Home Based Exercise Program and Fall Risk Reduction In Older Adults With MS

Background: Falls are a major health concern for persons with multiple sclerosis (MS).  There is minimal evidence that a home-based exercise program can reduce fall risk in persons with MS.

Objectives: To determine the efficacy of a home-based exercise intervention that targets balance, and lower limb muscle weakness for reducing fall risk based on Physiological Profile Assessment (PPA) scores in persons with MS.

Methods: 27 older adults with MS who had fallen in the last year participated in the study. Following baseline testing, participants were randomly assigned to the exercise (n=13) or control group (n=14). Participants underwent fall risk (PPA), balance (Berg Balance Scale: BBS), and walking (timed 25’ walk: T25FW) assessment prior to and immediately following the 12-week intervention. The PPA provides an overall fall risk score ranging from +4 to -2 (very high risk to very low risk).  This score is based on the quantification of 5 key markers (vision, leg strength, proprioception, balance, and cognition) compared to age and gender matched normative data. The exercise program consisted of ten exercises focusing on balance, and lower limb muscle strength. Particiapnts were instructed to engage in exercise 3 times/week for 12 weeks.  Each outcome measure was placed in an independent repeated measures analysis of variance with group as the between-subject factor and time as the within-subject factor.

Results: 22 participants (n = 12 control; n=10 exercise) completed post-intervention testing. Overall, fall risk was found to decrease in the exercise group following the intervention (1.1±1.0 vs. 0.6±0.6; d=0.6), while there was an increase in fall risk in the control group over time (1.9 ±1.5 vs. 2.2±1.9; d=0.2). This change in fall risk coincided with an increase in the BBS for the exercise group (48.5±4.1 vs. 50.2±3.1; d=0.4) and a decrease in the control group (42.6±14.6 vs. 40.3±15.7; d=0.2).  The control group also decreased T25FW performance (6.8±1.2 vs. 7.7±1.6 s; d=0.6), while there was no change in the exercise group (6.6±1.1 vs. 6.7±1.2 s; d=.1).

Conclusions: A home-based exercise program led to reductions in overall fall risk in older adults with MS who had fallen in the past year. The reductions in fall risk coincided with improvements in balance and maintenance of walking speed. The current observations lend additional support to the growing efforts to examine the potential of exercise to reduce fall risk. Further work needs to determine if reductions in fall risk result in reductions in fall incidence in persons with MS.