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Isokinetic protocol, with start (maximal flexion: 90°) (A) and final (maximal extension: 10°) (B) positions; Isometric protocol (70° position) (C).
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Background and objectives: Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods: 26 participants with MS were balanced according...
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... Regarding MS phenotype, the most common type was the mixed phenotype (n = 19) [19,21,31,35,39,42,51,52,59,61,63,64,66,67,[71][72][73][74]76], followed by the relapsing-remitting type in six studies [46,49,55,60,68,70]. Twenty-six studies [17, 20, 32-34, 36-38, 40, 41, 43-45, 47, 48, 50, 53, 54, 56-58, 62, 65, 69, 75, 77] did not report the MS phenotype. ...
... All intervention groups implemented one of the following types of exercise: aerobic exercise, resistance exercise, or multicomponent training. The most common intervention was multicomponent training (n = 41) [18-21, 31, 36-43, 45, 46, 48, 50-58, 60, 62-76], followed by aerobic exercise (n = 7) [17,32,34,47,53,59,74] and resistance exercise (n = 6) [33,35,44,49,61,77]. The total duration of the interventions ranged from 2 to 24 weeks, with each session lasting between 4 and 102.5 min. ...
... However, five studies [35,49,66,67,69] did not report the duration of each session. Weekly intervention minutes ranged from 35 to 420 min. ...
Objective
This systematic review and meta-analysis aimed to evaluate the effect of exercise on balance function in multiple sclerosis (MS) patients and identify the optimal exercise prescription for this population.
Methods
A comprehensive search was conducted across PubMed, Web of Science, EBSCO, Cochrane, and Scopus up to February 21, 2025. The data were pooled using weighted mean differences (WMD) and 95% confidence interval.
Results
Fifty-two studies fulfilled the inclusion criteria. Exercise significantly improved Berg balance scale (BBS; WMD, 4.03; p < 0.00001) and timed up and go test (TUG; WMD, −1.01; p < 0.00001) in MS patients. The subgroup analyses revealed that resistance exercise (WMD, 6.07; p = 0.004), interventions lasting ≥ 8 weeks (WMD, 4.24; p < 0.00001), ≥ 3 times per week (WMD, 4.57; p < 0.00001), ≥ 60 min per session (WMD, 4.36; p < 0.00001), ≥ 180 min per week (WMD, 4.41; p < 0.00001) were most effective in improving BBS. Greater improvements were observed in patients aged < 45 years (WMD, 4.57; p < 0.00001) and those with baseline EDSS > 3.5 (WMD, 3.97; p < 0.00001).
Conclusions
Exercise was found to improve balance in MS patients. Our results suggest that MS patients may benefit from engaging in exercise sessions at least three times per week, with each session lasting 60 min or more, for a minimum duration of 8 weeks. Achieving a weekly exercise goal of 180 min or more may further enhance balance function.
... These latter studies corroborate that there is a consistent, significant benefit of resistance training on muscle strength improvement in pwMS. Apart from one (Andreu-Caravaca et al., 2022b), all studies reported increased maximum voluntary isometric contractions (MVIC) of the lower limb muscles (Callesen et al., 2020;Gomez-Illan et al., 2020;Moghadasi et al., 2020;Correale et al., 2021;Keller et al., 2021;Andreu-Caravaca et al., 2022a). MVIC is a standard method to measure muscle strength and is predictive of mobility-related parameters (Valenzuela et al., 2020). ...
... MVIC is a standard method to measure muscle strength and is predictive of mobility-related parameters (Valenzuela et al., 2020). Resistance training is associated with improvements in the Timed-Up-and-Go (TUG) and 6-min walk test (6-MWT) (Callesen et al., 2020;Gomez-Illan et al., 2020;Keller et al., 2021;Andreu-Caravaca et al., 2022a;Andreu-Caravaca et al., 2022b;Andreu-Caravaca et al., 2023). Several studies report additional, beneficial effects of resistance exercise on general fatigue (Akbar et al., 2020;Callesen et al., 2020;Gomez-Illan et al., 2020;Englund et al., 2022). ...
