Elliptical exercise improves fatigue ratings and quality of life in patients with multiple sclerosis

Fatigue, reduced quality of life (QOL), and lower physical activity levels are commonly reported in patients with multiple sclerosis (MS). This study evaluated the effects of elliptical exercise on fatigue and QOL reports in patients with MS. Patients with MS (n = 26) completed the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) before and after completing 15 elliptical exercise training sessions. Changes in fatigue and QOL were assessed based on any changes in the fatigue and SF-36 questionnaires, and correlations between changes in each of the scales were made to determine whether a relationship was present between the fatigue and QOL measures. Results showed significant improvement in FSS, MFIS, and five SF-36 subscales as a result of elliptical exercise. The change in FSS correlated with change in two of the SF-36 subscales. Elliptical exercise for patients with MS results in significant improvements in both fatigue and QOL. These findings indicate that regular elliptical exercise could be a part of inpatient and outpatient MS rehabilitation programs

Supervised Resistance Training Results in Changes in Postural Control in Patients With Multiple Sclerosis

Postural disturbances are one of the first reported symptoms in patients with Multiple Sclerosis (MS). The purpose of this study was to investigate the effect of supervised resistance training on postural control in MS patients. Postural control was assessed using amount of sway variability [Root Mean Square (RMS)] and temporal structure of sway variability [Lyapunov Exponent (LyE)] from 15 MS patients. Posture was evaluated before and after completion of three months of resistance training. There were significant differences between MS patients pretraining and healthy controls for both LyE (p = .000) and RMS (p = .002), but no differences between groups after training. There was a significant decrease in RMS (p = .025) and a significant increase in LyE (p = .049) for MS patients pre- to posttraining. The findings suggested that postural control of MS patients could be affected by a supervised resistance training intervention

Gait Mechanics are Different between Healthy Controls and Patients with Multiple Sclerosis

Multiple sclerosis (MS) causes severe gait problems in relatively young individuals, yet there have been limited studies to quantitatively identify the specific gait parameters that are affected. The purpose of this study was to define any differences in biomechanical gait parameters between patients with MS and healthy controls. A total of 31 MS patients and 31 healthy controls were evaluated: joint torques and joint powers were calculated at the ankle, knee, and hip during the stance phase of gait. The self-selected walking velocity was used as a covariate in the analysis to ensure that group differences were not due to differences in walking velocity between the MS and healthy control groups. Reduced angular range, less joint torque, and reduced joint power were seen in patients with MS. We also found significant correlations between biomechanical gait parameters and EDSS score, which provides a clinical rating of disease severity. Our findings provide a quantitative assessment of the gait mechanics employed in patients with MS. The altered lower extremity mechanics observed in patients with MS reflect both a neurological and strength deficit compared with healthy controls during walking

Multiple Sclerosis Alters the Mechanical Work Performed on the Body\u27s Center of Mass During Gait

Patients with multiple sclerosis (MS) have less-coordinated movements of the center of mass resulting in greater mechanical work. The purpose of this study was to quantify the work performed on the body’s center of mass by patients with MS. It was hypothesized that patients with MS would perform greater negative work during initial double support and less positive work in terminal double support. Results revealed that patients with MS perform less negative work in single support and early terminal double support and less positive work in the terminal double support period. However, summed over the entire stance phase, patients with MS and healthy controls performed similar amounts of positive and negative work on the body’s center of mass. The altered work throughout different periods in the stance phase may be indicative of a failure to capitalize on passive elastic energy mechanisms and increased reliance upon more active work generation to sustain gait

Postural control strategy during standing is altered in patients with multiple sclerosis

Disturbances in balance are one of the first reported symptoms of Multiple Sclerosis (MS), yet limited research has been performed to classify the postural control deficits in this population. This study investigated the variability present in the sway patterns during quiet standing in patients with MS (PwMS) and healthy controls. Subjects were assessed (eyes open, closed) standing on a force platform. Variability of the sway patterns was quantified using a measure of amount of variability (root mean square; RMS) and two measures of temporal structure of variability (Lyapunov Exponent – LyE; Approximate Entropy – ApEn). RMS results revealed significantly higher amount of variability in the sway patterns of PwMS. PwMS also exhibit increased regularity (decreased ApEn) and decreased divergence (decreased LyE) during standing compared to healthy controls. Removing vision resulted in significantly decreased divergence (decreased LyE) in the MS subject group. These changes in the temporal structure correspond well with the theoretical model of the optimal movement variability hypothesis and the results support using variability measures to understand the mechanisms that underline postural control in PwMS and possibly other neurodegenerative disease pathologies

Is There a Relationship Between Fatigue Questionnaires and Gait Mechanics in Persons With Multiple Sclerosis?

