The effects of home-based resistance exercise on balance, power and mobility in adults with multiple sclerosis.
1. To determine the efficacy of an eight-week home-based, lower limb resistance exercise programme on balance, power and mobility in adults with multiple sclerosis (MS).
2. To investigate the feasibility of the programme in terms of adherence and complications.
Design: A pre-test/post-test experimental group design was used. Following pre-testing volunteers with MS were stratified by gender and then matched by severity of disease (with the Expanded Disability Status Scale) and age before being randomly allocated into an exercise or control group.
Intervention: Participants in the exercise programme (n=19) were instructed in six sessions on the safe and correct performance of the exercise programme. Participants were provided with ankle weights, weighted vests, a step, data recording sheets and an instructional video, and completed an eight-week, three-times a week programme. The control group (n=17) continued with normal physical activities. Fortnightly home visits and weekly telephone calls were made to both groups.
Outcome Measures: The primary outcome measures included postural sway (measured with the [AccuSway.sup.PLUS] force platform), leg power (using the Leg Extensor Power Rig) and the Timed Up and Go test (TUG).
Results: Only the exercise group achieved statistically significant improvement in leg extensor power. There were no statistically significant changes in postural sway or the TUG. Participants completed 95% of the 24 exercise sessions and no complications as a result of the exercise programme were reported. Only one participant with drew and this was due to an exacerbation of their disease process.
Appraisal: It is pleasing to see the emergence of more studies investigating positive and challenging rehabilitation programmes for people with MS. Past perceptions of advocating rest and cautious strategies to prevent secondary complications are being replaced by more exercise-based dynamic approaches aimed at enhancing strength, aerobic capacity and balance. Furthermore it is reassuring to see published robust rehabilitation trials, fulfilling the stringent requirements necessary to attain good evidence for practice.
DeBolt LS, and McCubbin JA. (2004) Archives of Physical Medicine and Rehabilitation 85: 290-297.
This paper describes a carefully designed study that investigated the effects of an eight-week resistance exercise programme on power, mobility and balance for adults with MS. The authors pragmatically argue the case for a home-based setting and provide enough detail to ensure that the intervention programme can be easily reproduced. Compliance was enhanced by adequate preparation of participants, using instructional sessions and videos, and quality assurance was ensured by fortnightly home visits and weekly telephone calls.
The exercise programme was specifically designed, based on previous research. Exercises were selected for their functional nature and their proven ability to increase lower limb power. The duration of the programme ensured appropriate muscle adaptations for hypertrophy, strength and power. The exercises were systematically progressed with respect to resistance and frequency, with the use of ankle weights and weighted vests. The progressive nature of the "vest-resistance" was described, based on percentage body weight, however, the authors failed to detail how ankle weight resistance was increased.
This study shows, once again, the specificity of exercise prescription. It was not surprising that the leg extensor power test was the only measure to show significant changes. The exercises were purposely designed to increase extensor leg power, and would not have had any specific effect on postural sway or mobility (as tested with the TUG). It was interesting to note, however, that "leg curls", involving knee flexion, were included into the exercise repertoire although the power test only targeted the extensor leg muscles. Although the authors argued that leg strength and balance are correlated in research with elderly participants, the carryover between leg power and balance and mobility were not evident in this study. Anecdotal results from the study implied that the exercise programme might have had a positive impact on activities of daily living (ADL). It was a pity therefore, that an ADL and/or quality of life measure were not included.
A power analysis performed prior to the study, based on the leg extensor power rig results of previous studies, indicated that a sample size of 25 participants per group would be required to achieve an effect size of 0.5 (power 80%). Unfortunately final data analyses were completed on 19 exercise and 17 control participants only. The authors considered that future research would require a larger sample size and a longer exercise programme duration to achieve more substantial results. In addition to these suggestions, a six-month follow-up would also be a useful addition, as knowing the long-term effects of an exercise programme would help guide the frequency of its prescription. This of course is difficult in MS related research as the progressive nature of MS often obscures the long-term benefits of rehabilitation programmes.
School of Physiotherapy University of Otago
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|Title Annotation:||Critically Appraised Papers|
|Publication:||New Zealand Journal of Physiotherapy|
|Article Type:||Clinical report|
|Date:||Nov 1, 2004|
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