Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study

Abstract

Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16°C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids.Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. Results: Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.

Walking Training Enhances Corticospinal Excitability in Progressive Multiple Sclerosis—A Pilot Study

“…This study was part of a feasibility and proof-of-principle interventional study aiming at restoring walking function among patients with MS-related walking disability (51). The data on feasibility and restoration of walking have been reported elsewhere (51).…”

“…This study was part of a feasibility and proof-of-principle interventional study aiming at restoring walking function among patients with MS-related walking disability (51). The data on feasibility and restoration of walking have been reported elsewhere (51). This interventional study (10 weeks, 3×/week exercise training) with TMS assessment pre, post, and 3-month follow-up was approved by the local health ethics board prior to initiation (Health Research Ethics Board, #2019.0225, NCT04066972).…”

“…All participants signed informed consent prior to study inclusion. Recruitment and screening details have been described elsewhere (51). Participants were included if they (1) were diagnosed with progressive MS (SPMS or PPMS), (2) reported no relapses 3 months prior to inclusion, (3) presented with walking impairments (e.g., use of bilateral or unilateral gait aids), (4) had disability level ≥6.0 on the Expanded Disease Status Scale (EDSS), (5) were capable of participating in physical exercise [as per Physical Activity Readiness Questionnaire (PAR-Q) screening form (52)], and (6) were eligible to undergo TMS (53) and dual energy X-ray absorptiometry (DEXA) (54) as per screening procedures.…”

“…Participants underwent 10 weeks (3×/week) of vigorous treadmill walking exercise training in a temperature-controlled room (16 • C) (51). The treadmill was equipped with a harness to prevent falls and to support ≤10% of participants' body weight.…”

ASPIRE trial: study protocol for a double-blind randomised controlled trial of aspirin for overheating during exercise in multiple sclerosis

“…19 In pwMS, slight increases in body temperature may lead to prohibitive levels of exhaustion during exercise. As a response to this, several cooling methods (eg, ice baths, cooling contraptions or garments, cooled environments) developed for pwMS have effectively reduced fatigue 20 and improved exercise performance, [21][22][23][24][25] although such methods can be cumbersome, prohibitively expensive or unavailable. Also, it is important to note that none of these prior trials of cooling methods in MS were conducted using doubleblind study design.…”