The Effect of Community Exercise Interventions for People with MS Who Use Bilateral Support for Gait

Abstract

Background. Mobility limitations are a key feature of MS and 25% will require the use of a walking aid 15 years after diagnosis. Few studies have specifically evaluated the effectiveness of physiotherapy and exercise interventions delivered in the community for those with significant disability. Methods. An assessor blind, block randomised, and controlled study recruited participants who required bilateral assistance for gait and who occasionally used wheelchairs for longer distances. They were randomised to 10 weeks of group physiotherapy (balance and strengthening exercises), individual physiotherapy, yoga group, or a control group. Results. Repeated measures ANOVA found significant time effects for physical component of MSIS-29v2 (f = 7.993, P = 0.006) and MFIS (f = 8.695, P = 0.004). The group × time interaction was significant for the BBS (f = 4.391, P = 0.006). Post hoc analysis revealed no difference between group and individual physiotherapy for BBS. There was no significant difference between groups but the 6MWT improved for individual physiotherapy (P = 0.001) and MSIS-29v2 psychological score for group physiotherapy (P = 0.005). Discussion. This study found that balance and strengthening exercises, delivered in the community to those with significant mobility limitations, improve balance. The effect on walking endurance and patient-reported outcomes are unclear and warrants further investigation with a larger control group with similar baseline characteristics to the intervention groups.

Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis–Related Disability

“…Other studies have reported conflicting findings on indices of fatigue, with four reporting improved fatigue after yoga 34,35,37,39 and two reporting no improvement. 38,41 The present findings of improved QOL are in agreement with reports by Ahmadi et al, 34,35 Doulatabad et al, 36 and Garrett et al, 37 whereas Hogan et al 38 reported no improvement in QOL after yoga intervention. We did not find a change in pain as measured by the PES, whereas Doulatabad et al 36 reported improved pain after 12 weeks of yoga.…”

“…Findings related to walking endurance in other studies are conflicting, with two studies reporting improvement in the 2-minute walk test distance 34,35 and two reporting no change in 6MWT distance. 37,38 The present finding of improved walking speed (T25FW) was consis-publicly available, we have not yet solicited feedback on its utility. Yoga instructors who use the protocol should have adequate experience in working with individuals who may require physical assistance.…”

“…Other yoga studies for people with MS have incorporated yoga for periods ranging from 8 weeks to 6 months, with class frequencies ranging from once a week to three times per week. [34][35][36][37][38][39][40][41][42] This variation in dosing creates heterogeneity, limiting useful comparisons of results between studies.…”

“…12 Compared with non-yogic exercise programs, yoga was not superior in any of these domains. Cramer et al 12 reported that none of the trials reviewed [34][35][36][37][38][39][40][41] were robust against methodological bias. Furthermore, the forms of yoga and dosing varied across studies, and sufficient detail to reproduce the programs was generally absent.…”

“…Trials that measured balance in people with MS after yoga reported improvements. 34,35,38,42 Those studies used the Berg Balance Scale. Although we did not use the Berg Balance Scale, we found improvements in the MDRT-Back, indicative of improved balance.…”