Advertisement

Resistance Training Improves Gait Kinematics in Persons With Multiple Sclerosis

      Abstract

      Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Castellano V, White LJ. Resistance training improves gait kinematics in persons with multiple sclerosis.

      Objective

      To evaluate the effects of an 8-week lower-body resistance-training program on walking mechanics in persons with multiple sclerosis (MS).

      Design

      Repeated-measures design, evaluating gait kinematics before and after an 8-week progressive resistance-training intervention.

      Setting

      Biomechanics laboratory and fitness center (with conventional, commercially available resistance-training equipment).

      Participants

      Eight ambulatory subjects with MS (age, 46.0±11.5y) with Expanded Disability Status Scale scores ranging from 2.5 to 5.5.

      Intervention

      An 8-week progressive resistance-training program.

      Main Outcome Measures

      Kinematic gait parameters including knee range of motion, duration of stance, swing, and double-support phases in seconds and as percentages of the stride time, percentage of stride time spent in stance, swing, and double-support phases, step length, foot angle, stride length, velocity, step width, and toe clearance for both the more affected and less affected lower limbs. Isometric strength, 3-minute stepping, fatigue, and self-reported disability were also measured.

      Results

      After 2 months of resistance training, there were significant increases (P<.05) in percentage of stride time in the swing phase, step length, stride length, and foot angle; and significant decreases (P<.05) in percentage of stride time in the stance and double-support phases, duration of the double-support phase, and toe clearance. Isometric leg strength improved (P<.05) in 2 of the 4 muscle groups tested. Fatigue indices decreased (P=.04), whereas self-reported disability tended to decrease (P=.07) following the training program. Three-minute stepping increased by 8.7%.

