Blood-Flow Restriction Training for a Person With Primary Progressive Multiple Sclerosis: A Case Report.

OBJECTIVE: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. METHODS: The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale, Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 lower extremity strength tests. RESULTS: The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). Fatigue Severity Scale was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the Fatigue Severity Scale score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. CONCLUSION: The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. IMPACT: Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS. LAY SUMMARY: Blood flow restriction, which has been used to help improve strength in healthy adults and in some people with chronic disease, applies pressure around the arm or leg to limit the flow of blood to that body part during exercise, helping to reduce fatigue. Blood flow restriction coupled with low-intensity strengthening exercises can be used for a person with MS.

Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course.

OBJECTIVES: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion-based recommendations for promoting exercise and lifestyle physical activity across disability levels. METHODS: The National MS Society ("Society") convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0-9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. RECOMMENDATIONS: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers:Healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS.Early evaluation by a physical or occupational therapist or exercise or sport scientist, experienced in MS (hereafter referred to as "specialists"), is recommended to establish an individualized exercise and/or lifestyle physical activity plan.Taking into account comorbidities and symptom fluctuations, healthcare providers should encourage ⩾150 min/week of exercise and/or ⩾150 min/week of lifestyle physical activity.Progress toward these targets should be gradual, based on the person's abilities, preferences, and safety.If disability increases and exercise/physical activity becomes more challenging, referrals to specialists are essential to ensure safe and appropriate prescriptions.When physical mobility is very limited, exercise should be facilitated by a trained assistant.

The effect of fatigue on balance performance in Parkinson's disease.

INTRODUCTION: Balance loss and falls are a common and multifactorial finding in persons with Parkinson's Disease (pwPD). Objective fatigability is thought to contribute to falls in other neurologic conditions, but its impact on balance in pwPD is not known. The two-fold purpose of this study was to: 1) establish that a 6-minute walk (6MWFast) is a stimulus to subjective fatigue for pwPD; and, 2) determine if the Mini Balance Evaluation Systems Test (MBT) is sensitive to change that was induced by a fatiguing condition. METHODS: Using a randomized crossover design, 19 research participants performed a Mini Balance Evaluation Systems Test (MBT) before and after either a 'fast' 6-minute walk (6MWFast) to induce fatigue or a 6-minute rest. RESULTS: VASF scores increased after the 6MWFast. Total MBT scores in research participants with Modified Hoehn and Yahr (H&Y) scores of 3.0 and above differed significantly before and after the 'fast' 6-minute walk (p = .007, n = 9) while participants with H&Y scores of 1.5 to 2.5 (p = .084, n = 10) did not, suggesting that more disabled pwPD were more likely to experience fatigability that interfered with balance. CONCLUSIONS: A 6MWFast is a sufficient stimulus to induce subjective fatigue in pwPD and to decrease total MBT scores for more disabled pwPD. Balance evaluations should occur when pwPD are in fatigued and unfatigued states to determine whether fatigue has an impact on balance performance.

The Effect of Maximal Strength Training on Strength, Walking, and Balance in People with Multiple Sclerosis: A Pilot Study.

There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (t(6) = -6.032, P = 0.001), left leg 1RM (t(6) = -5.388, P = 0.002), 6MWT distance (t(6) = -2.572, P = 0.042), and BBS score (Z = -2.371, P = 0.018) after the MST intervention. There was no significant change in FSS scores (F(1, 3.312) = 2.411, P = 0.092). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS.

Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis: A Randomized Crossover Trial.

BACKGROUND AND PURPOSE: Fatigue is a common, disabling symptom experienced by persons with multiple sclerosis (MS). Evidence shows that intermittent exercise is associated in improved performance and negligible fatigue. The purpose of this study was to examine whether subjects with MS walk greater distances with less fatigue under intermittent (INT) or continuous (CONT) walking condition. METHODS: Twenty-seven subjects with MS (median Extended Disability Severity Scale 3.5, interquartile range 1.6) walked in the CONT (ie, 6 uninterrupted minutes) and INT (ie, three 2-minute walking bouts) conditions in a randomized crossover. Distance was measured for the entire 6-minute walking period and each 2-minute increment. Fatigue was measured as the difference in a visual analog scale of fatigue (ΔVAS-F) immediately preceding and following each trial. RESULTS: Participants walked greater distances in the INT condition compared to the CONT condition (P = 0.005). There was a significant interaction of walking condition and time (P < 0.001), indicating that the distances walked in the INT condition changed across time. ΔVAS-F was significantly lower in the INT condition than in the CONT condition (P = 0.036). DISCUSSION AND CONCLUSION: Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent. Further study to determine the benefits of a walking exercise program using intermittent walking is recommended.Video Abstract available for additional insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A103).

Effect of a Single Bout of Intermittent versus Continuous Walking on Perceptions of Fatigue in People with Multiple Sclerosis.

Fatigue may limit the ability of people with multiple sclerosis (MS) to participate in walking exercises, which could ultimately reduce their benefit from physical therapy. An exercise program that minimizes the fatigue experienced by people with MS during exercise may lead to an increase in the amount of exercise being performed. The purpose of this study was to determine whether subjective feelings of fatigue differ in people with MS depending on whether they exercised intermittently or continuously. Using a within-subjects, counterbalanced crossover design, a sample of 30 individuals with MS performed 6 minutes of continuous and 6 minutes of intermittent walking 1 week apart. Fatigue was measured on the Visual Analogue Scale of Fatigue (VASF) and recorded before and after the walking conditions. A 2 × 2 repeated-measures analysis of variance was used to assess the potential effects of intermittent versus continuous walking on self-reported fatigue. A significant interaction revealed that pre-post mean self-ratings of fatigue on the VASF increased less in the intermittent condition (from 37.93 mm to 44.83 mm; difference = 6.90 mm) compared with the continuous condition (from 34.33 mm to 54.43 mm: difference = 20.10 mm) (P < .001), suggesting that patients experienced less fatigue in the intermittent condition despite walking an equivalent total duration. The interaction effect was not influenced by age, gender, disease severity or duration, use of antispasticity medication, use of assistive devices, or mood. The results suggest that people with MS may be more tolerant of, and able to perform, greater amounts of exercise if they exercise intermittently.