Safety, Feasibility, and Efficacy of an Eccentric Exercise Intervention in People with Multiple Sclerosis with Ankle Contractures

Abstract

Background: The primary aim of this study was to investigate the safety and feasibility of an eccentric exercise program for people with multiple sclerosis (MS) who have ankle contractures, i.e. reduced ankle range of motion (ROM). Secondary aims were to explore the efficacy of eccentric exercise on ankle joint ROM and functional mobility. Methods: Five people with MS (3 females and 2 males, mean age 50.8 ± 9.4, duration of MS 7.6 ± years) completed two eccentric exercise training sessions (between 10 - 45 min) per week for 12 weeks (total = 24 sessions). The training involved walking backwards downhill on an inclined treadmill (gradient = 10 - 14°) at a self-selected pace. The intervention was assessed for its safety (adverse events) and feasibility (recruitment rates, adherence rates, enjoyment levels, difficulty and discomfort) along with clinical outcomes including passive/active ankle ROM and distance walked in 6 minutes. Results: There were no adverse events during or following the eccentric training. There was a 100% adherence rate. All participants enjoyed the training and experienced low levels of muscle soreness/discomfort. The training program improved passive and active ankle ROM in all participants, however, improvements did not translate to improvements in walking for all participants. Conclusions: Eccentric exercise (walking backwards and downhill) is a safe and feasible training modality for people with MS with ankle contractures. Clinical outcomes (greater passive and active ankle ROM) following training were evident. However, translation to clinically meaningful changes in walking function requires further examination.

Effects of Eccentric Resistance Training on Lower-Limb Passive Joint Range of Motion: A Systematic Review and Meta-analysis

“…The large effect sizes reported in the present meta-analysis are greater than those reported after static stretching, and thus, eccentric exercise might be trialed more extensively in clinical conditions in which joint ROM is compromised and current therapies are ineffective. This suggestion is supported by clinically relevant improvements in ROM being reported after eccentric exercise in patients with contracture secondary to multiple sclerosis (68), emphasizing the potential for eccentric exercise to be an effective alternative therapy to enhance ROM in clinical populations. Furthermore, the present review examined passive rather than active ROM, and given that muscular strength is also frequently compromised in clinical conditions, measuring active ROM may highlight important functional (mobility) adaptations.…”

Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis

“…Only few studies have evaluated eccentric exercises in people with MS. Recently, a small pilot study demonstrated the feasibility, safety and efficacy of eccentric downhill walking in five people with MS affected by ankle contractures [ 37 ]. Additionally, eccentric strength training of the elbow flexors was proven to be feasible as well as beneficial for strength- and function-related parameters in people with MS with spasticity [ 38 ].…”