STUDY: Exercise program improves balance, reduces falls

[ActiveMSers]

CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study

Anna Carling⇑
University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden/Department of Physiotherapy, School of Medical Sciences, Örebro University, Örebro University Hospital, Örebro, Sweden
Anette Forsberg
University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Martin Gunnarsson
Department of Neurology, School of Medical Sciences, Örebro University, Örebro, Sweden
Ylva Nilsagård
University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Department of Physiotherapy, Örebro University Hospital, 701 85 Örebro, Sweden.

Abstract

Background: Imbalance leading to falls is common in people with multiple sclerosis (PwMS).

Objective: To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0–7.5).

Methods: A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest–posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up.

Results: Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; −2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004).

Conclusion: This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

[ActiveMSers]

Another study, from 2014, reinforces these findings. And for the record: CoDuSe stands for core stability, dual tasking, and sensory strategies. - D

Arch Phys Med Rehabil. 2014 Dec;95(12):2428-34. doi: 10.1016/j.apmr.2014.06.016. Epub 2014 Jul 6.

Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial.

Nilsagård YE1, von Koch LK2, Nilsson M3, Forsberg AS4.

Abstract

OBJECTIVE:
To evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).

DESIGN:
Multicenter, single-blinded, single-group, pretest-posttest trial.

SETTING:
Seven rehabilitation units within 5 county councils.

PARTICIPANTS:
Community-dwelling adults with MS (N=32) able to walk 100m but unable to maintain 30-second tandem stance with arms alongside the body.

INTERVENTION:
Seven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dual tasking, and sensory strategies (CoDuSe).

MAIN OUTCOME MEASURES:
Primary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7 preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale, Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale; perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scale rated 7 weeks before intervention, directly after intervention, and 7 weeks later.

RESULTS:
Number of falls (166 to 43; P≤.001) and proportion of fallers (17/32 to 10/32; P≤.039) decreased significantly between the preintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected for perceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.

CONCLUSIONS:
The CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderate MS but did not significantly alter perceived limitations in walking and balance confidence.