Progressive resistance therapy is not the best way to rehabilitate deficits due to multiple sclerosis: Yes

Abstract

MULTIPLE SCLEROSIS MSJ JOURNAL ProposalProgressive resistance training (PRT) is a promising intervention that may be appropriate to increase strength for some patients; however, there is insufficient evidence for its benefit for rehabilitating other deficits due to multiple sclerosis (MS). A recent systematic review found 16 papers that studied the effect of PRT. 1 Of concern is the finding that only one of the studies met the criteria for blinding of assessors. The lack of blind assessors is a source of detection bias and suggests that the results of 15 papers in that review must be interpreted with an element of caution.When considering the symptoms of MS, gait is reported as the main problem, 2 but the evidence from the two largest resistance trials is conflicting. Dalgas et al. 3 reported that resistance training had a significant effect on walking tests, while Dodd et al. 4 found no significant improvements in walking. The complex motor task that is walking and the specificity principle of motor learning means the lack of effect on walking tests is not an unsurprising result. If you want to get better at a tennis serve you don't practise a golf swing -therefore in order to see an improvement in walking endurance or walking speed, interventions that involve a small number of repetitions performed in sitting or lying positions are, most likely, not going to improve those parameters.Fatigue is also a major issue for people with MS; however, only three studies in the systematic review 1 measured the effect of PRT on fatigue, 3-5 albeit finding positive results. Only one had a blinded assessor, and the total number of patients in the intervention groups was 70, which arguably is too few to enable a robust statement about the benefits of PRT on fatigue to be made.Balance is an issue affecting a significant proportion of people with MS; however, the effect of PRT on balance is not clear. Only three studies in the systematic review of PRT 1 measured balance; two studies found an increase in functional reach, 5,6 and one did not find an effect on balance measured by a force platform. 7 The effect of PRT on balance therefore remains unclear, and the specificity of training principle may once again come into play.Despite advances in the drug management of MS, many people still progress to a level of disability that requires use of a walking aid. It is difficult to establish how PRT affects walking aid users as their results have been combined with people with fewer mobility limitations in studies to date. Given the severity of symptoms and the complex combinations of symptoms that result in the need for a walking aid, it is possible that these individuals will not respond similarly to those with lower Expanded Disability Status Scale scores; studies specifically addressing this group are needed.The "best" intervention is one that, through a clinical reasoning process, addresses the symptoms of the person, and assists in meeting their specific goals. One size therefore does not fit all, given that the symptoms of MS a...

Benefits of Exercise Training in Multiple Sclerosis

“…This further is important considering that one approach alone is unlikely to be sufficient in managing the consequences of MS, as a single approach is rarely recommended by healthcare providers for managing MS. We know little about the mechanisms for the benefits of exercise in MS and how the mechanisms might vary by outcomes, stages of the disease, and clinical courses of the disease. We know little about the effects of different modes of exercise training (e.g., aerobic vs. resistance; continuous vs. interval) on consequences of MS, and this has been the focus of recent debate [14,16]. We need considerable effort directed toward understanding and maximizing compliance with participation in exercise training among persons with MS.…”

“…Some researchers have argued that exercise training, defined as planned, structured, and repetitive physical activity undertaken for improving one's physical fitness levels [13], is the single most effective nonpharmacological approach for managing symptoms of MS [14] and its functional consequences [12,15]. Others have argued against such a statement based on an insufficient amount and poor quality of research [16,17]. Researchers This article is part of the Topical Collection on Demyelinating Disorders have recently reported on the overall safety profile of exercise training in MS, including a reduced rate of reported relapses (i.e., approximately 27 % lower relapse rate for exercise training conditions versus non-exercise control conditions) and minimal, exercise-related adverse or serious adverse events in randomized controlled trials (RCTs) [18].…”

Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences

“…To date, there has been no such systematic review to establish both the perceived determinants and consequences of physical activity in persons with MS. This remains an important endeavor considering that rehabilitation is still considered a highly effective approach for improving outcomes of persons with MS [46,47], yet we do not have a clear understanding of the possible range of outcomes and approaches for maximizing participation rates.…”

Endurance Exercise Attenuates Established Progressive Experimental Autoimmune Encephalomyelitis and Is Associated with an Amelioration of Innate Immune Responses in NOD Mice

“…Therefore, while the positive impact of the potent anti-inflammatory effects of regular exercise on numerous diseases is known, the reason for the benefit of exercise in MS remains unclear. Additionally, an optimal exercise program remains undefined, given limited research in this area [9][10][11].…”