Combined Training Program Improves Balance, Static Strength in Patients With MS

September 11, 2020
Jaime Rosenberg
Jaime Rosenberg

Results of a combined training program in 17 patients with multiple sclerosis indicate patients reap benefits from daily activities like walking or sitting-to-standing, and show the program reduces the dual-task cost of performing cognitive tasks while walking.

Results of a 24-week combined training program (CTP) in 17 patients with multiple sclerosis (MS) indicate patients reap benefits from daily activities like walking or sitting-to-standing, and show the program reduces the dual-task cost (DTC) of performing cognitive tasks while walking.

While the program did not result in significant improvements across all tested parameters, the researchers highlighted the progress made in balance, specifically enhanced somatosensory response, which indicates to what extent vision is used in postural control when somatosensory afferences are restricted. Of the 14 controls included in the study, no statistically significant differences were observed.

Researchers also found significant decreases in the time it took patients in the program to sit and then stand up rapidly when a signal was delivered, dropping by 12.7% at 12 weeks and by 19.7% at 24 weeks.

Patients completed 3 1-hour sessions per week, which consisted of various strength exercises, including those targeting general dynamic strength and dynamic strength against resistance. Patients’ abilities were measured prior to the program, after 12 weeks, and at 24 weeks.

The static strength of patients in the program—measured by having them step on a force plate—also improved throughout the 24 weeks, with mean values of vertical peak force increasing by 9.3% at week 12 and by 11% at the end of the program.

The program also included 2 cognitive-motor tasks—dual walking and/or running and dual tasking on instable plates—to help determine changes in motor activity patterns while simultaneously performing a cognitive task. By measuring performance of these tasks, the researchers were able to determine the DTC, calculated when simultaneous activities compete for resources.

“After the 24-week CTP, the dual-task cost to gait performance decreased by 54% (center of mass [CM] velocity) in the intervention group, as compared to control,” explained the researchers.

Patients were asked to walk normally and then to walk but stop walking as soon as 2 red lights turned on. Results showed no statistically significant differences between the 3 assessment points. While the mean double-support time tended to decrease following the program (7.1% at 12 weeks and 8.9% at 24 weeks), the mean values for single-support time tended to increase following the program. However, differences in mean values for single-support time only reached significance after 24 weeks.

“The mean dual-task cost for all the time records (DTC%) remained negative,” explained the researchers. “This indicates that the mean value times were higher in the dual-task gait as compared to the normal gait. No evidence was obtained that the intervention program had any effect on the DTC for gait cycle time.”

The researchers observed that differences in mean step length reached significance at the end of the program, increasing by 4.4% at 24 weeks compared with baseline. For this measure, the DTC remained positive in all 3 assessment periods, indicating that the step length was lower in the dual-task gait than in the normal gait. Compared with the control group, patients in the program had a 48% reduction in dual-cost of step length.

Reference:

Gutiérrez-Cruz C, Rojas-Ruiz FJ, De la Cruz-Márquez JC, Gutiérrez-Dávila M. Effect of a combined program of strength and dual cognitive-motor tasks in multiple sclerosis subjects. Int J Environ Res Public Health. Published online September 2, 2020. doi:10.3390/ijerph17176397