Effectiveness of blood flow‐restricted slow walking on mobility in severe multiple sclerosis: A pilot randomized trial

Abstract

Objective We tested the safety, feasibility, and effectiveness of blood flow restriction‐empowered low‐intensity interval walking exercise (BFR‐W) compared with conventional intensive overground walking (CON‐W) at improving gait speed and functional capacity in patients with multiple sclerosis (MS) and severe gait disabilities. Methods 24 patients (58 ± 5 years; 7 males) with progressive MS (Expanded Disability Status Scale 5.5 − 6.5) were randomized to receive 12 rehabilitation sessions over 6 weeks. The BFR‐W group (n = 12) performed interval walking (speed paced by a metronome that increased weekly) with BFR bands at the thighs. The CON‐W group (n = 12) received physiotherapist‐assisted overground walking therapy. The primary outcome was gait speed, measured by the timed 25‐foot walk test. Secondary outcomes included walking endurance, balance, strength, fatigue, and quality of life. The measurements were collected at baseline, at the end of training, and a 6‐week follow‐up. Results The two groups did not present any baseline difference. BFR‐W group safely walked without limitations due to sleeve compression, with lower increase in perceived exertion (RPE) (P < .001) and heart rate (P = .031) compared with the CON‐W. Gait speed improved significantly in both groups (BFR‐W + 13%; CON‐W + 5%) with greater increases in the BFR‐W group at end of the training (P = .001) and at the follow‐up (P = .041). Most of the secondary outcomes significantly improved in the two groups, without between‐group differences. Conclusions Slow interval walking with moderate BFR to the lower limbs was superior to overground walking in improving gait speed in patients with MS with a lower training load and a more durable clinical benefit.

Rehabilitation Improves Mitochondrial Energetics in Progressive Multiple Sclerosis: The Significant Role of Robot-Assisted Gait Training and of the Personalized Intensity

“…Again, according to the training speed, stimulation of conversion of fibers might be different in terms of the proportion of I and II fibers, as previously reported in MS subjects training at different intensities [ 49 ]. Improved 6MWDs were observed in MS subjects with the same disability level following low intensity interval walking associated with mild blood flow restriction in the lower limb muscles [ 55 ].…”

Effect of Blood Flow Restriction on Functional, Physiological and Structural Variables of Muscle in Patients with Chronic Pathologies: A Systematic Review

“…Table 1 presents a minimum sample size of 20 patients [34] and a maximum of 79 [35], in which the mean age of the participants was 45 years, ranging from 14 [36] to 76 years [37]. Likewise, when the blood flow restriction cuff was placed, a minimum pressure of 30% of the total blood flow restriction was applied [38] and a maximum of 80% [36]. The interventions used were strength, aerobic type and blood flow restriction training.…”

“…For the strength variable (Table 2), heterogeneity is shown in terms of the data collection unit, especially with the dynamometer measurement tool. In the short term, changes in the dynamometer are evidenced in favor of the control groups with 2.3 Nm [38] and the experimental groups with 7.1 Nm [41]. In both studies, the study subjects presented the same pathology and better results when they performed moderate-intensity or lowload exercises.…”

“…The dynamometer tool shows favorable differences for all groups in the medium term, especially for the BFR group, with improvement changes between 11.52% and 26.83% [36,38,43] and between −8.57% and 9.09% in the entire knee flexion-extension range on both the unaffected and injured sides, except for the unaffected side at 60 degrees with 14.63% and at 300 degrees with 12.12%, where there was greater improvement in the high-load exercise group [56]. In addition, for patients with cardiac surgery, in the BFR group, it was observed that knee extension strength improved by 36.7% and fist closure by 12.89% [55].…”

A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study

“…Even if exercises are performed at low to moderate intensity, increases in muscle mass and muscle strength are significant [18], similar to those of high-intensity, heavy resistance training [19]. BFR training has been used safely and effectively in older individuals and physically limited populations [20][21][22][23], including presurgical patients with cancer [11]. The participants (mean age 64.9 years, SD 9.8 years) in our previous study reported little difficulty (mean score 1.6, SD 0.6) and high enjoyment (mean score 5.2, SD 0.5) on a standardized 7-point scale when performing the BFR exercise.…”