... Resistance training is associated with improvements in the Timed-Up-and-Go (TUG) and 6-min walk test (6-MWT) (Callesen et al., 2020;Gomez-Illan et al., 2020;Keller et al., 2021;Andreu-Caravaca et al., 2022a;Andreu-Caravaca et al., 2022b;Andreu-Caravaca et al., 2023). Several studies report additional, beneficial effects of resistance exercise on general fatigue (Akbar et al., 2020;Callesen et al., 2020;Gomez-Illan et al., 2020;Englund et al., 2022). ...
Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammation and demyelination in the central nervous system (CNS) with subsequent axonal and neuronal degeneration. These changes are associated with a broad range of symptoms including skeletal muscle dysfunction. Importantly, musculoskeletal impairments manifest in various ways, compromise the quality of life and often precede the later development of mobility disability. As current standard disease modifying therapies for MS predominantly act on neuroinflammation, practitioners and patients face an unmet medical need for adjunct therapies specifically targeting skeletal muscle function. This review is intended to detail the nature of the skeletal muscle dysfunctions common in people with MS (pwMS), describe underlying intramuscular alterations and outline evidence-based therapeutic approaches. Particularly, we discuss the emerging role of aerobic and resistance exercise for reducing the perception of fatigue and increasing muscle strength in pwMS. By integrating the most recent literature, we conclude that both exercise interventions should ideally be implemented as early as possible as they can address MS-specific muscle impairments. Aerobic exercise is particularly beneficial for pwMS suffering from fatigue and metabolic impairments, while resistance training efficiently counters muscle weakness and improves the perception of fatigue. Thus, these lifestyle interventions or possible pharmacological mimetics have the potential for improving the general well-being and delaying the functional declines that are relevant to mobility.
... Contrary to these results, Häkkinen et al., (2022) investigated a group of healthy women for 10 weeks of resistance training followed by 5 weeks of DT and observed decreases in isometric strength −6.6 ± 3.6% (p < 0.01) [44]. Similarly, Gomez-Illan et al., (2020) investigated individuals with multiple sclerosis for 8 weeks in high-intensity resistance training, 90% 1RM, and reported losses in isometric strength after 10 weeks of DT [45]. ...
Spinal cord injury (SCI) is a condition that significantly affects the quality of life (QoL) of individuals, causing motor, physiological, social, and psychological impairments. Physical exercise plays a crucial role in maintaining the health and functional capacity of these individuals, helping to minimize the negative impacts of SCI. The aim of this study was to evaluate the effect of detraining (DT) (reduction or cessation of physical exercise) during the pandemic on five individuals with thoracic SCI. We assessed muscle strength using strength tests, functional capacity using a functional agility test, mental health using anxiety and depression inventories, and body composition using dual-energy X-ray absorptiometry (DEXA). The results after 33 months of DT showed significant losses in functional agility and MS, as well as a worsening in symptoms of anxiety and depression. It was observed that total body mass and fat mass (FM) exhibited varied behaviors among the individuals. Similarly, the results for lean body mass were heterogeneous, with one participant showing significant deterioration. It is concluded that DT caused by the pandemic worsened the physical and mental condition of individuals with SCI, highlighting the importance of continuous exercise for this population and underscoring the need for individual assessments to fully understand the impacts of DT.
... Regarding fatigue and its influence on the frailty of the population under consideration, previous studies have demonstrated the efficacy of resistance exercise as a mitigating factor for this effect [60]. Additionally, noteworthy is the impact that the combination of resistance training with motor control training can have on fatigue, leading to significant improvements in fatigue levels [61]. ...
Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45–65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.
... Irrespective of cause, PNP often results in considerable functional impairments, i.e., increased tendency to fall, dependency on walking aids, inability to ascend-descend stairs and difficulties in activities of daily living (Callaghan et al., 2015;Hoffman et al., 2015). Strength training has been shown to improve strength, gait and functional outcomes in healthy young and older adults (de Vos et al., 2005;Liu and Latham, 2009;Garber et al., 2011;Raymond et al., 2013;Borde et al., 2015;Hvid et al., 2016;Chen et al., 2021), patients with stroke (Hill et al., 2012) and patients with multiple sclerosis (Dalgas et al., 2009;Gomez-Illan et al., 2020). Since treatment only exists for very few percentages of the potential underlying causes (inflammatory) it is obvious to consider if strength training could be a potential treatment to counteract functional impairments and loss of physical capacity in patients with PNP. ...
