Resistance Training on Patients with Multiple Sclerosis

Elizabeth M. Osantowski
Student Physical Therapist
Eosantowski07@gmail.com
Central Michigan University
Abstract

Among the population of patients who have multiple sclerosis (MS), resistance training is

found to improve muscle function and growth, which could improve their quality of life.

Objective: The purpose of this paper is to evaluate the efficacy of resistance training on patients

with MS. Methods: The method of this literature review is to compare five research articles on

resistance training for patients with multiple sclerosis from 2006-2017. Results: The results from

the five journal articles show that resistance training may be an effective intervention plan for

patients with MS. Discussion/Conclusion: The conclusion lends supports that resistance training

may benefit patients with Multiple Sclerosis and therefore, is recommended.

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Introduction

Multiple Sclerosis is a disease in which “the immune system attacks the protective sheath

(myelin) that covers nerve fibers and causes communication problems between your brain and

the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or

become permanently damaged.”1 MS can affect anyone, but it is estimated that 2.3 million

people are affected worldwide.1,2 People are at a higher risk to get MS if: 15-60 years old,

female, someone in their immediate family has the disease, certain infections such as Epstein-

Barr, Caucasian, live in temperate climates, smoke, or have an autoimmune disease such as

thyroid disease, Type 1 Diabetes, or inflammatory bowel disease.1 Symptoms of MS include:

fatigue, gait difficulties, numbness and/or tingling, spasticity, weakness, vision problems,

bladder or bowel problems, pain, dizziness or vertigo, cognitive changes, pain, emotional

problems, sexual problems, speech/swallowing problems, tremors, seizures, breathing problems,

headaches, etc.2

MS can appear in different severities, and although it is not a curable disease, the

symptoms can be managed.2 There are numerous medications to reduce the disease activity

and/or progression of relapses. In addition to medications, there are rehabilitative services

available to maintain or improve function. These services include Physical Therapy,

Occupational Therapy, Speech-Language Therapy, and Cognitive and Vocational rehabilitation.

Furthermore, people can experience depression, anxiety, and/or mood changes, so it is

recommended to have emotional support by mental health professionals or support groups to

provide support and education related to this disease.2

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 For this literature review, the focus will be directed to resistance training in patients who

have MS to analysis neuromuscular influences. This could be used in Physical Therapy as

rehabilitation to treat patients with MS. Resistance training can help the patient manage or

reduce the symptoms of this disease, which could improve their quality of life. Among the

population of patients who have MS, resistance training is found to improve muscle function and

growth. The purpose of this literature review is to examine the efficacy on resistance training in

patients with MS by comparing five journal articles.

Methods

Article 1 and 2

The first two articles examined in this paper determine physical activity guidelines for

adults with MS. In the first journal article, the study examined what type of exercise (aerobic,

resistance training, aerobic and resistance training, and non-traditional) would be best to improve

the fitness, mobility, fatigue, and quality of life. This study was conducted by using systematic

review of evidence, which included at least one of the analyzes measured and included

randomized and nonrandomized control design. Two researchers were used to search and

compile evidence from previous studies that demonstrated exercise intervention had an impact

on MS patients. The researchers narrowed the list down from 4362 to 54 studies by using

specific criteria to ensure the evidence worked.3 The second journal article expanded on this

information. In addition to everything stated above, this study used a project team, which

consisted of a consensus panel for the objectives, questions, and population. Evidence was

discussed until the panel reached a unanimous consensus on the recommendations of physical

activity.4

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Article 3

This study used a 2-arm, 12-week, randomized controlled trial that included a follow up

period of 12 weeks. There were 38 moderately impaired patients with MS whom were

randomized into two groups: a progressive resistance training (PRT) exercise group or a control

group. The exercise group completed a biweekly 12-week lower extremity PRT program. Then,

the control group was instructed to complete the same 12-week lower extremity PRT program.

Both groups were tested before and after the 12-week PRT program and at the 24-week follow

up. This study tested isometric muscle strength of the knee extensors and functional capacity.5

Article 4

This study used a pre-post single group research design method. This consisted of a 4-

week baseline phase. Nine subjects with MS were used to attend a gym three times over a 4-

week period to familiarize themselves. Then, the subjects completed a 10-week progressive

resistance exercise program twice a week. The subjects were asked to complete 10-12 repetitions

of each exercise. This study measured muscle strength, muscle endurance, walking speed, a 2-

min walk test, timed stairs test, and physical and psychological function at 2, 4, and 14 weeks.6

Article 5

This study used eight ambulatory patients with an Expanded Disability Status Scale

scores ranging from 2.5 to 5.5. The subjects participated in an 8-week progressive resistance

training program. This study measured knee range of motion, duration of stance, swing, and

double-support phases in seconds and as percentages of the stride time, percentage of stride time

spent in stance, swing, and double-support phases, step length, foot angle, stride length, velocity,

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step width, and toe clearance for both the more affected and less affected lower limbs.