      Conclusions

      Resistance training may be an effective intervention strategy for improving walking and functional ability in moderately disabled persons with MS.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Noseworthy J.H.
        • Lucchinetti C.
        • Rodrigues M.
        • Weinshenker B.G.
        Multiple sclerosis.
        N Engl J Med. 2000; 343: 938-952
        • Kraft A.M.
        • Wessman H.C.
        Pathology and etiology in multiple sclerosis.
        Phys Ther. 1974; 54: 716-720
        • Ashburn A.
        • DeSouza L.H.
        An approach to the management of multiple sclerosis.
        Physiother Pract. 1988; 4: 139-145
        • Frzovic D.
        • Morris M.E.
        • Vowels L.
        Clinical tests of standing balance.
        Arch Phys Med Rehabil. 2000; 81: 215-221
        • Holden M.K.
        • Gill K.M.
        • Magliozzi M.R.
        Gait assessment for neurologically impaired patients.
        Phys Ther. 1986; 66: 1530-1539
        • Chiou I.L.
        • Burnett C.N.
        Values of activities of daily living.
        Arch Phys Med Rehabil. 1985; 65: 901-906
        • Hobart J.C.
        • Lamping D.L.
        • Fitzpatrick R.
        • Riazi A.
        • Thompson A.J.
        The multiple sclerosis impact scale (MSIS-29).
        Brain. 2001; 124: 962-973
        • Mostert S.
        • Kesselring J.
        Effects of a short-term exercise-training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis.
        Mult Scler. 2002; 8: 161-168
        • Petajan J.H.
        • Gappmaier E.
        • White A.T.
        • Spencer M.K.
        • Mino L.
        • Hicks R.W.
        Impact of aerobic training on fitness and quality of life in multiple sclerosis.
        Ann Neurol. 1996; 39: 432-441
        • Gehlsen G.M.
        • Grigsby S.A.
        • Winant D.M.
        Effects of an aquatic fitness program on the muscle strength and endurance of persons with multiple sclerosis.
        Phys Ther. 1984; 64: 653-657
        • Debolt L.S.
        • McCubbin J.A.
        The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2004; 85: 290-297
        • Frontera W.R.
        • Hughes V.A.
        • Krivickas L.S.
        • Kim S.K.
        • Foldvari M.
        • Roubenoff R.
        Strength training in older women.
        Muscle Nerve. 2003; 27: 601-608
        • Rodgers M.M.
        • Mulcare J.A.
        • King D.L.
        • Mathews T.
        • Gupta S.C.
        • Glaser R.M.
        Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program.
        J Rehabil Res Dev. 1999; 36: 183-188
        • White L.J.
        • McCoy S.C.
        • Castellano V.
        • et al.
        Resistance training improves strength and functional capacity in persons with multiple sclerosis.
        Mult Scler. 2004; 10: 668-674
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis.
        Neurology. 1983; 33: 1444-1452
        • Scheinberg L.C.
        • Feldman F.M.
        • Ratzker E.A.
        Self-assessment of neurological impairment in multiple sclerosis.
        Neurology. 1986; 36: 284
        • Flachenecker P.
        • Kumpfel T.
        • Kallmann B.
        • et al.
        Fatigue in multiple sclerosis.
        Mult Scler. 2002; 8: 523-526
        • Vaughan C.L.
        • Davis B.L.
        • O’Connor J.C.
        Dynamics of human gait.
        Kiboho Publ, Cape Town1999
        • Todd G.
        • Gorman R.B.
        • Gandevia S.C.
        Measurement and reproducibility of strength and voluntary activation of lower-limb muscles.
        Muscle Nerve. 2004; 29: 834-842
        • Surakka J.
        • Romberg A.
        • Ruutiainen J.
        • Virtanen A.
        • Aunola S.
        • Maentaka K.
        Assessment of muscle strength and motor fatigue with a knee dynamometer in subjects with multiple sclerosis.
        Clin Rehabil. 2004; 18: 652-659
        • Kent-Braun J.A.
        • Ng A.V.
        • Castro M.
        • et al.
        Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis.
        J Appl Physiol. 1997; 83: 1998-2004
        • Ng A.V.
        • Miller R.G.
        • Gelinas D.
        • Kent-Braun J.A.
        Functional relationships of central and peripheral muscle alterations in multiple sclerosis.
        Muscle Nerve. 2004; 29: 843-852
        • Surakka J.
        • Romberg A.
        • Ruutiainen J.
        • et al.
        Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis.
        Clin Rehabil. 2004; 18: 737-746
        • Kollmitzer J.
        • Ebenbichler G.R.
        • Sabo A.
        • Kerschan K.
        • Bochdansky T.
        Effects of back extensor strength training versus balance training on postural control.
        Med Sci Sports Exerc. 2000; 32: 1770-1776
        • American College of Sports Medicine
        ACSM’s guidelines for exercise testing and prescription.
        6th ed. Lippincott Williams & Wilkins, Philadelphia2000
        • Kuramoto A.K.
        • Payne V.G.
        Predicting muscular strength in women.
        Res Q Exerc Sport. 1995; 66: 168-172
        • Kraft G.H.
        • Alquist A.D.
        • de Lateur B.J.
        Effect of resistive exercise on function in multiple sclerosis (MS) [abstract].
        Arch Phys Med Rehabil. 1996; 77: 984
        • Kraft G.H.
        • Alquist A.D.
        • de Lateur B.J.
        Effect of resistive exercise on strength in multiple sclerosis (MS) [abstract].
        Arch Phys Med Rehabil. 1996; 77: 984
        • Cali C.M.
        • Keil D.P.
        An epidemiological study of fall-related fractures among institutionalized older people.
        J Am Geriatr Soc. 1995; 43: 1336-1340
        • Oberg T.
        • Karzania A.
        • Oberg K.
        Basic gait parameters.
        J Rehabil Res Dev. 1993; 30: 210-223
        • Lord S.R.
        • Lloyd D.G.
        • Li S.K.
        Sensori-motor function, gait patterns, and falls in community dwelling women.
        Age Ageing. 1996; 25: 292-299
        • Benedetti M.G.
        • Piperno R.
        • Simoncini L.
        • Bonato P.
        • Tonini A.
        • Giannini S.
        Gait abnormalities in minimally impaired multiple sclerosis patients.
        Mult Scler. 1999; 5: 363-368
        • Maki B.E.
        Gait changes in older adults.
        J Am Geriatr Soc. 1997; 45: 313-320
        • Imms F.J.
        • Edholm O.G.
        Studies of gait and mobility in the elderly.
        Age Ageing. 1981; 10: 147-156
        • Chao E.Y.
        • Laughman R.K.
        • Schneider E.
        • Stauffer R.N.
        Normative data of knee joint motion and ground reaction forces in adult level walking.
        J Biomech. 1983; 16: 219-233
        • Vinci P.
        • Perelli S.L.
        Footdrop, foot rotation, and plantarflexor failure in Charcot-Marie-Tooth disease.
        Arch Phys Med Rehabil. 2002; 83: 513-516
        • Said C.M.
        • Goldie P.A.
        • Patla A.E.
        • Sparrow W.A.
        Effect of stroke on step characteristics of obstacle crossing.
        Arch Phys Med Rehabil. 2001; 82: 1712-1719
        • Hsu A.L.
        • Tang P.F.
        • Jan M.H.
        Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.
        Arch Phys Med Rehabil. 2003; 84: 1185-1193
        • Kim C.M.
        • Eng J.J.
        • Whittaker M.W.
        Level walking and ambulatory capacity in persons with incomplete spinal cord injury.
        Spinal Cord. 2004; 42: 156-162
        • Teixeira-Salmela L.F.
        • Olney S.J.
        • Nadeau S.
        • Brower B.
        Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors.
        Arch Phys Med Rehabil. 1999; 80: 1211-1218
        • Lewek M.
        • Rudolph K.
        • Axe M.
        • Snyder-Mackler L.
        The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction.
        Clin Biomech (Bristol, Avon). 2002; 17: 56-63
        • Nadeau S.
        • Gravel D.
        • Arsenault A.B.
        • Bourbonnais D.
        Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of the hip flexors.
        Clin Biomech (Bristol, Avon). 1999; 14: 125-135