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Manago M1, Coote S2, Glick S3, Hebert J4, Schenkman M1
1University of Colorado Denver, Physical Therapy Program - Department of Physical Medicine and Rehabilitation, Aurora, United States, 2University of Limerick, School of Allied Health and Health Research Institute, Limerick, Ireland, 3University of Colorado Denver Hospital, Rehabilitation, Aurora, United States, 4University of Colorado Denver, Physical Medicine and Rehabilitation, Aurora, United States
Background: Difficulty walking and muscle weakness are among the most common problems reported for people with MS and muscle weakness is an important contributor to decreased gait performance. However, while strengthening interventions consistently improve muscle strength, there are mixed reports for their effectiveness to improve gait performance. Prior reviews have considered the rigor of design, heterogeneity of interventions and outcomes, and characteristics of enrolled samples (e.g., disability level, MS type, and other contributors besides weakness) as reasons for the inconsistent results. However, little consideration has been given to exercise parameters (frequency, intensity, duration) or intervention approach (mode, position, muscle targets) of the strengthening exercises applied in each study.
Purpose: Acritical review was conducted to explore exercise parameters and intervention approach ofstudies that included strength training and measured gait performance outcomes in people with MS.
Methods: An electronic search was conducted through July 2017 on PubMed, PEDro, and Embase databases. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk, and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets.
Results: Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, while four reported within-group changes. Four studies reported significant between-group improvements for gait speed and/or endurance, and two studies reported within-group changes. Eight studies performed exercises exclusively on weight machines. All studies performed at exercises in non-standing positions, while five also included standing strengthening exercises. Ten studies targeted knee extension, while six also targeted knee flexion, and very few studies targeted ankle, hip, or trunk muscles.
Conclusion(s): Studies generally were dosed consistent with recommended guidelines in people with MS, and improved strength. However, only two studies reported potentially meaningful between-group changes in gait speed and/or endurance. Possible reasons for the lack of consistent gait improvements in the strength training literature for people with MS may be that exercises 1) need to be dosed at a higher intensity than current exercise guidelines, 2) are not performed in positions that are task-specific to walking, and/or 3) are not targeting the appropriate muscle groups.
Implications: Strength training is part of recommended guidelines for exercise in people with MS, however based on the results of this review, new approaches should be considered by clinicians and researchers when the goal is to improve gait performance. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength, and/or explore muscles targets, positions, and modes that are task-specific to walking.
Keywords: multiple sclerosis, strength training, gait
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Purpose: Acritical review was conducted to explore exercise parameters and intervention approach ofstudies that included strength training and measured gait performance outcomes in people with MS.
Methods: An electronic search was conducted through July 2017 on PubMed, PEDro, and Embase databases. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk, and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets.
Results: Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, while four reported within-group changes. Four studies reported significant between-group improvements for gait speed and/or endurance, and two studies reported within-group changes. Eight studies performed exercises exclusively on weight machines. All studies performed at exercises in non-standing positions, while five also included standing strengthening exercises. Ten studies targeted knee extension, while six also targeted knee flexion, and very few studies targeted ankle, hip, or trunk muscles.
Conclusion(s): Studies generally were dosed consistent with recommended guidelines in people with MS, and improved strength. However, only two studies reported potentially meaningful between-group changes in gait speed and/or endurance. Possible reasons for the lack of consistent gait improvements in the strength training literature for people with MS may be that exercises 1) need to be dosed at a higher intensity than current exercise guidelines, 2) are not performed in positions that are task-specific to walking, and/or 3) are not targeting the appropriate muscle groups.
Implications: Strength training is part of recommended guidelines for exercise in people with MS, however based on the results of this review, new approaches should be considered by clinicians and researchers when the goal is to improve gait performance. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength, and/or explore muscles targets, positions, and modes that are task-specific to walking.
Keywords: multiple sclerosis, strength training, gait
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Neurology; Neurology
Ethics approval required: No
Institution: University of Colorado
Ethics committee: Colorado Multiple Institutional Review Board
Reason not required: Approval was not required as this review as it analyzed existing published literature and did not enroll human subjects.
All authors, affiliations and abstracts have been published as submitted.