Introduction: Polyneuropathy (PNP) is a chronic progressive disease that over time can lead to damage of sensory, motor and/or autonomic peripheral nerves. Symptoms vary from predominantly sensory to severe sensorimotor affection both proximally and distally. This can result in considerable functional impairments that affect activities of daily living. In other neurological patients, strength training has shown to improve strength and functional outcomes. Since medical treatment only exists for very few percentages of the underlying causes it is obvious to consider if strength training could be a potential treatment for functional impairments. To date little is known on the effect of strength training in patients with PNP.
Aim: The aim of this scoping review was to summarize research on strength training and outcomes on physical function in patients with PNP.
Methods: We systematically searched five data bases; Pubmed, Embase, Cinahl, Cochrane library and Web of science. Studies on strength training (load ≥70% of 1RM) in patients with PNP were included. The search was carried out in November 2022.
Results: 362 articles were screened by title and abstract, 101 articles were full text screened. Eight studies were included. Patients with Charcot-Marie-Tooth (CMT), chronic inflammatory polyneuropathy (CIDP) and diabetic polyneuropathy (DPN) were represented in the studies (five RCTs, two case-series, and one cross-over trial). The methodological quality ranged from fair-poor in seven studies, one study reached good quality. Results from the studies indicated that strength training in CMT, CIDP and DPN may improve strength. However, various outcomes were used to evaluate strength training, so direct comparisons were difficult.
Discussion: In this scoping review we summarized research on strength training and outcomes evaluated in interventions in patients with PNP. Eight studies were included, they indicated that strength training may be beneficial for patients with PNP. However, due to low methodological strength of most studies a recommendation for patients with PNP cannot be made. Thus, the low number of studies with relatively low quality, where various functional outcomes were used, underscores the importance of future studies to evaluate the effect of strength training on relevant functional outcomes and strength in patients with PNP.
... However, physical exercise is currently considered safe for pwMS [9] and is a fundamental part of its nonpharmacological treatment. Although exercise does not modify the clinical course of the disease, it can help mitigate some of its symptoms [10,11]. ...
Background and Objectives: Multiple sclerosis (MS) is a disease that manifests with varied neurological symptoms, including muscle weakness, especially in the lower extremities. Strength exercises play an important role in the rehabilitation and functional maintenance of these patients. The individualized prescription of strength exercises is recommended to be based on the maximum force determined by the one-repetition maximum (1RM), although to save time and because it requires less equipment, it is often determined by the maximum voluntary isometric contraction (MVIC). The purpose of this work was to study, in patients with MS (pwMS), the reliability of MVIC and the correlation between the MVIC and 1RM of the knee extensors and to predict the MVIC-based 1RM. Materials and Methods: A total of 328 pwMS participated. The study of the reliability of MVIC included all pwMS, for which MVIC was determined twice in one session. Their 1RM was also evaluated. The sample was randomized by MS type, sex, and neurological disability score into a training group and a testing group for the analysis of the correlation and prediction of MVIC-based 1RM. Results: MVIC repeatability (ICC, 2.1 = 0.973) was determined, along with a minimum detectable change of 13.2 kg. The correlation between MVIC and 1RM was R² = 0.804, with a standard error estimate of 12.2 kg. The absolute percentage error of 1RM prediction based on MVIC in the test group was 12.7%, independent of MS type and with no correlation with neurological disability score. Conclusions: In patients with MS, MVIC presents very good intrasubject repeatability, and the difference between two measurements of the same subject must differ by 17% to be considered a true change in MVIC. There is a high correlation between MVIC and 1RM, which allows estimation of 1RM once MVIC is known, with an estimation error of about 12%, regardless of sex or type of MS, and regardless of the degree of neurological disability.
