Rehabilitation of Gate and Balance Disorders in Multiple Sclerosis using Progressive Resistance Power Training: a Randomized Controlled Study

Abstract

INTRODUCTION. Progressive resistance training (PRT) has been recognized as an effective tool in the rehabilitation of patients with multiple sclerosis (MS), however its comparative efficacy remains has yet to be determined.
 AIM. In this study, we aimed to evaluate the efficacy and safety of the self-guided in-patient progressive resistance power training (PRT) program for improving gait and balance in patients with MS compared with the standard rehabilitation program.
 MATERIALS AND METHODS. 60 patients with MS were equally randomized into control group (CG) and the PRT group (PG). Training was performed 5 times/week, for 4 weeks in both groups. The primary endpoint was the percentage of patients with improvement in the 6-minute walking test above a minimal clinically significant difference in both groups. Tests of walking speed and balance (Timed 25-foot walking test (T25FW), Timed up-and-go (TUG) test, walking speed), mean voluntary muscle contraction on dominant and non-dominant legs as well as quality of life tests (cognitive and physical domains) at week 4 were used as secondary endpoints.
 RESULTS. In PG, 17/27 (63 %) patients reached the primary endpoint compared to 11/23 (48 %) in KG, which did not make a statistically significant difference (p = 0.89). Patients showed significant improvement in the T25FW test and TUG test in PG, but not in CG one. Muscle strength improved in both groups, however patients in PG showed mostly improvement in non-dominant leg and more on knee flexors and feet extensors, while patients in the CG showed improvement in hip flexors on both legs. Quality of life parameters improved in both groups. There were no statistically significant differences between the groups at all the endpoints studied at week 4.
 DISCUSSION. In both groups, significant increases in distance and walking speed prevented reaching the primary endpoint. PRT has been shown to provide a statistically significant improvement in short-distance walking speed, which may have been due to a positive effect on the rate of force development, increasing walking speed and improving walking balance. The increase in muscle strength occurred in trained muscle groups and had differences between the study groups. This result could be obtained both due to the direct training of certain muscle groups, and due to the phenomenon of contralateral transfer.
 CONCLUSION. Progressive resistance training may have some beneficial differences compared to non-progressive training that need to be elucidated further.