Traditionally, one of the basic clinical recommendations in treating RLS symptoms involves exercise and stretching maneuvers. This has been endorsed by the RLS Foundation (www.rls.org) in their latest patient brochure although the data supporting this is limited. There have been earlier studies by suggesting that exercise close to bedtime is counterproductive for RLS. In a large study, Ohayon assessed the prevalence of RLS and PLMD in the general population. During the multivariate analysis of the secondary results, the researchers (Ohayon, 2002) found that physical exercise close to bedtime (within 2 hours for at least 15 minutes exercise 3 or more times per week) was associated with an increased risk of RLS (OR 1.34, p<0.05) and PLMD (OR 1.43, p<0.05). However, in a conflicting study from 2000, Phillips et al. found that a lack of exercise was significantly associated with RLS. In a telephone survey of over 1800 participants, a single question (modified from the 1995 IRLSSG criteria) was used to screen for RLS. In this study, there was an age-adjusted prevalence of RLS of 10.0% and a lack of exercise (less than 3 hours/month) was significantly associated with RLS (OR 3.32). In 1996, a Brazilian study evaluated 11 volunteers with to study the effect of acute physical activity on RLS and PLMD. In this report using a baseline PSG followed the next day by exercise and then a repeat PSG, there was a reduction in PLMD noted on the second night PSG (de Mello, 1996). In the only randomized-controlled trial of exercise in RLS, Aukerman studied 28 individuals in a 12 week exercise trial. The average age was 53.7 years and 39% of study subjects were male. Subjects were randomized to either a control group with usual activities or to an exercise group. The exercise program consisted of 3 days a week aerobic and lower extremity resistance/conditioning training. The IRLSSG severity scale and an RLS ordinal severity scale were checked at 0, 3, 6, 9, and 12 weeks. Of the 28 subjects, most (23) completed the trial with 11 in the exercise training group. The researchers found that the exercise group had a significant improvement in RLS symptoms compared to the control group with a p = 0.001 for the IRLSSG severity score and p < 0.001 for the RLS ordinal scale. The research team concluded that a prescribed exercise program is effective in improving RLS symptoms (Aukerman MM 2006).

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