The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials

Abstract

Background: Persons with chronic neurological conditions (CNCs) often present with asymmetrical impairments, creating significant differences between contralateral limbs in body functions. These asymmetries have been associated with reduced mobility and balance, and are often targeted for reduction during rehabilitation. Exercise training has established benefits for persons with CNCs, and may have positive effects on asymmetry outcomes. Objectives: The purpose of this review was to summarize the current evidence for the effects exercise training on gait, balance, and physical fitness asymmetry in randomized control trials (RCTs) of persons with CNCs. Methods: A search of four electronic databases (EMBASE, CINAHL, SPORTdiscus, and ovidMEDLINE) was conducted following the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search retrieved 3,493 articles, with 465 articles assessed for eligibly, and nine articles meeting the criteria for inclusion. Of the included articles, five incorporated resistance exercise, three incorporated aerobic exercise, and one incorporated combined exercise (i.e., resistance and aerobic exercise). Gait asymmetry improved significantly in four studies after resistance, aerobic, and combined exercise. Significant improvements in weight bearing asymmetry were reported in three studies after resistance exercise. One study reported significant improvements in both gait and balance asymmetry after resistance exercise. Conclusions: Preliminary evidence suggests that exercise training, as a component of rehabilitation, may have positive effects on gait and balance asymmetry in persons with CNCs. Several limitations of the current literature were noted, including a limited number of studies, combination of exercise with other rehabilitation modalities, a lack of reporting on exercise prescriptions (e.g., number of repetitions, intensity), and variability in the calculation of asymmetry outcomes. These limitations prevent definitive conclusions on the effects of exercise training on asymmetry outcomes. Future trials are needed to determine the potential of exercise training for reducing asymmetry in persons with CNCs.

Kinematic Analysis of Lower Limb Joint Asymmetry During Gait in People with Multiple Sclerosis

“…While confirming that MS differentially alters most aspects of lower limb motor functionality, the findings of the present study also suggest that the asymmetries of spatio-temporal parameters reported by many studies on gait of pwMS are likely to reflect the combined effect of muscular and joint kinematics asymmetries. In such a context, the use of waveformbased methods to assess interlimb (and possibly interlimb) symmetry may provide useful insights not only to better understand the impairments in motor control associated with the presence of MS, but also to accurately assess the effect of physical therapy and exercise training programs, which have been shown to have a positive effect on gait and balance asymmetries of individuals with MS as well as other chronic neurologic conditions [58]. However, future studies (possible longitudinal) are necessary to clarify the evolution of asymmetry during the disease progression, to identify specific peculiarities associated with MS type and with the sex of the affected individual and to assess the effects of fatigue.…”

The Effect of Nordic Walking Training with Poles with an Integrated Resistance Shock Absorber on the Body Balance of Women over the Age of 60

“…Therefore, various forms of PA willingly undertaken by the elderly are still being sought, as they are known to improve their overall functional efficiency, including body balance. Previous studies demonstrated positive effects of various forms of physical training on the gait and body balance [15][16][17]. One of the frequently examined forms of physical activity is Nordic Walking (NW).…”

“…Previous studies demonstrated positive effects of various forms of physical training on the gait and body balance [ 15 , 16 , 17 ]. One of the frequently examined forms of physical activity is Nordic Walking (NW).…”

Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study

“…Another urgent investigation, which should be further explored, is optimal and safe exercise prescription (e.g., training intensity and duration) ( Farrell et al, 2020 ; Luo et al, 2020 ). We used the definition of training intensity and duration in a review ( Antje et al, 2020 ) as a reference: (1) training intensity (high: five times per week vs. moderate: 2–3 times per week), (2) training duration (short: 2–3 weeks vs. long: 4–8 weeks).…”