disorder (MDD) with a secondary focus on fatigue, cognition, quality of life (QOL). MDD is prevalent among nearly one-quarter of the estimated one million persons living with MS in the United States. MDD is burdensome based on its widespread, negative effects on other symptoms, cognition, and QOL among other outcomes. The treatment of MDD in MS is currently considered sub-optimal. Indeed, fewer than 50% of people with MS who present with clinically significant depressive symptoms receive treatment. The efficacy of antidepressants for depression in MS is further considered equivocal, and CBT has been considered a possibly efficacious treatment for depression in MS, yet nearly 50% of participants do not benefit from CBT. Exercise training is a potent, physiological stimulus that may be a breakthrough approach for managing depressed mood (i.e., symptomatology) and perhaps MDD in MS. This is based on evidence from three summary analyses of exercise training and depressive symptomatology in persons with MS who have normal mood scores, and Class I evidence of exercise training effects on MDD in the general population Applicability and Impact in MS Patient Care: The proposed study would provide the first, high-quality data supporting the delivery and effect of a home-based exercise training program for the treatment of depression severity in persons with MS who have MDD. This is critical as exercise training would likely have secondary effects on other symptoms, cognition, and QOL, and provide a novel, pleiotropic stimulus for managing the many negative outcomes of MDD in MS. This is essential considering the prevalence and burden of depression and MDD in MS, and summary evidence that the treatment of MDD in MS, unfortunately, is currently considered sub-optimal. Clinical Applications and Benefits: There is broad interest among healthcare providers, particularly neurologists, in the application and promotion of exercise in MS, but this is contrasted by limited evidence supporting the range and scope of treatment implications for exercise training as well as the prescriptive guidelines for exercise training. To that end, this study would provide initial efficacy evidence for an evidence-based, exercise training program that is applicable for treatment of depression and MDD in MS. The GEMS program is further included in recent models developed by our team for exercise promotion through healthcare providers in MS clinical care. This study would provide data on an established prescriptive guideline for promotion of exercise training by healthcare providers in MS clinical care. The GEMS program follows the accepted, evidence-based guidelines for exercise training developed by members of our research team. Such benefits would be profound for advancement of MS care and treatment through the application of exercise training in MS, and would likely be extended into treatment of other, significant symptoms and areas of dysfunction requiring clinical care. Advancing MS Care and QOL: Depression and MDD have robust, secondary effects on other symptoms, cognition, and QOL in MS. Indeed, those with MS and MDD have worse fatigue, cognitive function, and QOL, and aerobic capacity and muscle strength are further reduced and highly relevant for QOL and independence. To that end, exercise training provides a novel, pleiotropic stimulus for managing the many negative, secondary outcomes of MDD in MS including worse fatigue, cognitive function, and QOL, and deconditioning in aerobic capacity and muscle strength. Collectively, exercise training represents a pot
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110952
Entities
People
- Robert Motl
Organizations
- United States Army
- University of Alabama at Birmingham