Fall Risk Reduction in Individuals with MS: Pilot Examination of Exercise and Education

Background:  Falls are common in individuals with multiple sclerosis (MS) and are associated with adverse physical and psychological outcomes. The effectiveness of various fall risk reduction strategies for persons with MS, however, is not clear.

Objectives: To determine the effectiveness of three distinct, 12-week fall risk reduction programs specifically designed for individuals with MS: A) a home-based exercise program targeting physiological risk factors; B) an educational program targeting behavioral risk factors; and C) a combined exercise and education program targeting both physiological and behavioral risk factors.

Methods: 37 individuals with MS who had fallen in the last year participated in the study. Following baseline testing, participants were randomly assigned into one of four groups wait-list control (Con; n=9), home-based exercise (EX; n=11), education (ED; n=9), or a combined exercise and education (EX+ED; n=8) group. Participants underwent fall risk (physiological profile assessment: PPA), balance (Berg Balance Scale: BBS), and walking (timed 25’ walk: T25FW) testing prior to and immediately following the 12-week intervention. They also self-reported information on the frequency of fall prevention behaviors (Falls Prevention Strategy Survey), and balance confidence (Activities-specific Balance Confidence scale). 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: 34 participants (n = 8 CON; n=10 EX; n=8 ED; n=8 EX+ED) completed post-intervention testing. Overall, fall risk was found to decrease in both the EX and EX+ED groups following the intervention (1.8±1.1 vs. 1.3±1.3; d=0.4), while there was a small increase in fall risk in the other groups (1.2 ±0.8 vs. 1.7±1.1; d=0.1).  There was an overall increase in the utilization of fall prevention behaviors in all four groups following the intervention (11.7±4.1 vs. 13.0±4.3; d=0.3), but no significant differences across groups. Following the intervention there was a significant decrease in balance confidence only in the education-only group (62.5±11.3 vs. 34.9±19.1; d=1.65).  There was no significant change in balance or walking following the intervention in any of the groups.

Conclusions: The findings add to the knowledge base concerning the benefit of exercise and fall prevention education on fall risk among people with MS. Given their positive influence on physiological fall risk the home-based exercise program in isolation and in combination with an education component warrant further investigation. Future studies involving larger sample sizes and a longer follow-up period investigating the relative benefits of exercise-only and exercise combined with education are indicated.