Home-Based Resistance Training for Older Adults with Severe Multiple Sclerosis

Background: Multiple sclerosis (MS) is associated with the progressive loss of skeletal muscle mass and strength, and this loss is seemingly worsened with normal aging. Progressive resistance training (PRT) is a strategy for increasing muscle mass and strength, and has been effective for improving functional and symptomatic outcomes in MS and older adults. The majority of PRT interventions have been conducted among those with mild-moderate MS and in supervised exercise settings. Such environments present barriers to exercise participation for those with severe MS and older adults. To date, no studies to have examined home-based PRT among older adults with severe MS.

Objectives: To examine the safety and efficacy of a 6-month home-based PRT intervention among older adults with severe MS.

Methods: 25 older adults (age=50-75) with severe MS (Expanded Disability Status Scale [EDSS]=6.5-8.0) were randomized to either a home-based PRT program (n=13) or a wait-list control (n=12) condition for 6 months. The PRT intervention consisted of 2 weekly home-based training sessions and 5 in-person visits over 6 months. Primary outcomes were safety and efficacy, determined as the ability of the intervention to improve muscle strength and lean mass. Secondary outcomes included functional, symptomatic, and participatory measures. Outcomes were assessed at baseline and 6-months.

Results: 13 individuals completed the intervention (PRT n=6; control n=7). Three adverse events (1 shoulder injury, 1 fall, 1 relapse) were reported by participants in the home-based PRT group. There was a moderate-to-large positive effect of PRT on muscle strength including the knee flexors (η_ρ² =.22), shoulder flexors (η_ρ² =.07), and dorsiflexors (η_ρ² =.22) compared to control. There was a moderate positive effect of PRT on whole-body lean soft tissue mass (η_ρ² =.06), cognitive processing speed (η_ρ² =.06), and overall impact of fatigue (η_ρ² =.10) compared to control. The intervention did not improve functional outcomes, other MS symptoms, or health-related quality of life (HRQOL).

Conclusions: We provide preliminary evidence that a home-based PRT intervention is safe for older adults with severe MS and can improve muscle strength and lean mass. There are potential benefits of this intervention for cognition and fatigue, although other exercise modalities or combined strategies might be more effective for managing MS symptoms and HRQOL. The effectiveness might be improved by strategies for promoting retention.