Efficacy of Progressive Power Training in Enhancing Neuromuscular and Physical Function in Older Patients with Multiple Sclerosis: Preliminary Results from the PoTOMS Trial

Abstract

outcomes were Peak Power Output (PPO) of a graded exercise test (Watts), 10-Meter-Walk-Test (10MWT), Two-Minute-Walk-Test (2MWT), Six-Minute-Walk-Test (6MWT), Timed-Up-and-Go-Test (TUG) and Patient-Reported-Outcomes-Measurement-Information-System-Questionnaire (PROMIS) at baseline (T 0) and discharge after three weeks (T 1). Results: The study protocol is feasible (80% of participants completed 79% of planned series within planned sessions) and 88% of the data collection could be successfully achieved. Results of the interviews show high acceptability and motivation. The descriptive analysis of the secondary outcomes showed improvements of the mean values of all outcomes: Increase of 6.07% in Introduction: Fatigue is a complex, debilitating, and highly frequent symptom in people with multiple sclerosis (PWMS). The modified fatigue impact scale (MFIS) estimates fatigue and subdivides it into a physical (MFISphysical) and a cognitive component (MFIScognitive). Both aerobic training (AT) and resistance training (RT) reduce fatigue. However, the effects of the two modalities have not been directly compared. Objective: To perform a head-to-head comparison of the effectiveness of AT and RT on fatigue measured by MFIS in PWMS. Materials & Methods: A total of 150 PWMS (45±8 years, EDSS score 2.7 ± 1.6, 73 % women) were enrolled and randomized in a 2:2:1 ratio into either 12 weeks of AT (n=60, 30 sessions), RT (n=60, 30 sessions), or control ('usual care', n=30). Pre and post intervention assessments of isometric knee extensor muscle strength (MVC; isokinetic dynamometry), aerobic capacity (VO2peak; incremental exercise test), and fatigue (MFIS) were performed. Results: Aerobic capacity increased in AT vs. control by 5.6 [2.0;9.2] mL O 2 /min/kg (mean [95CI]) and in AT vs. RT by 3.6 [0.8;6.6], but not in RT vs. control (1.9 [-1.6;5.5]). Knee extensor muscle strength increased in RT vs. control by 1.03 [0.25;1.80] Nm/kg and in RT vs. AT 0.68 [0.27;1.08], but not in AT vs. control (0.35 [-0.42;1.13]). MFIS total seemed not to be reduced in neither RT vs. control-5.6 [-14.9; 3.7] points nor in AT vs. RT