STRONG-MS: A clinician-led intervention to improve bone health and muscle strength in people with multiple sclerosis

The prevalence of osteoporosis is much higher in people with multiple sclerosis (MS) than the general Australian population and the incidence of fracture is 1.4-fold higher in people with MS compared with age- and sex-matched controls. Osteoporosis and falls have a high healthcare expenditure and large negative impact on quality of life. People with MS engage in less physical activity than healthy controls, even when controlling for disability level. Low levels of physical activity and exercise increase disability and decrease bone mineral density (BMD), thereby increasing falls and risk of fracture. Given people with MS have existing disabilities, the impact of a fracture is likely to have a greater detrimental health effect than in people without MS. This is further compounded by other potential risk factors for osteoporosis and fractures, such as immobility, repeated courses of corticosteroids, vitamin D deficiency, impaired physical function, muscle weakness, and falls. “Mobility and walking” were the number one symptom-related research priority according to a 2021 MS Australia Survey, while falls and balance were in the top five. Despite this, sustainable behaviour-change for people with MS may be difficult, especially when experiencing compounding physical and emotional difficulties. People with MS need safe and effective exercises, targeting bone and muscle strength, to improve mobility and reduce falls and fractures. We will undertake a randomised controlled trial of a High-intensity Resistance Impact Training (HiRIT) intervention to assess it for feasibility, acceptability and pilot efficacy for people with MS across varying abilities and symptom profiles, which will provide information important to broader intervention implementation. Aims: 1) to determine whether the ONERO program maintains or improves: i) health-related quality of life (HRQoL), ii) mood, iii) physical function and iv) aBMD in people with MS; 2) characterise the safety, feasibility and acceptability of the previously validated ONERO program to improve muscle strength and prevent aBMD deterioration, falls and fracture in people with MS; 3) assess the mean and total healthcare utilisation cost over 12 months for people with MS, using: i) self-reported data, ii) Medicare Benefits Schedule (MBS) costs, and iii) Pharmaceutical Benefits Scheme (PBS) costs. The trial is currently recruiting participants.