Objective: To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics. Design: Cross-sectional. Setting: Biomechanics laboratory. Participants: Subjects with MS (n=32) and age- and sex-matched controls (n=30). Interventions: None. Main Outcome Measures: Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure. Results FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables. Conclusions Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS

Multiple sclerosis affects the frequency content in the vertical ground reaction forces during walking

Background: Multiple sclerosis is a progressive neurological disease that results in a high incident of gait disturbance. Exploring the frequency content of the ground reaction forces generated during walking may provide additional insights to gait in patients with multiple sclerosis that could lead to specific tools for differential diagnosis. The purpose of this study was to investigate differences in the frequency content of these forces in an effort to contribute to improved clinical management of this disease. Methods: Eighteen patients and eighteen healthy controls walked across a 10 meter long walkway. The anterior–posterior and vertical ground reaction forces generated during the stance phase of gait were evaluated in the frequency domain using fast Fourier transformation. T-tests were utilized for comparison of median frequency, the 99.5% frequency, and the frequency bandwidth between patients and healthy controls and also for comparisons between patients with mild and moderate severity. Findings: Patients with multiple sclerosis had significantly lower 99.5% frequency (P = 0.006) and median frequency (P \u3c 0.001) in the vertical ground reaction force. No differences were found in the anterior–posterior reaction force frequency content. There were no differences between patients with mild and moderate severity. Interpretation: The lower frequency content suggests lesser vertical oscillation of the center of gravity. Lack of differences between severities may suggest presence of differences prior to currently established diagnosis timelines. Analysis of the frequency content may potentially serve to provide earlier diagnostic assessment of this debilitating disease

Gait Variability Measures Reveal Differences between Multiple Sclerosis Patients and Healthy Controls

The purpose of this study was to determine the differences in gait variability between patients with multiple sclerosis (MS) and healthy controls during walking at a self-selected pace. Methods: Kinematics were collected during three minutes of treadmill walking for 10 patients with MS and 10 healthy controls. The Coefficient of Variation (CoV), the Approximate Entropy (ApEn) and the Detrended Fluctuation Analysis (DFA) were used to investigate the fluctuations present in stride length and step width from continuous strides. Results: ApEn revealed that patients with MS had significantly lower values than healthy controls for stride length (p \u3c .001) and step width (p \u3c .001). Conclusions: ApEn results revealed that the natural fluctuations present during gait in the stride length and step width time series are more regular and repeatable in patients with MS. These changes implied that patients with MS may exhibit reduced capacity to adapt and respond to perturbations during gait

Persons With Multiple Sclerosis Show Altered Joint Kinetics During Walking After Participating in Elliptical Exercise

Patients with multiple sclerosis (MS) experience abnormal gait patterns and reduced physical activity. The purpose of this study was to determine if an elliptical exercise intervention for patients with MS would change joint kinetics during gait toward healthy control values. Gait analysis was performed on patients with MS (n = 24) before and after completion of 15 sessions of supervised exercise. Joint torques and powers were calculated, while also using walking velocity as a covariate, to determine the effects of elliptical exercise on lower extremity joint kinetics during gait. Results show that elliptical exercise significantly altered joint torques at the ankle and hip and joint powers at the ankle during stance. The change in joint power at the ankle indicates that, after training, patients with MS employed a walking strategy that is more similar to that of healthy young adults. These results support the use of elliptical exercise as a gait training tool for patients with MS

Impact of Resistance Training on Balance and Gait in Multiple Sclerosis

Multiple sclerosis (MS) is an incurable neurodegenerative disease whose symptoms are only partially relieved by pharmaceutical intervention. Disability due to this disease process can impede activities of daily living and decrease quality of life, both for MS patients and for their care partners and families. A nonrandomized, nonblinded prospective cohort study of 45 patients with MS was undertaken to investigate the impact of an exercise program emphasizing resistance training on balance and gait. This article presents data for the first 33 participants to complete the study protocol. The exercise program consisted of twice-weekly 50-minute sessions for 6 months. At 3 months and 6 months, statistically significant improvements (P \u3c .05) from baseline were observed for the following measures: Nine-Hole Peg Test, 2- and 3-second Paced Auditory Serial Addition Test, Modified Fatigue Impact Scale, NeuroCom Balance Master (NeuroCom International, Inc, Clackamas, OR), Timed Up and Go test, and Berg Balance Scale. Three-dimensional biomechanical gait analysis showed increased knee power generation during midstance and increased hip power generation during terminal stance. To determine whether individuals with varying levels of disability responded to exercise in a similar fashion, participants were divided into two subgroups based on Expanded Disability Status Scale score: little or no disability (EDSS score 1.0–4.0) and mild-to-moderate disability (EDSS score 4.5–6.5). No statistically significant differences in results were found. The results of this study indicate that participation in a resistance training program improves MS patients\u27 ability to walk and to generate muscular forces during locomotion