Resistance training improves strength and functional capacity in persons with multiple sclerosis

Abstract

The purpose of this study was to evaluate the effect of an eight-week progressive resistance training programme on lower extremity strength, ambulatory function, fatigue and self-reported disability in multiple sclerosis (MS) patients (mean disability score 3.79-0.8). Eight MS subjects volunteered for twice weekly training sessions. During the first two weeks, subjects completed one set of 8 -10 reps at 50% of maximal voluntary contraction (MVC) of knee flexion, knee extension and plantarflexion exercises. In subsequent sessions, the subjects completed one set of 10 -15 repetitions at 70% of MVC. The resistance was increased by 2 -5% when subjects completed 15 repetitions in consecutive sessions. Isometric strength of the quadriceps, hamstring, plantarflexor and dorsiflexor muscle groups was assessed before and after the training programme using an isokinetic dynamometer. Magnetic resonance images of the thigh were acquired before and after the exercise programme as were walking speed (25-ft), number of steps in 3 min, and self-reported fatigue and disability. Knee extension (7.4%), plantarflexion (52%) and stepping performance (8.7%) increased significantly (PB-0.05). Self-reported fatigue decreased (PB-0.05) and disability tended to decrease (P -0.07) following the training programme. MS patients are capable of making positive adaptations to resistance training that are associated with improved ambulation and decreased fatigue.

Keywords

disability exercise fatigue fitness multiple sclerosis skeletal muscle strength training

Get full access to this article

View all access options for this article.

References

Wolinsky JS. The diagnosis of primary progressive multiple sclerosis . J Neurol Sci 2003; 206: 145-152 .

Frohman EM. Multiple sclerosis . Med Clin North Am 2003; 87: 867-897, viii-ix .

Noseworthy JH , Lucchinetti C , Rodriguez M , Weinshenker BG. Multiple sclerosis . N Engl J Med 2000; 343: 938-952 .

Armstrong LE , Winant DM , Swasey PR , Seidle ME , Carter AL , Gehlsen G. Using isokinetic dynamometry to test ambulatory patients with multiple sclerosis . Phys Ther 1983; 63: 1274-1279 .

Ponichtera-Mulcare JA , Matthews T , Barret PJ , Glaser RM. Change in aerobic fitness of patients with multiple sclerosis during a 6-month training program . Sports Med Train Rehabil 1997; 7: 265-272 .

Petajan JH , Gappmaier E , White AT , Spencer MK , Mino L , Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis . Ann Neurol 1996; 39: 432-441 .

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 .

Gehlsen GM , Grigsby SA , Winant DM. Effects of an aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis . Phys Ther 1984; 64: 653-657 .

Scheinberg LC , Feldman FM , Ratzker EA. Self-assessment of neurological impairment in multiple sclerosis . Neurology 1986; 36: 284-284 .

10.

ACSM . ACSM’s guidelines for exercise testing and prescription, sixth edition. Philadelphia, PA: Lippincott Williams & Wilkins , 2000.

11.

Phillips WT , Ziuraitis JR. Energy cost of the ACSM single-set resistance training protocol . J Strength Cond Res 2003; 17: 350-355 .

12.

Stackhouse SK , Stevens JE , Lee SC , Pearce KM , Snyder-Mackler L , Binder-Macleod SA. Maximum voluntary activation in nonfatigued and fatigued muscle of young and elderly individuals . Phys Ther 2001; 81: 1102-1109 .

13.

Kent-Braun JA , Le Blanc R. Quantitation of central activation failure during maximal voluntary contractions in humans . Muscle Nerve 1996; 19: 861-869 .

14.

Elliott MA , Walter GA , Gulish H , Sadi AS , Lawson DD , Jaffe W , et al. Volumetric measurement of human calf muscle from magnetic resonance imaging . Magma 1997; 5: 93-98 .

15.

Clarke LP , Velthuizen RP , Camacho MA , Heine JJ , Vaidya-nathan M , Hall LO et al. MRI segmentation: methods and applications . Magn Reson Imaging 1995; 13: 343-368 .

16.

