Exercise and Restless Legs Syndrome: A Randomized Controlled Trial

Melissa McManama Aukerman, MS; Douglas Aukerman, MD; Max Bayard, MD; Fred Tudiver, MD; Lydia Thorp, MD; Beth Bailey, PhD


J Am Board Fam Med. 2006;19(5):487-493. 

In This Article

Background and Objectives

Restless Legs Syndrome (RLS) is a common neurological movement disorder affecting a large segment of the population. Studies of the prevalence of RLS suggest the condition affects approximately 10% of the adult population, although one study found a prevalence of 24% in patients presenting to a primary care office.[1,2,3] Although RLS is common, it is seldom diagnosed. The 2001 Sleep in America Poll found a prevalence of 13% in the adult population, but only 3% of those had actually been diagnosed with RLS.[4] Factors associated with higher incidence of RLS include older age, multiparity, sedentary lifestyle, positive family history, and obesity.[1,2] Secondary causes of RLS include iron deficiency, renal failure, neuropathy, pregnancy, and certain medications.[5] RLS is associated with depression, anxiety, and negative quality of life.[6,7]

The diagnosis of RLS is clinical. Minimal criteria for the diagnosis are: 1) a compelling urge to move the limbs, usually associated with paresthesias/dysesthesias; 2) motor restlessness as seen in activities such as floor pacing, tossing and turning in bed, and rubbing the legs; 3) symptoms worse or exclusively present at rest (ie, lying, sitting) with variable and temporary relief by activity; and 4) symptoms worse in the evening and at night.[8]

RLS tends to cluster in older, overweight adults,[6,9,10] who are at increased risk for comorbid conditions. Physical activity and exercise may be important in the reduction of the risk for comorbid conditions; however, the effects of exercise on RLS severity are unknown. Furthermore, the current treatment for RLS is primarily pharmacological in nature. The vast majority of clinical trials have concentrated on the use of dopaminergic agents, anticonvulsants, and benzodiazepines.[11,12,13] These agents often have significant side effects. Little research has been undertaken to determine whether lifestyle changes, such as exercise interventions, can improve the symptoms of RLS.

RLS symptoms typically occur during periods of inactivity and are generally alleviated, at least temporarily, by movement[5]; however, the association between physical activity and RLS symptoms is unclear. Individuals with RLS frequently abstain from vigorous exercise because it has been reported anecdotally that such participation can exacerbate symptoms. Furthermore, current clinical guidelines make no mention of exercise or physical activity recommendations[5]; however, popular patient-oriented Web sites, such as (www.wemove.org) advocate light to moderate exercise over vigorous exercise, even though there is no compelling research to support this recommendation.

Epidemiologic studies have shown a link between RLS and physical activity.[1,14] Ohayon and colleagues reported physical activity performed close to bedtime was associated with a significantly increased risk of RLS[14]; however, a separate study reported a significant link between lack of exercise and risk of RLS.[1] Therefore, the association between RLS and physical activity remains unclear. Possible reasons for the conflicting findings may be: differing diagnostic criteria for RLS, disparate operational definitions of physical activity and exercise, and reliance on measures of physical activity that have not been validated.

In a literature search, no clinical trials evaluating the efficacy of exercise in the treatment of RLS in the general population were identified (Medline search in September 2005 with keywords "restless legs syndrome AND exercise"; "restless legs syndrome AND physical activity"; "restless legs syndrome AND RCT"). However, exercise has been shown to improve symptoms of RLS and periodic limb movements in individuals with spinal cord injuries.[15,16]

A need exists for randomized controlled trials that study the effectiveness of non-pharmacological interventions for the treatment of RLS. A treatment such as exercise would be useful in taking a multidimensional approach to management that is currently used with most chronic diseases. This study was designed to evaluate the effects of a conditioning program on the symptoms of RLS. The primary hypothesis was that a conditioning program, consisting of an aerobic component and a lower extremity resistance component, would improve the symptoms of RLS.


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