Additionally, this study measured isometric strength, 3-minute stepping, fatigue, and self-

reported disability.7

Results

Articles 1 and 2

The results for the first two articles indicate the guidelines of physical activity on MS

patients and which type of exercise works best. The first article stated, “There was strong

evidence that exercise performed 2 times per week at a moderate intensity increases aerobic

capacity and muscular strength.”3 Additionally, this study found that resistance training of

various types (weight machines, free weights, resistance bands) and other, less traditional forms

of strength training (specialized locomotor training, cycling with or without electrical

stimulation, aquatics) improved muscular strength. In fact, there is consistent evidence

supporting the efficacy and beneficial effects of exercise training for improving muscular

strength.3 However, the second article stated, “…the recommended dose in our guideline for

adults with MS is lower in duration and intensity than the amount recommended for the general

population (150 minutes of moderate to heavy intensity aerobic activity each week and strength

training 2 times per week).”4 The consensus panel determined that the evidence was adequate to

formulate guidelines to improve aerobic capacity and muscle strength, but not to achieve

mobility, fatigue, or HRQOL benefits. These guidelines specify the frequency, intensity, and

duration of aerobic and resistance training needed to obtain fitness benefits.4

Article 3, 4, and 5

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 The results for the third journal article showed knee extensors and functional capacity

improved after the 12-week PRT program in the exercise group. Knee extensors improved 15.7%

and functional strength improved 21.5%. The improvements were even higher in the control

group. It was encouraged to continue with the PRT program after the trial period. The 24-week

follow up showed that there were more improvements in both functional capacity and knee

extensors.5 The results for the fourth journal article showed an increase in arm strength by

14.4%, leg endurance by 170.9%, and fast walking speed by 6.1%. An increase trend was found

for the 2-min walk test and the perceived impact of MS on physical function reduced.6

Additionally, the fifth journal article found “there were significant increases (P<.05) in

percentage of stride time in the swing phase, step length, stride length, and foot angle; and

significant decreases (P<.05) in percentage of stride time in the stance and double-support

phases, duration of the double-support phase, and toe clearance. Isometric leg strength improved

(P<.05) in 2 of the 4 muscle groups tested. Fatigue indices decreased (P=.04), whereas self-

reported disability tended to decrease (P=.07) following the training program. Three-minute

stepping increased by 8.7%.”7

Discussion

For this study, the discussion was to focus on resistance training effects, but the

guidelines determined for MS patients that both, resistance training and aerobic exercise, are

beneficial simultaneously. Specifically, “There was consistent and strong evidence that aerobic

and resistance exercise performed 2 times per week at a moderate intensity increases physical

capacity and muscular strength, respectively.”3 However, another article found that the

“guidelines state that adults with MS should engage in at least 30 minutes of moderate intensity

aerobic activity 2 times per week and strength training of major muscle groups 2 times per week

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to achieve important fitness benefits.”4 As a guideline to improve fitness, mobility, fatigue, and

quality of life, it is recommended to engage in both, aerobic exercise and resistance training to

gain the most benefit.

However, other articles found that engaging in only resistance training can strengthen the

muscles and improve functionality. Specifically, an article found that resistance training

programs of the lower extremities led to an increase in muscle strength and functional capacity in

patients whom have MS.5 Also, it is found that resistance training programs improve muscle

performance without adverse effects.6 It is suggested that progressive resistance exercise may be

a useful alternative for people with mild to moderate MS.6 Furthermore, resistance training may

be effective in improving walking and functional ability in moderate MS patients.7

Conclusion

The evidence from these journal articles have shown an increase in neuromuscular effects

from resistance training in MS patients. The efficacy on resistance training was examined in this

literature review to show an increase muscle growth and function. It is suggested that resistance

training be used for patients with multiple sclerosis to improve or maintain the symptoms of this

disease. Resistance training is recommended to be utilized at least 2 times per week at moderate

intensity. For optimal results, resistance training should be used in combination with aerobic

exercise 2 times per week. This is important and useful information for a Physical Therapist

when designing the plan of care for MS patients to receive optimal results. This study confirms

and lends support that resistance training may improve the effects that multiple sclerosis has on

an individual.

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 Reference List
1. Multiple Sclerosis. MayoClinic.org. http://www.mayoclinic.org/diseases-
conditions/multiple-sclerosis/home/ovc-20131882. Updated August 4, 2017. Accessed
September 14, 2017.
2. National Multiple Sclerosis Society. http://www.nationalmssociety.org/. Accessed
September 14, 2017.
3. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon
KA, Motl RW. Effects of Exercise Training on Fitness, Mobility, Fatigue, and Health-
Related Quality of Life Among Adults With Multiple Sclerosis: A Systematic Review to
Inform Guideline Development. Archives of Physical Medicine and Rehabilitation 2013;
94:1800-28.
4. Latimer-Cheung AE, Martin Ginis KA, Hicks AL, Motl RW, Pilutti LA, Duggan M,
Wheeler G, Persad R, BASc, Smith KM. Development of Evidence-Informed Physical
Activity Guidelines for Adults With Multiple Sclerosis. Archives of Physical Medicine
and Rehabilitation 2013; 94:1829-36.
5. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C, Overgaard K,
Ingemann-Hansen T. Resistance training improves muscle strength and functional
capacity in multiple sclerosis. Neurology 2009;73(18), 1478-1484.
http://www.neurology.org/content/73/18/1478.short
6. Taylor NF, Dodd KJ, Prasad D, Denisenko S. Progressive resistance exercise for people
with multiple sclerosis. Disability and Rehabilitation 2006; 28(18) 1119-1126.
7. Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Castellano V, White LJ. Resistance
Training Improves Gait Kinematics in Persons With Multiple Sclerosis. Archives of
Physical Medicine and Rehabilitation 2005; 86(9) 1824-1829.