Analysis of an ESSA position statement

ESSA position statement on exercise for people with mild to moderate MS

“Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in
MS and should be supplemented by balance exercise to prevent falls”

What evidence supports this statement?

A systematic review by Latimer-Cheung et al., (2013) including 54 studies has been referenced to support the
above statement. Their resulting guidelines suggested 30 minutes of moderate intensity aerobic exercise and
strength training for major muscle groups twice a week – to reduce fatigue, improve mobility and enhance
quality of life (QoL). The supporting evidence contradicts the statement’s conclusion, stating that there is
inadequate quality evidence to correlate balance exercises with health benefits. However, the statement
draws on newer evidence, supported by Halabchi et al., (2017) and Kalb et al., (2020), further concluding that
standing/seated balance training has statistically significant effect on improving stability and decreasing falls
risks. It is to be noted that population size or number of studies utilised by these specific studies have not
been determined within the paper.

Are there new papers supporting these statements?

Following the release of this ESSA position statement in 2022, very few systematic reviews (SR) or randomised
controlled trials (RCT) have been conducted specifically for MS to further support the above statement.
Gravestejin et al., (2023) conducted a secondary analysis of an RCT investigating the neuroprotective effects of
aerobic training (AT) specifically on blood-based markers in MS individuals. Specific blood-based markers
increase in people with MS and are associated with worsening disease severity scores and progression. This
study including 89 participants implemented high intensity AT and found a small, clinically irrelevant
difference in biomarkers between their testing groups. This suggests that more focus is required in this field of
study. Furthermore, an SR by Amin and Tayebi., (2022) highlighted the effects of resistance training (RT) on
molecular mechanisms of MS individuals. Several statistically significant studies – determined by p<0.001 –
within the SR utilised different methods of RT – including PRT, HIIT, machine weights and resistance bands –
concluding a neuroprotective correlation between RT and the CNS of MS patients, contributing to their
increased QoL. Additionally, a paper by Celesti et al., (2022) conducted a study specific to balance training
using a balance board device. Although not so cost effective, this study’s results aligned with previous study
claims regarding balance training; ameliorating balance and gait and improving QoL of MS patients.

Are you satisfied with this evidence?

To some extent. These papers are derived from databases specific to MS research, therefore significantly
remove results of conditions similar to MS and provide a more evidence-based practice. Most studies have
provided a statistically significant value, hence providing a strong link between the supporting evidence and
the claims of the statement. However, some supporting studies have not identified certain population groups
or a number of studies that they have included in their analysis, therefore cannot claim to represent the larger
demographic of persons with MS.

How would you convey to a client the evidence you have just gathered?
Empathy is an important skill during communication with a client – specifically with an MS client. A lot of
emerging evidence – portrayed in the ESSA position statement and other current literature reviews – support
an increased quality of life for MS individuals. Therefore, breaking down and explaining to the client how a
statistically significant study correlates with strong evidence to the field of MS research and their QoL would
be ideal and beneficial. Exercise should be tailored to every individual, therefore concerns to the patient’s
profile (e.g. barriers) should be taken into considerations when providing evidence-based practice.
Latimer-Cheung et al., (2013)
https://www.sciencedirect.com/science/article/pii/S0003999313004255?pes=vor

Halabchi et al., (2017)

https://link.springer.com/content/pdf/10.1186/s12883-017-0960-9.pdf

Kalb et al., (2020)

https://journals.sagepub.com/doi/pdf/10.1177/1352458520915629

Gravestegin et al., (2023)

https://www.sciencedirect.com/science/article/pii/S2211034822009932

Amin and Tayebi (2022)

https://www.sciencedirect.com/science/article/pii/S2211034822009051

Celesti et al., (2022)

https://www.mdpi.com/2076-3271/10/1/13