Is it feasible to exercise severely disabled patients with multiple sclerosis?

Abstract

Background: Research on the effects of exercise therapy in severely disabled (EDSS >6.0) patients with progressive multiple sclerosis (PMS) is deficient. Objective: To evaluate whether upper body endurance training (ET) is 1) safe and tolerable and 2) can be executed at a sufficient volume and intensity to expectedly induce cardio-vascular adaptations over time. Methods: Eleven PMS patients (6.5≤EDSS≤8.0) were randomized to either a control group (n=5,4F/1M, 55.2±8.2y,169.0±10.3cm,84.5±20.5kg,3SP/2PP, EDSS:7.3±0.6) or to an intervention group (n=6,4F/2M, 62.0±5.8y,172.3±8.7cm, 71.9±6.3kg, 5SP/1PP,EDSS:7.0±0.4). Both groups received a four week inpatient programme with individualized MS rehabilitation and within same period the intervention group completed 10 sessions of upper body ET (six 3 minute intervals at a heart rate corresponding to 65-75% of VO2-peak). All ET sessions were performed using fitness equipment designed for persons with impaired leg function. Primary outcome measures were tolerance to ET and training quality. Before and after the four week intervention period all patients completed VO2-peak testing (incremental arm exercise test performed on a Monark Ergomedic 834E bicycle ergometer), tests of physical function (9 hole peg test, hand grip strength, Box and Block test and 6 minute wheelchair test) and fulfilled questionnaires on depression, disease impact and fatigue (MDI, MSIS-29, FSMC). Results: One patient from the EXE group was excluded from the analysis, because the patient had to be hospitalized during the intervention, giving a drop-out rate of 1/6~17%. No adverse events were recorded. Participants in the EXE group completed on average 9.3±0.8 sessions of the planned 10 sessions (~96.0±5%). An average heart rate of 93.9±9.3beats*min-1 were sustained during the ET sessions corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. An average Borg score of 14.6±1.7 were registered during the ET sessions. Four participants in the EXE group showed improved VO2-max, while none of the participants in the CON group showed improvements. Comparison of the changes (EXE: 308±312ml O2/min vs. CON: 2±30ml O2/min) in VO2-max showed a tendency towards a groups difference (p=0.06). When changes in all other measures of physical function and questionnaires were compared no significant group differences were found. Conclusion: ET is feasible and safe in severely disabled patients with MS and ET can probably be performed at sufficient intensity to induce increases in VO2-max.