Progressive resistance power training for gait and balance rehabilitation in multiple sclerosis: a pilot single-arm study

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Background: Progressive resistance training (PRT) has been recognized as an effective rehabilitation tool for people with multiple sclerosis (pwMS), leading to increased muscle strength and improvements a gait, balance. However, still little is known about the effectiveness of muscle power training on gait and balance. Aims: The aim of the study was to evaluate the effectiveness of 4-weeks inpatient power training protocol on parameters of gait and balance in pwMS. Materials and methods: 26 subjects aged 1865 years and Expanded Disability Status Scale (EDSS) score 2.0 to 6.5 Receiving standard rehabilitation with PRT was applied for 30 minutes, 5 days a week for 4 weeks in addition to other rehabilitation methods. The primary endpoint was the time of 6-minute walking test (6MWT) at week 4 (W4) compared to week 1 (W1). Secondary outcomes included the time in Timed 25-foot walking test (T25FW), Timed Up-n-Go test (TUG), 5 times sit-to-stand test (5TSST), Expanded Disability Status Scale Score (EDSS), muscle strength. Results: After the 4-week course of rehabilitation a significant improvement was reached in all tests. The most prominent was the improvement in the 6MWT with 20/25 (80%) patients showing the increase in the distance walked above the minimal clinically important difference (MCID). Changes in other tests were less manifest: 3/25 (12%) of patients improved above MCID in both TUG and 5TSST, 6/25 (24%) patients in T25FW. After a 4-week course of rehabilitation, a significant improvement was acquired in the 6MWT. Changes in other tests were significantly less manifest. Muscle in hip flexors improved significantly on the left side: mean (SD) at W1 3,96 (0,67) vs W4 4,72 (0,46; p=0,04), and showed the trend to significance of the right side: W1 3,68 (0,8); W4 4,52 (0,65), p=0,08. Conclusions: The most significant effect was achieved in the primary outcome that was the distance walked in 6MWT. Less disabled patients can show better improvement in further studies, as was defined by T25FW test. Regular exercise can improve daily activity using a program that patients can easily do at home on their own.

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