Hypothesis/Aim: To test that progressive resistance training (PRT) of the lower body can improve muscle strength and functional capacity in patients with MS and that the improvements will be maintained for 12 wks after the trial.

Subjects: 38 adults (mean age: experimental 49.1 yrs, control group 47.7 yrs) with mild to moderate severity MS participated (mean EDSS scores, experimental group 3.9, control group 3.7). All subjects were ambulatory and functionally independent and had not done resistance training in the 3 mos prior to study enrollment.

Inclusion criteria: Definite relapsing-remitting MS EDSS between 3.0 and 5.5, ability to walk >100m, no need for help with transportation to training facility, age >18 yrs.

Exclusion criteria: Persons with dementia, alcoholism, or pacemaker treatment, had any serious medical co-morbidities, had experienced an MS attack within the past 8 wks, or were pregnant. During the study, participants were excluded if they had an attack influencing pyramidal functions or if they participated in less than 80% of the training sessions.

Groups:

1. Exercise Group
2. Control Group

Exercise Group 12 wks of 2x/wk LE resistance training. After warm-up, 5 exercises were performed (leg press, knee extension, hip flexion, hamstring curl, and hip extension). All exercises were performed with a fast concentric phase and a slow eccentric phase. Progression was as follows: wks 1 and 2, 3 sets of 10 reps at 15 reps maximum (RM); wks 3 and 4, 3 sets of 12 reps at 12RM; wks 5 and 6, 4 sets of 12 reps at 12RM; wks 7 and 8, 4 sets of 10 reps at 10RM; wks 9 and 10, 4 sets of 8 reps at 8RM; wks 11 and 12, 3 sets of 8 reps at 8RM. All exercise sessions were supervised.

Control Group: Maintenance of pre-study daily activity level. After the trial, the control group was enrolled in the resistance training intervention.

Data collection: Pre-Intervention and post intervention (12 wks later) and at follow-up (24 wks later). After post-testing, the control participated in the resistance training intervention.

Outcome Measures: Isometric muscle strength of the knee extensors (knee extensor maximal voluntary contraction [KE MVC]) and functional capacity (FS; combined score of 4 tests: Chair stand test, stair climb test, 10 meter walk, 6 min walk) were utilized.

Results: KE MVC and FS improved after 12 wks of PRT in the exercise group (KE MVC: 15.7% [95% confidence interval 4.3-27.0], FS: 21.5% [95% confidence interval 17.0-26.1]; p<0.05). Muscle force and all of the functional tests used for the functional capacity score improved more in the experimental group than in the control group (p <0.05). The improvements of KE and FS in the exercise group persisted at follow-up after 24 wks. Also, the exercise effects were reproduced in the control group during the 12-wk follow-up period.

Conclusions: 12 wks of lower extremity progressive resistance training in persons with MS leads to improvements of muscle strength and functional mobility, In addition, the exercise effect remain after 12 wks of independent physical activity.

Hypothesis/Aim: To evaluate the effects of an 8-wk lower-body resistance-training program on 1) walking mechanics [Gutierrez et al., 2005], 2) lower extremity strength, 4) ambulatory function, 5) fatigue, and 6) self-reported disability in persons with multiple sclerosis (MS) [White et al., 2004].

Subjects: 8 adults with MS (7 females; 1 male). Inclusion criteria: physician-diagnosed MS with an EDSS score between 1 and 5.

Exclusion criteria: Individuals with cardiovascular disease, thyroid disorders, gout, or orthopedic limitations. In addition, individuals using prednisone or anti-spasticity drugs were excluded.

NOTE: These publications are presented together because they report on the same group of subjects undergoing the same intervention. They only differ in the outcome measures reported.

Exercise program: The first 3 wks consisted of participant screening, study orientation and baseline measurements followed by 8 wks of 2x/wk of progressive resistance exercise training. Duringthe first wk of training, subjects performed 1 set of 6-10 reps at 50% of MVC. During the second wk, subjects performed 1 set of 10-15 reps at 60% MVC. From wk 3 until wk 8, subjects completed 1 set of 10-15 reps at 70% of maximal predicted force for all lower body exercises consisting of knee flexion / extension, plantar flexionand spinal flexion / extension using conventional weight machines. Each time a participant was able to complete 15 reps of an exercise on consecutive sessions, the resistance was progressed by 2-5%.

Outcome Measures:

1. Muscle strength testing - as measured by the force produced during a maximal isometric voluntary contraction.
2. Muscle activation as measured by central activation ratio.
3. Muscle cross sectional area as measured by MRI.
4. Percent body fat as measured by skin-folds.
5. Ambulatory function: 2 measures were used a) a 25-ft walking test, b) a 3-min step test.
6. Self-reported fatigue and disability: The modified fatigue impact scale and self-assessed EDSS score were used.
7. Gait spatiotemporal variables and kinematics as measured by a motion analysis system.

Results: Significant increases in knee extension (7.4%), plantar flexion (52%) and stepping performance (8.7%) were observed (p<0.05). Self-reported fatigue decreased (p<0.05) . In addition, significant increases were observed in percentage of stride time in the swing phase, step length, stride length, and foot angle. Significant decreases (p<0.05) in percentage of stride time in the stance and double-support phases, duration of the double-support phase, and toe clearance.

Conclusions: Resistance training appears to be an effective intervention for improving muscle strength, walking distance, gait characteristics, and fatigue in mild to moderately disabled persons with MS.

Hypothesis/Aim: To determine if resistance training program could: (1) increase the ability to generate maximal muscle force, (2) increase muscle endurance, (3) increase functional activity, and (4) improve overall psychological function of people with multiple sclerosis (MS).

Exclusion criteria: Acute exacerbation of their MS either immediately prior to or during the study, physiotherapy treatment, or any resistance training in the 4 wks prior to starting the study.

Study design: Single group repeated measures design (pre test, post test).

Exercise program: The first 4 wks consisted of a familiarization phase of 3 sessions in those first 4 wks. This was followed by a 10-wk, 2x/wk progressive resistance exercise training program. Exercises were: Leg press, knee extension, heel raises, Latissimus pull down, arm press, and seated row. Training intensity was set at a weight which could be lifted for 2 sets of 12 reps (approximately 60-80% of 1 rep max)

Outcome Measures:

1. Muscle strength: The maximum amount of weight lifted in a single seated arm press and seated leg press (1RM).
2. Muscle endurance: The number of reps able to be performed when the weight on the seated arm press and seated leg press was lowered to half of 1RM.
3. Self-selected and maximal walking speed: The time taken for participants to walk the middle 10m of a level 14m walkway.
4. Walking endurance: The distance covered in 2 minutes of walking at the participants preferred speed was measured (2-min walk test).
5. Timed stair walk: The time taken for participants to walk up a flight of 15 steps at comfortable speed.
6. Physical and psychological impact of MS: The multiple sclerosis impact scale (MSIS-29) was used to gain information on the participant's perspective of the physical and psychological impact of MS on their day-to-day life.

Results: Participants were compliant, and there were no adverse responses to training. There were statistically significant improvements in arm strength (14.4%), leg endurance (170.9%), and fast walking speed (6.1%). In addition, the perceived impact of MS was reduced.

Conclusions: Adults with MS experienced improved muscle performance and physical activities without adverse events as a result of participation in a resistance exercise program. These findings suggest that resistance exercise may be a feasible exercise alternative for people with mild to moderate disability due to MS.