Effects of Maximal Strength Training on Gait and Balance in Persons with Multiple Sclerosis: A Pilot Study

Friday, May 29, 2015: 2:00 PM
Herbert I Karpatkin, PT, DSc, NCS, MSCS , Physical Therapy, Hunter College, New York, NY
David Park, SPT , Physical Therapy, Hunter College, New York, NY
Sarah Dworetsky, SPT , Physical Therapy, Hunter College, New York, NY
Charlie Wright, SPT , Physical Therapy, Hunter College, New York, NY
Michael Zervas, DPT , Physical Therapy, Hunter College, New York, NY

Background: Clinicians who treat gait and balance impairments in persons with MS (pwMS) frequently utilize resistance training. Typically, the type of resistance training done utilizes relatively low loads, with the implicit assumption that higher intensity training may not be well tolerated due to neurogenic fatigue.  Recent evidence has suggested that using maximal strength training (MST) in pwMS as well as other CNS disorders may actually offer a unique and effective means of improving gait and balance. However, the effect of MST on gait and balance in pwMS has not been examined. 

Objectives: The purpose of this study was to examine whether an MST program in pwMS would result in improvements in gait and balance measures.  A secondary goal was to assess whether such a program will be well tolerated in this population.

Methods: A single-group pretest-posttest design was used with 7 participants with mild MS.  The exercise program entailed participants completing a 2x/week program for 8 weeks where they performed 4 sets of 4 repetitions of leg presses on each leg at a weight equal to 85-90% of their 1-repetition maximum.  Data from the 6-minute walk test (6MWT), the Berg Balance Scale (BBS), and the MSIS-29 were collected from participants at baseline and upon completion of the exercise program.  Participants’ 1RM lift for a seated hip extension was also determined for the right and left legs at baseline and upon completion of the program. 

Results: Five females and 2 males with mild MS (EDSS x̅  = 3.75) completed the study. None of the subjects reported any adverse effects. Results from a repeated-measures MANOVA with bootstrapping showed that participants’ maximal right leg press increased significantly from pretest (x̅ =146.07, SD = 93.36) to posttest (x̅ = 228.93, SD = 95.98), F = 20.26, p = .004.  Participants’ maximal left leg press also increased significantly from pretest (x̅ =142.86, SD = 100.87) to posttest (x̅ = 215.00, SD = 114.07), F = 63.03, p < .001.  BBS scores significantly improved from pretest (x̅ =44.29, SD = 8.34) to posttest (x̅ = 49.57, SD = 5.83), F = 15.56, p = .008.  Scores for the 6MWT also showed significant increases from pretest (x̅ =1040.04, SD = 429.25) to posttest (x̅ =1190.73, SD = 579.95), F = 6.35, p = .045. 

Conclusions: Subjects increased in maximal leg press strength, BBS scores, and 6MWT distance following the MST intervention.  The MST was well tolerated by all subjects. MST may provide an additional means of improving mobility in pwMS.  Discerning the mechanism of its effectiveness requires further examination.