Effects of Cooling during Exercise on Balance Performance in Persons with Multiple Sclerosis

Background: Thermosensitivity limits physical performance in Multiple Sclerosis (MS), preventing the ability of patients to engage in rehabilitation programs of sufficient intensity to result in meaningful improvements. If MS thermosensitivity could be decreased, patients could engage in more vigorous rehabilitation programs, and potentially achieve greater improvements in mobility.

Objectives: The purpose of this study was to examine the effects of cooling on exercise induced thermosensitivity in persons with MS by measuring post-exercise balance performance in cooled and uncooled conditions. We hypothesized that cooling during exercise would improve post-exercise balance in persons with MS. If our hypothesis was correct, it would suggest that cooling may lead to improved balance training and performance in persons with MS. 

Methods:  A randomized crossover design was used. Fourteen subjects were randomized into either cooled (C) or uncooled (UC) groups. Balance was assessed for all subjects using the Berg Balance Scale (BBS). All subjects then received a thermal lode via performance of 10 minutes of cycling ergometry in either a (C) or (UC) condition. Cooling was imparted via use of a cooling vest. One week later, subjects crossed over, performing the cycling in whatever condition they did not perform in previously, with the BBS again done before and after. BBS scores were then compared for the 2 conditions (C and UC).

Results: Mean BBS scores showed non-significant increases in the cooled condition (50.0-50.7) and non-significant decreases in the uncooled condition (50.6-49.7), (p>.2568), suggesting that balance improved slightly following the cooled condition and worsened slightly following the uncooled condition. The small trend toward improvement that was seen in post-exercise balance performance with use of the cooling vest during moderate exercise may point to a functionally important mitigation of fatigue-related balance deficits in persons with MS. It is possible that more significant results could have been obtained with an outcome measure of greater sensitivity. 

Conclusions: Cooling may result in improved balance performance in MS by limiting the effects of thermosensitivity. However more sensitive tests may be required to clearly demonstrate this effect.