Exercise therapy in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions
Multiple sclerosis (MS) is a chronic, neurological disorder affecting 1 in 1,000 people in the United States the most common non-traumatic cause of neurological disability in young adults (Freeman, 2001). The disease is characterized by inflammation, demyelination and neurodegeneration in the central nervous system (CNS) and this damage results in functional disorders and symptomatic experiences. Unfortunately, these limitations and symptoms increase as neurological disabilities increase.
There is evidence for the benefits of body training in persons with multiple sclerosis (MS). However, these benefits have been found especially in subjects with mild to moderate disability (i.e. Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than in persons with significant mobility impairments. Furthermore, the approaches to conduct training that have been effective in people with mild MS disabilities may not be physically accessible to persons with mobility impairments. Therefore, there is a demand for an evidence base for the benefits of physically accessible exercise methods for managing disabilities in people with MS with mobility problems.
A systematic review of the current literature regarding body training in persons with multiple sclerosis (MS) with a severe mobility disability was performed. Four electronic databases (PubMed, EMBASE, OvidMEDLINE and PsychINFO) were searched for relevant articles published until October 2016. The assessment focused on English language studies that examined the effect of physical education in people with MS with severe mobility disabilities, characterized as the need for help with ambulation or EDSS score ≥ 6.0. The inclusion criteria related to full-text articles that: (i) included participants with a diagnosis of MS; (ii) including primary participants with a screened EDS score ≥ 6.0 and / or the definitively described disability corresponding to this level of neurological damage; and (iii) implement a prospective, structured effort intervention. Data were analyzed using a descriptive approach and summarized by exercise modality (conventional or adjusted body training) and by outcome (disability, physical fitness, physical function and symptoms and participation).
Five studies investigated conventional physical exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities, including training of bodyweight training (BWSTT), total body recumbent stepper training (TBRST) and electrostimulation cycling (ESAC). Relation omomobility, fatigue, and quality of life (QOL) were the most commonly reported. Two of the five conventional resistance training studies indicated that there were significant improvements in physical fitness, physical function and / or symptomatic and participatory outcomes. Nine of the 13 studies on adapted movement training reported significant improvements in disability, physical fitness, physical function and / or symptomatic and participatory outcomes.
There is limited but promising evidence for the benefits of exercise therapie in people with MS with a severe mobility disability. Given the lack of effective therapeutic strategies for managing long-term accumulation of disabilities, exercise therapy can be considered an alternative approach. In general there can be advantages of conventional resistance training on muscle mass, balance, fatigue and QOL. There are potential benefits of customized body training on disability, physical fitness, physical function, fatigue and QOL, and the evidence was most consistent for BWSTT.
Physical Therapy Science