Effects of a balance programme focusing on core stability exercises and dual- task activities in persons with multiple sclerosis: a randomized controlled trial
A.S. Forsberg, L. von Koch, Y.E. Nilsagård (Örebro, Stockholm, SE)

Background: Balance impairment and risk of falls is common in persons with multiple sclerosis (PwMS). Several factors may cause the impaired balance, spasticity, sensory deficits, and weakness but also difficulties with dual-task activities. In this study an intervention consisting of a structured group balance program including core stability exercises in lying, quadruped and standing, dual-task activities, and activities challenging sensory strategies was evaluated. The aim was to investigate the effects of the structured group balance program on dynamic balance, walking ability, self-rated balance and walking confidence in PwMS compared to no exercise.

Methods: A multi-centre randomized controlled trial with allocation to exercise or non-exercise was conducted. Seven hospitals or primary health care centers in Sweden participated. The exercise group participated in the intervention 2 times/week for 7 weeks, each session lasted 60 minutes. Inclusion criteria: ability to walk 100 meters (assistive device allowed). Exclusion criteria: only minor balance impairment. Assessments were performed before randomization and the week after the intervention. Primary outcome measure was the Bergs Balance Scale (BBS). Secondary measures included the Four-Square step test (FSST), the Functional Gait Assessment (FGA), and the self-rating MS Walking Scale-12 (MSWS-12) and the Activities-specific Balance Confidence (ABC) scale. Power calculation based on detecting a 5 point difference between groups on the BSS suggested 70 participants.

Results: The study sample included 87 PwMS. The exercise group consisted of 36 women and 8 men (mean age 52 years), and the non-exercise group of 33 women and 10 men (mean age 55 years). Nine persons were lost to follow-up in the exercise group and five in the non-exercise group, mainly due to was lack of time. After the intervention, there was no difference between groups on the BBS (mean change score 2.6±4.1 vs. 1.6±4.1). There were significant differences in favor of the exercise group on the FGA (mean change score 2.7±4.1 vs. 0.7±2.0); the MSWS-12 (mean change score -3.4±5.0 vs. 0.1±5.2); and the ABC (mean change score 7.7±16 vs. -1.9±13.2). There was no difference between the groups on the FSST.

Conclusions: Participants in a 7-week group balance program including core stability and dual task activities had larger improvements in dynamic balance during walking and self-rated balance and walking confidence than people in the non-exercise group.