How do resistance training and balance and motor control training affect gait performance and fatigue impact in people with multiple sclerosis? A randomized controlled multi-center study

Abstract

Background: Despite a shared purpose of improving functional capacity, the principles of progressive resistance training (PRT) and balance and motor control training (BMCT) are fundamentally different. Objectives: To investigate the effects of PRT and BMCT on gait performance and fatigue impact in people with multiple sclerosis (PwMS). Methods: A multi-center, single-blinded, cluster-randomized controlled trial with two intervention groups (PRT and BMCT) and a control group (CON). The interventions lasted 10 weeks. A total of 71 participants with impaired mobility (Timed 25-Foot Walk (T25FW) > 5 seconds or Six Spot Step Test (SSST) > 8 seconds) were enrolled. Primary outcomes were the T25FW and the SSST. Fatigue impact, self-perceived gait function, 6-minute walk, balance, and muscle strength were secondary outcomes. Results: In total, 83% completed the study. The primary comparisons showed that BMCT, but not PRT, improved T25FW, SSST, and self-perceived gait function when compared to CON. Secondary comparisons showed that BMCT improved SSST more than PRT, while T25FW did not differ. Both BMCT and PRT reduced the fatigue impact. Finally, the effect of BMCT was superior to PRT on dynamic balance, while PRT was superior to BMCT on knee extensor muscle strength. Conclusion: BMCT, but not PRT, was superior to CON in improving gait performance, while both BMCT and PRT reduced fatigue.

Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis

“…The duration of AT interventions ranged from 3-26 weeks (involving 9-48 sessions) with the intensity being deemed moderate (n=5) [43][44][45][46][47] , high (n=4) 26,[48][49][50] , or unknown (no information, n=5) 25,[51][52][53][54] . The duration of RT interventions ranged from 8-24 weeks (involving 15-48 sessions) with the intensity being deemed moderate (n=1) 55 , high (n=4) 28,[56][57][58] , or unknown (no information, n=3) 40,59,60 . Due to the missing information and the use of divergent scales of exercise intensity for both AT (e.g.…”

“…Two 25,60 of the 22 identified RCTs reported a primary outcome that was not based on a sample size calculation. Ten papers 26,28,44,[48][49][50]52,54,55,57 of the 22 identified RCTs reported a primary outcome based on a sample size calculation, with five of these having a primary outcome aligned with the purpose of the present systematic review.…”

“…In regard to RT studies, seven out of nine studies 28,40,[55][56][57][58][59] reported a between-group change in one or more strength measurements, with five of these changes being reported as statistically significant. The meta-analysis showed an overall large effect of RT on muscle strength, ES=0.86 [0.02: 1.70], p=0.013, I 2 =75% (Figure 2).…”

“…Four RT studies 28,55,57,58 reported a between-group change in any long term walking test, with one of these reporting a statistically significant finding and the meta-analysis showing a moderate effect of RT on long walking test performance, ES=0.36 [-0.35: 1.08], p=0.11, I 2 =48% (Figure 4). Long walk ES was positively associated with RT intervention duration (weeks: slope 0.07, r 2 =0.87, p=0.025; number of sessions slope 0.07, r 2 =0.87, p=0.025).…”

“…Five 28,[56][57][58]60 of the RT studies investigated the performance on a functional mobility test between groups, with two 56,58 of these changes being reported as statistically significant.…”