Blood-Flow Restriction Training for a Person With Primary Progressive Multiple Sclerosis: A Case Report

Abstract

Objective Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable to traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. Methods (Case Description) The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities (LE) biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale (FSS), Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 LE strength tests. Results The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). FSS was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the FSS score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. Conclusion The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. Impact Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS.

Effectiveness of Blood Flow Restriction in Neurological Disorders: A Systematic Review

“…An additional aspect to take into account, apart from the favorable results, are the adverse effects that BFR may have. None of the articles in our review found any that were in agreement with the majority of the scientific literature [ 17 , 18 , 20 ]. Nevertheless, one study found adverse effects.…”

“…There are several therapeutic possibilities, including conservative treatment, with the goal of enhancing daily activities, avoiding deformities, preserving joint motion, relieving pain, and reducing muscle tone [ 14 ]. While most of the investigations on BFR training have focused on healthy populations [ 15 , 16 ], some case or observational studies have been performed on BFR in patients with neurological problems, such as Parkinson’s disease [ 17 , 18 ], multiple sclerosis [ 19 , 20 , 21 , 22 ], spinal cord injury [ 7 ] and stroke [ 23 ].…”

Effects of Different Exercise Therapies on Balance Function and Functional Walking Ability in Multiple Sclerosis Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials

“…Our findings suggest that aquatic exercise is superior to other interventions in improving functional walking ability. The mechanism by which aquatic exercise improves TUG can be explained in several ways: (1) The presence of water resistance allows the patient to perform exercises more slowly than land-based exercises, resulting in an increased weight-bearing time on the lower limbs; in addition, the patient’s torso is subjected to a certain amount of water pressure in the aquatic environment [ 59 ] which has a similar effect on the skeletal muscles as blood flow restriction training [ 60 ] (a training modality that was shown to have a significant effect on increasing muscle strength) [ 61 ]. (2) When exercising in the water, hydrostatic force causes the blood and lymphatic fluid to move up the torso, and combined with the gravitational offload and hydrostatic effect of the water, it increases the amount of blood circulating from the periphery to the center, resulting in an increase in the end-diastolic volume of the heart and thus an increase in cardiac output [ 62 ].…”

Potential Role of Blood Flow Restricted Exercise for Older Adults

“…Ensuring appropriate prescreening, methodology and application of MBFR is of utmost importance whether used with RT, aerobic training or in a passive manner (for a review see [17]). Some laboratories have successfully implemented MBFR interventions for individuals with Parkinson disease [65], chronic kidney disease [66,67] and multiple sclerosis [57,68], as well as following spinal cord injury [59], with results appearing to suggest the technique is tolerated and possibly beneficial, however evidence is still lacking for other diseased states. Although limited evidence exists for the use of MBFR in clinical populations, a risk stratification model has been proposed to identify risk factors prior to participating in exercise programs utilizing MBFR [69].…”