Impact of Resistance Training on Balance in Multiple Sclerosis Patients

Monday, 7 July 2008
Mary L. Filipi, PhD, APRN, RN, BSN, MSN , Adult Health and Illness, University of Nebraska Medical Center, Omaha, NE

Learning Objective 1: compare current clinical quantitative measurements to research grade measurements in evaluation of gait and balance problems in Multiple Sclerosis.

Learning Objective 2: discuss the impact of a structured weight resistance exercise program on gait and balance in patients with Multiple Sclerosis.

The purpose of this study is to test the hypothesis that standardized, structured resistance training programs will improve balance outcome measures in Multiple Sclerosis (MS) patients with differing levels of gait and balance problems. Secondary goals compare accuracy and precision of different balance measures in the MS population and evaluate the effect of resistance training on disease progression, fatigue and immuno-regulatory biomarkers.

For over 12 years, pharamacologic therapy has effectively decreased the number and severity of MS relapses. However, MS patients continue to experience disease progression, fatigue, muscle weakness and balance problems. Physical rehabilitation has shown positive effect in MS patients. Early studies did not evaluate resistance or strength training programs because of the perception that they exacerbate the fatigue associated with MS. These studies also did not evaluate traditional strength outcome measures to determine how best to monitor changes in balance and fatigue in this population. Current clinical measures are limited and reliability of these measures is unknown.

This unique collaborative study is being done in conjunction with physical therapy, a research grade gait lab and a private training gym. Forty five subjects are being stratified into 3 groups on the basis of disability: Group 1, no clinical evidence of mobility problems; Group 2, minimal mobility and balance problems and Group 3, moderate mobility and balance problems. Evaluation is at baseline, as well as 3 and 6 months after enrollment in a weight resistance program. The groups are evaluated separately for improvement in strength and balance and any correlation between any change in strength and balance. Secondary outcome measures include fatigue level, disease progression, general balance and circulating inflammatory biomarkers. Balance is measured by the current clinical tool, the Balance Master, and a biomechanics evaluation using a Vicon-Peak high speed system and Kistler force platform. Interim analysis is reviewed.