Systematic Review of Exercise Training in Adults with Multiple Sclerosis with Severe Mobility Impairment

Background: There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.0), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment.

Objectives: To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility impairment (EDSS ≥6.0).

Methods: Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe disability, characterized as the need for assistance in ambulation or EDSS score ≥6.0. Data were analyzed using a descriptive approach and summarized by exercise training modality as conventional (e.g., arm ergometer) or adapted (e.g., bodyweight supported treadmill training).

Results: Initially, 1164 studies were identified and after removal of duplicates, 530 studies remained. In total, 512 studies did not meet the inclusion criteria. 18 studies were included in the final review. The evidence reviewed suggests that there are potential benefits of conventional exercise training for improving physical fitness and mobility. Adapted exercise training may be beneficial for physical fitness, mobility, symptoms, and quality of life outcomes.

Conclusions: There is limited but promising evidence for the benefits of exercise training in persons with MS with severe mobility impairment. Considering the lack of effective therapeutic strategies for managing long-term disability accumulation, exercise training should be considered as an alternative approach. Further research is necessary to optimize the prescription and benefits of exercise training for adults with MS with severe disability.