Zusammenfassung
Die Fatigue ist eines der häufigsten Symptome der Multiplen Sklerose (MS). Gekennzeichnet durch unverhältnismäßige Erschöpfung nach physischer oder kognitiver Belastung führt sie zu massiven Beeinträchtigungen in sämtlichen Lebensbereichen. Die Therapie der MS-assoziierten Fatigue stützt sich vor allem auf nicht-medikamentöse Maßnahmen. Sportliches Training kann sich positiv auf verschiedene Symptome der MS auswirken. Hinsichtlich der Fatigue wird empfohlen, Betroffene über die Effekte körperlichen Trainings aufzuklären. Bislang bestehen allerdings nur wenige Erkenntnisse über eine optimale Trainingsgestaltung.
Ziel dieser Arbeit ist es, anhand aktueller Forschungserkenntnisse den Einfluss sportlichen Trainings auf die Fatigue bei Patient*innen mit MS zu analysieren und anhand dessen mögliche Trainingsempfehlungen abzuleiten. Dafür wurden die Fachdatenbanken PubMed, Cochrane Library, PEDro und BISp Surf systematisch nach randomisierten kontrollierten Studien (RCTs), welche die Auswirkungen sportlichen Trainings auf die Fatigue bei Patient*innen mit MS analysierten, durchsucht. Eine Bewertung der methodischen Qualität der Arbeiten erfolgte anhand der PEDro-Skala. Die Effektgröße wurde mittels Cohen's d kalkuliert. Neun RCTs (n=564) wurden eingeschlossen. Die durchschnittliche methodische Qualität lag mit 6,9 Punkten auf der PEDro-Skala bei „gut“.
Die Ergebnisse der Studien zeigten, dass sportliches Training die Fatigue bei Patient*innen mit MS reduzieren kann. Das Ausmaß der Linderung fällt je nach Art der Belastung allerdings unterschiedlich aus. Krafttrainingsformen zeigten die höchste Effektivität. Um die langfristige Aufrechterhaltung der positiven Effekte zu gewährleisten, ist ein kontinuierliches Training erforderlich.
Die Aussagekraft der Ergebnisse ist durch die hohe Heterogenität der Arbeiten sowie die begrenzte Vergleichbarkeit der verwendeten Assessments limitiert. Aufgrund unzureichender Daten über die optimale Gestaltung von Belastungsparametern und individuelle Einflussfaktoren ist aktuell eine spezifizierte Trainingsempfehlung nur eingeschränkt möglich und bedarf weiterer Forschung.
Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.70 p < 0.0001). Interventions lasting 2–6 weeks and 16–24 weeks demonstrated the larger effects on fatigue reductions (SMD=0.86, p<0.00001; SMD=1.82, p=0.01, respectively). Interventions with 30-36 sessions showed a large effect on fatigue reduction (SMD = 0.94, p < 0.04). Resistance, aerobic cycling and combination training interventions had a large to moderate effect (SMD= 0.93, p 0.03; SMD = 0.66, p= 0.0005; SMD = 0.76, p = <0.00001, respectively). Small long-term effects were found during follow-up(SMD=0.38, p= 0.002). Notably, both short (2-6 weeks) and longer-term (16-24 weeks) interventions were effective in reducing fatigue. . Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.
Multiple sclerosis (MS) is characterized by a complex aetiology that is mirrored by the perplexing and inconsistent treatment responses observed across different patients. Although epigenetic research has garnered rightful interest in its efforts towards demystifying and understanding aberrant responses to treatment, the interim undoubtedly requires alternative non-pharmacological approaches towards attaining more effective management strategies. Of particular interest in this review is resistance training (RT) as a non-pharmacological exercise-based interventional strategy and its potential role as a disease-modifying tool. RT has been reported across literature to positively influence numerous aspects in the quality of life (QoL) and functional capacity of MS patients, and one of the attributes of these benefits may be a shift in the immune system of these individuals. RT has also been proven to affect different immune system key players associated with MS pathology. Ultimately, this brief review aims to provide a potential yet crucial link between RT, alterations in the expression profile of the immune system, and finally an imminent improvement in the overall well-being and QoL of MS patients, suggesting that utilizing RT as an interventional exercise modality may be an effective strategy that would aid in managing such a complex and debilitating disease.
