Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis

Summary

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis. Isolated muscle strengthening is a useful method to target specific weaknesses. This protocol describes a progressive resistance-training program using exercise bands to increase hip muscle strength.

Abstract

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can improve strength in individuals with MS, however; it remains unclear the duration of RST that is needed to make strength gains and how to adapt hip strengthening exercises for individuals of varying strength using only resistance bands. This paper describes the methodology to set up and implement an adapted resistance strength training program, using resistance bands, for individuals with MS. Directions for pre- and post-strength tests to evaluate efficacy of the strength-training program are included. Safety features and detailed instructions outline the weekly program content and progression. Current evidence is presented showing that significant strength gains can be made within 8 weeks of starting a RST program. Evidence is also presented showing that resistance strength training can be successfully adapted for individuals with MS of varying strength with little equipment.

Introduction

In MS, compromised neural function typically leads to motor dysfunction, resulting in weakness. It is known that muscle weakness contributes to reduced daily activity in people with MS and inactivity further compromises functional ability^1;2. Our lab has shown that weak hip flexor muscles in individuals with MS affect walking speed³, particularly in the weakest individuals⁴. The significance of weak proximal hip muscles to walking has been shown in MS as well as in other neurodegenerative conditions^4;5. This vicious cycle contributes to increased disability and reduced quality of life^6;7. Regular exercise can impr....

Protocol

NOTE: The institutional review boards at Johns Hopkins University School of Medicine and Kennedy Krieger Institute approved this work. All participants provided written consent before participating.

1. Training

1. Ensure that the instructor is adequately trained in the use of hand held dynamometry and specifics of exercise details prior to initiating this protocol.
   NOTE: Test a mix of individuals with varying strength levels to assure competence and consistency following the specifics of testing and exercise details as described in in Sections 6 and 8.2.

2. Select Location and Equipment Requi....

Results

We show results from 26 individuals with MS who participated in a 12-week lower extremity progressive, resistance training (PRT) at our facility. Our participants have varying levels of disability with a median EDSS of 4.0 (range: 1-6.5), are on average 50.0 (11.3) years of age (youngest is 23 years, oldest is 64 years), 17 are female, and have an average symptom duration of 12.5 (8.7) years.

Figure 1 shows that hip strength improved following 12-weeks of training (p<0.005 .......

Discussion

The protocol describes a progressive resistance training program using isolated muscle strengthening with resistance bands for people with MS. This protocol has unique features for individuals with degenerative conditions whose strength limitations may be compromising their ability to ambulate and maintain their quality of life. The focus is on improving proximal muscle strength in the lower extremities that is important for walking speed in MS^21;4. One advantage of this protocol is that it emphasizes isolated.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
microFET2	Hoggan Scientific, LLC		Digital hand held muscle tester
REP Bands (all colors)	Power Systems	5600-011	Resistance bands for the exercise program
TheraBand Latex-Free Exercise Bands (all colors)	TheraBand	11726-11730	Resistance bands for the exercise program
8'' Cable Ties	Lowes Home Improvement	76329	Tied into the resistance bands to provide places for the carabiner to clip onto
Door Anchor	GoFit		Anchors the REP bands to doors
Hollow-Braid Poly Rope	Home Depot	140538	Anchors REP bands to table legs/other fixtures
Zinc-Plated Steel Hang All	Home Depot	550768	Thigh straps for the hip exercises
Neoprene Ankle Strap	TKO	106 BK	Ankle strap for leg exercises
Positron Carabiner	Black Diamond	BD2102610000ALL1	Carabiners to link ankle/thigh strap to REP bands
Fitness Gear 3mm Mat	Dick's Sporting Goods	41857546	Yoga mat for exercises on the ground
1/2 inch, 2 by 2 Exercise Tiles	FoamTiles		Gym matting for exercies on the ground
Spirit LT Portable Massage Table	EarthLite		Table for hip extension and other exercises that required a raised platform
Performa Treatment Table	Sammons Preston	553736	Heavy treatment table for testing/anchoring REP bands
STATA SE 11	STATA		Software for statistical analysis
STATISTICA	Dell Software		Software for statistical analysis