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Old 06-21-2017, 11:42 AM
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Default STUDY: The effect of exercise training in adults with MS with severe disability

The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions

Thomas Edwardsa, Lara A. Piluttib

https://doi.org/10.1016/j.msard.2017.06.003

Highlights

•A systematic review of exercise training in people with severe MS was conducted.
•19 articles met inclusion criteria and data were summarized by training modality.
•2/5 studies reported significant improvements after resistance exercise training.
•9/13 studies reported significant improvements after adapted exercise training.
•Exercise training could be considered as a therapeutic approach in severe MS.

Abstract

Introduction
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 1.0–5.5), 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.

Objective
To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability.

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 mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation).

Results
Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were included in the final review. Five studies examined conventional exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities including body-weight support treadmill training (BWSTT), total-body recumbent stepper training (TBRST), and electrical stimulation cycling (ESAC). Outcomes related to mobility, fatigue, and quality of life (QOL) were most frequently reported. Two of five studies examining conventional resistance exercise training reported significant improvements in physical fitness, physical function, and/or symptomatic and participatory outcomes. Nine of 13 studies examining adapted exercise training reported significant improvements in disability, physical fitness, physical function, and/or symptomatic and participatory outcomes.

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

Abbreviations
2*MWT2-min walk test; 6*MWT6-min walk test; ABCactivities-specific balance confidence scale; BBSBerg Balance Scale; BWSTTbody-weight support treadmill training; DGIDynamic Gait Index; EDSSExpanded Disability Status Scale; ESACelectrical stimulation assisted cycling; FWSfast walking speed test; HRQOLhealth-related quality of life; MFISmodified fatigue impact scale; MMTmanual muscle test; MSmultiple sclerosis; MSIS-29Multiple Sclerosis Impact Scale; NNewtons; PEDrophysiotherapy evidence database; RCTrandomized control trial; SSWSself-selected walking speed test; TBRSTtotal body recumbent stepper training; T25FWTtimed 25-foot walk; TUGTimed Up-and-Go; VO2volume of oxygen consumption

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