White LJ , Robergs RA , Sibbitt WL Jr , Ferguson MA , McCoy S , Brooks WM. Effects of intermittent cycle exercise on intramyocellular lipid use and recovery . Lipids 2003; 38: 9-13 .

17.

Nygren AT , Karlsson M , Norman B , Kaijser L. Effect of glycogen loading on skeletal muscle cross-sectional area and T2 relaxation time . Acta Physiol Scand 2001; 173: 385-390 .

18.

Jackson AS , Pollock ML. Generalized equations for predicting body density of men . Br J Nutr 1978; 40: 497-504 .

19.

Brozek J , Grande F , Anderson JT , Keys A. Densitometric analysis of body composition: revision of some quantitative assumptions . Ann N Y Acad Sci 1963; 110: 113-140 .

20.

Flachenecker P , Kumpfel T , Kallmann B , Gottschalk M , Grauer O , Rieckmann P , et al. Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters . Mult Scler 2002; 8: 523-526 .

21.

Trappe TA , Lindquist DM , Carrithers JA. Muscle-specific atrophy of the quadriceps femoris with aging . J Appl Physiol 2001; 90: 2070-2074 .

22.

Gillson G , Wright JV , DeLack E , Ballasiotes G. Transdermal histamine in multiple sclerosis, part two: a proposed theoretical basis for its use . Altern Med Rev 2000; 5: 224-248 .

23.

McCartney N , Moroz D , Garner SH , McComas AJ. The effects of strength training in patients with selected neuromuscular disorders . Med Sci Sports Exerc 1988; 20: 362-368 .

24.

Spector SA , Gordon PL , Feuerstein IM , Sivakumar K , Hurley BF , Dalakas MC. Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy . Muscle Nerve 1996; 19: 1282-1290 .

25.

Hakkinen A , Sokka T , Kotaniemi A , Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis . Arthritis Rheum 2001; 44: 515-522 .

26.

Beelen A , Nollet F , de Visser M , de Jong BA , Lankhorst GJ , Sargeant AJ. Quadriceps muscle strength and voluntary activation after polio . Muscle Nerve 2003; 28: 218-226 .

27.

Fisk JD , Pontefract A , Ritvo PG , Archibald CJ , Murray TJ. The impact of fatigue on patients with multiple sclerosis . Can J Neurol Sci 1994; 21: 9-14 .

28.

Bergamaschi R , Romani A , Versino M , Poli R , Cosi V. Clinical aspects of fatigue in multiple sclerosis . Funct Neurol 1997; 12: 247-251 .

29.

Sartorio A , Fontana P , Trecate L , Lafortuna CL. Short-term changes of fatigability and muscle performance in severe obese patients after an integrated body mass reduction program . Diabetes Nutr Metab 2003; 16: 88-93 .

30.

Yates HA , Vardy TC , Kuchera ML , Ripley BD , Johnson JC. Effects of osteopathic manipulative treatment and concentric and eccentric maximal-effort exercise on women with multiple sclerosis: a pilot study . J Am Osteopath Assoc 2002; 102: 267-275 .

31.

Kaufman M , Moyer D , Norton J. The significant change for the timed 25-foot walk in the multiple sclerosis functional composite . Mult Scler 2000; 6: 286-290 .

32.

Kannus P , Jarvinen M. Long-term prognosis of conservatively treated acute knee ligament injuries in competitive and spare time sportsmen . Int J Sports Med 1987; 8: 348-351 .

33.

Koutedakis Y , Frischknecht R , Murthy M. Knee flexion to extension peak torque ratios and low-back injuries in highly active individuals . Int J Sports Med 1997; 18: 290-295 .

34.

Hakkinen A , Sokka T , Kotaniemi A , Kautiainen H , Jappinen I , Laitinen L , et al. Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density . J Rheumatol 1999; 26: 1257-1263 .

35.

Poser S , Kurtzke JF. Epidemiology of MS . Neurology 1991; 41: 157-158 .

36.

Sutherland G , Andersen MB. Exercise and multiple sclerosis: physiological, psychological, and quality of life issues . J Sports Med Phys Fitness 2001; 41: 421-432 .