Adapted Physical Activity and Multiple SclerosisPost-doctoral research by Anthony Khawaja

Supervisors:   Professor Guillaume MILLET, Professor Jean-Philippe CAMDESSANCHE

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system. It mainly affects the myelin sheath of the axons leading to demyelination. This inflamation disrupts the transmission of nerve messages and degrades the axon itself, causing neurodegeneration. MS mainly affects young adults with a strong female predominance. In France, more than 110,000 people have MS. Fatigue is the most reported symptom among patients and it is also one of the most debilitating. In fact, fatigue affects up to 80% of MS patients. Fatigue is defined as a “subjective lack of physical and/or mental energy, perceived by the individual or caregiver, which interferes with usual and desired activities” (Multiple Sclerosis Clinical Practice Guidelines) and which is not relieved by rest or sleep unlike healthy people.

Regular physical activity improves patients' quality of life by limiting the deconditioning process, improving physical fitness and social support while limiting depression. Strength training and/or endurance training can reduce perceived fatigue, increase muscle strength, cardiorespiratory capacity, gait, balance and neurological function. Despite the benefits provided by exercise, the results are not optimal and MS patients remain less active than the general population, mainly due to the fatigue they experience. Improving the benefits of exercise therapy could therefore be based on two approaches: personalization of the training program and practice at home. In this project, the individualized training program will be designed specifically to fill the gaps or areas for improvement for each patient while the control group will receive the usual guidelines from the High Authority of Health (HAS) for exercise practice and Physical activity guidelines for MS patients.

The main objective will be to compare the effect of a 12-week program of adapted, personalized and guided training (IND) at home via an application (MoveInLab) versus a program based on the standard recommendations of the HAS practice of exercises (TEM) on: the level of chronic fatigue, in patients diagnosed with MS for more than 2 years (first symptoms > 5 years, SEP-A group), with a significant level of fatigue.

Finally, the entire project is based on the structure of the chronic fatigue and APA (adapted physical activities) treatment course of the Myology Unit of the Clinical Physiology and Exercise department of the Saint Etienne University Hospital. Indeed, the latter welcomes patients with chronic fatigue (including patients with MS) during 2 half-days in day hospital before and after treatment with adapted physical activity. Our objective will therefore also be to compare the 2 training modalities (individualized and guided versus standard recommendations), on the different evaluations carried out as part of this treatment (neuromuscular fatigue, strength, physical capacities, etc.) with the aim of reduce perceived fatigue and improve patients' quality of life.

Contract duration: 07/2022 to 12/2023