Restless Legs Syndrome Severity in MS Decreased Through Exergaming

Serkan Ozakbas, MD

Despite a small sample size, recently published research suggest that exergaming can effectively reduce restless legs syndrome (RLS) severity in patients with multiple sclerosis (MS), and may also lead to improvements in sleep-related problems.

The single-blind randomized controlled study featured 16 patients with MS with and without RLS who completed the protocol after 8 weeks of treatment. Those who were on exergaming saw improvements in RLS severity (P = .004), anxiety level (P = .024), sleep quality (P = .005), walking (P = .004), and balance functions (P = .041) while controls saw RLS severity increase (P = .004).

Senior investigator Serkan Ozakbas, MD, Department of Neurology, Dokuz Eylul University, and colleagues used a Microsoft Xbox One and a 50-inch 4K Ultra HD LED TV for the video-based exergaming physical activity training. Specifically, patients played the Kinect Sports Rivals game, a whole-body experience that includes 6 games of target shooting, bowling, football, rock climbing, tennis, and Jet Ski racing.

The participants performed the 6 games at different timelines, with appropriate games selected by physiotherapist. The exergaming training was applied under this specialist’s provision 2 days a week for 8 weeks, with each session lasting 45 minutes. The treated group were evaluated at baseline, week 8 (post-treatment), and week 16 (follow-up). Controls did not receive any specific training, and were asked to continue their routine treatment from first evaluation to last.

In total, 27 patients with MS with RLS (exergaming: n = 11; controls: n = 15) and 27 patients with MS without RLS (exergaming: n = 12; controls: n = 15) were included in the 8-week post-treatment analyses. Both groups had no statistically significant differences in terms of basic demographic and clinical characteristics; however, there was significant differences between the treatment and control groups in patients with MS with RLS in baseline assessments of RLS severity, Pittsburgh Sleep Quality Index (PSQI)-daytime dysfunction, and PSQI-total score (P <.05).

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Compared with baseline, those exposed to exergaming significantly improved in RLS severity, sleep quality, walking and balance functions, and anxiety level at week 8 (P <.05). At the follow-up time point, investigators continued to see sustained gains in RLS severity, sleep quality, and walking capacity. RLS severity, which was evaluated using the Restless Legs Syndrome Rating Scale (RLSRS), was significantly increased after 8 weeks.

Patients with MS without RLS who received exergaming saw significant improvements in walking and balance functions at week 8 (P <.04); however, these improvements were nor preserved at the follow-up assessment at week 16 (P >.05). Notably, no significant differences were observed in the patients with MS without RLS control group at week 8 (P >.05).

Ozakbas et al noted several limitations to the study, including an ability to reach the targeted sample size due to the COVID-19 pandemic. Additionally, the study investigators pointed to potential disadvantages of exergaming, "such as the participants must be able to stand for at least half an hour without the support and requires a certain cognitive level to learn and practice the games, lack of MS-specific games and exercise prescription. Therefore, the selection of games and the progression of the sessions depend on the clinical experience of the physiotherapist." Lastly, the study did not use objective measures to capture RLS and physical activity data, which might be more effective to understand treatment effects.

REFERENCE
1. Ozdogar AT, Ertekin O, Kahraman T, Dastan S, Ozakbas S. Effect of exergaming in people with restless legs syndrome with multiple sclerosis: a single-blind randomized controlled trial. Multiple Scler & Relat Disor. 2023;70:104480. doi:10.1016/j.msard.2022.104480.