ClinicSpeak: progressive resistance training

Physical therapy improves fatigue, muscle endurance and balance in MS. #ClinicSpeak #MSBlog #MSResearch

"Another home physical therapy programme augmented with an electrical device to improve physical functioning in MSers with walking difficulties. Not surprisingly participants noticed an improvement in fatigue levels as well. Other positives included improved muscle endurance and balance. It would be interesting to find-out if the latter could transfer to better outcome in terms of reduced falls and fractures. The problem with this programme is that it needs a technology, neuromuscular electrical stimulation, and hence is not accessible to most MSers. It is obvious that this is quite a specialised intervention and will only be provided by specialist units. If you think you would benefit from this therapy you should discuss it with your physiotherapist. The latter is another problem in that most MSers don't have regular physio, nor do they have a named therapist."

Coote et al. A pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with Multiple Sclerosis who use walking aids. Arch Phys Med Rehabil. 2014 Oct 9. pii: S0003-9993(14)01128-9.

OBJECTIVE: To investigate the feasibility and preliminary outcomes of a home progressive resistance training program augmented by neuromuscular electrical stimulation.

DESIGN: Randomized, controlled, pilot trial 

SETTING: Participants home 

PARTICIPANTS: People with Multiple Sclerosis (n=37) who use a walking aid.

INTERVENTIONS: Twelve week home PRT program or the same augmented by neuromuscular electrical stimulation (NMES). 

MAIN OUTCOME MEASURES: Strength using hand held dynamometry, repeated sit to stand test, Berg balance scale, Timed Up and Go test (TUG), MS walking scale 12, MS Impact Scale 29v2, modified Fatigue Impact Scale (MFIS) and the NMES group completed a device usability questionnaire.

RESULTS: Only change in MFIS score was significantly greater in the NMES than the PRT group (p=0.012). The NMES group improved significantly in quadriceps endurance (median of change 8.5, p=0.043), balance (3.5, p=0.001), physical impact of MS (-8.3, p=0.001) and impact of fatigue (-17, p=0.001). Participants rated the device as highly usable.

CONCLUSION: This pilot study suggests that a home PRT program with NMES is feasible and the Kneehab device is usable by this population. Only the reduction in impact of fatigue was greater in the NMES than the PRT group.

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