Appendix 2
Reference summary tables
Title
Resistance training
Art
Author
Study design
36
Gutierrez
et al 2005
Resistance training
improves gait
kinematics
Repeated
measures design
Taylor et
al 2006
Progressive
resistance exercise
for people with MS
Single group pre
post clinical
design
White et
al 2004
Resistance training
13 week
improves strength & experimental
functional capacity
in persons with MS
Participan
ts
8
EDSS
2.5-5.5
RRMS
but active
Intervention
Limitations
Outcome
measures
MFIS self
assessed
EDSS
LL strength,
3 min
stepping,
gait
kinematics
8 wks 2 x
weekly
progressive
resistance
training (PRE)
No control
Small nos
Muscle measures
different to training
9 Mild to
mod
disability
(8
completed
1
withdrew
due to
work )
Ind mob
200 m
10 wks PRE
programme 3
UL & 3 LL exs
2 x week gym
based after 4
wk
familiarisation
baseline period
1 instructor to 3
pts
Small group, no
control
Was change in leg
strength during
baseline (small) so is
all change
attributable?
Muscle
strength &
endurance,
10m walk
speed, 2
min walk
test, timed
stair test at
2,4 & 14
wks
MSIS-29
8 (1
female)
8 wk
programme
after 3 wks
screening,
orientation etc
2 x weekly 30
mins
Progressive
trng as ACSM
Small group, no
control
Convenience sample
Gender imbalance
MFIS,
EDSS,
3 min step
test,
25 ft walk,
% body fat,
muscle
testing
EDSS 1-5
Results
No exacerbations 100%
adherence. Mild muscle
soreness in 3 pts. More normal
gait pattern (less time in
double support, inc stride
length etc)
Sig change in MFIS (32-26)
3 min stepping inc by 8.7%
Some increased (inc) strength
Good adherence 94.3%
Minor problems of muscle
soreness & back ache no
negative (neg) effects
32.6% increase in leg
strength,14.4 % in arm
strength, 170.9% inc in leg
endurance, (no sig change
arm) Sig improvement in walk
speed 6.1% MSIS-29 mean
change phys func 6.4 95%, no
change psycholog aspect.
Trend to increased distance
over 2 mins
100% adherence. Increased
volume & cross sectional area
quads & hamstrings. No
change walk test, steps in 3
mins sig improved (8.7%).
Knee ext & plantarflexion sig
inc strength, knee flex inc but
not significant.MFIS sig
improved(24%) No change
body fat.
EDSS 3.7-3.2
De Bolt &
Mc
Cubbin
2004
Effects of home
based resistance
exercise on balance,
power & mobility in
adults with MS
Pre test, post test
experimental
group design
Pts stratified (age
& EDSS)
randomised to ex
(19) & control
(17) groups
Scored 11 (50%)
in Cochrane
review
6/10 PEDro
37 pts 29
female, 8
male ind
mob 20 m
EDSS 16.5
6 session
instructional
phase then 8
wks home
based 3 x
weekly LL
resistance
training 25-30
mins + warm
up & stretch
Exs tailiored &
functional eg
lunges, step ups
Convenience
sample, relatively
small
No functional
measures used yet
exs were functional
Good detail of exs
given – used
weighted vests & of
progression of
weight & no of reps
Up & go
test, Leg
extensor
power rig
Accu Sway
force
platform
Modified
Ashworth
scale
No negative effects
Sig increase in leg extensor
power. (37.4%) Control group
6.7% (stronger at start|)
No change in balance
Up & go time improved by
12.7% but not significant
Adherence good (self
reported) 95% of 24 sessions
completed
Aerobic studies
Art Author
Title
Mostert & Effect of short term
Kesselring exercise training on
2002
aerobic fitness, fatigue,
health perception &
activity level of
subjects with MS
Van den
Berg et al
2006
Treadmill training for
individuals with MS: a
pilot randomised trial
Study
design
RCT
PEDRO
3/10
Cochrane
score 17
(64%)
Participants Intervention
Limitations
26 pwMS
EDSS 1 –
6.5 (2 inc
spasticity
after
testing)
26 healthy
controls
4 wks 5 x 30 min
sessions per week
bicycle ex with
tailored intensity
Statistical
analyses
restricted to
within group
comparison
Outcome
measures
Graded ex
test, lung
function
SF36, FSS,
BAECKE
activity
questionnaire
4 wks aerobic
treadmill training
supervised
Small sample,
short
intervention,
FSS, RMI,
GNDS, 10 m
walk, 2 min
Prospective 16
single centre ind mob.
Randomised Mild / mod
Results
Low compliance (65%)
No change max aerobic
capacity or lung function in
any group
In exercise group:
Improved aerobic threshold
Improved health perception
Increased activity levels
Tendency to less fatigue
No sig change in fatigue
Sig increase in walking
speed & non sig increase in
Crossover
Trial
Blinded
assessors
disability
3 x weekly up to
30 mins at 55-85%
of age predicted
max heart rate
4
EDSS 77.5
Av 40 sessions
over several mths
6/10 PEDro
7
change in
weather (inc
heat) may have
affected results
Convenience
sample
Giesser et
al 2007
Locomotor training
using body weight
support on a treadmill
improves mobility in
persons with MS: a
pilot study
Kileff &
Ashburn
2005
A pilot study of the
effect of aerobic
exercise on people with
moderate disability MS
Pilot study
6 pts all
Comparative female
pre & post
EDSS 4-6
intervention
study
12 weeks 2 x
weekly 30 min
cycling at max
exertion level
Small
convenience
sample
No control
Diff assessors
pre & post
intervention
Unable to
achieve aerobic
training zone
Rampello
et al 2007
Effect of aerobic
training on walking
capacity & maximal
exercise tolerance in
patients with MS: a
randomised crossover
controlled study
Randomised
crossover
controlled
study
8 wks 3 x weekly
Aerobic (40 mins
cycling?) + 15
mins stretching vs
Neurorehabilitation
(60 mins)
Convenience
sample.
Different DMTs
in use
26 % dropout
11
EDSS <6
walk at
baseline, wks
7 & 12
EDSS, Berg
balance scale,
MSIS,
Ashworth
scale., 10m
walk test, 6
min walk test
10m & 6 min
walk tests,
Functional
reach test,
GNDS, Gulick
scale, FSS,
Modified
Ashworth
scale
6 min walk,
MSQOL 54,
MFIS,
LFTs, Oxygen
uptake
endurance after training but
returned towards baseline in
follow up period after
training
No change walking HR so
did not increase fitness
No Change GNDS
Improvements in muscle
strength, spasticity,
endurance, balance, walking
speed, QOL
No adverse effects or reports
of fatigue
Improved GNDS (mean
score 13 to 9). Improved 6
min walk test
No neg effects, trend
towards improvement,
fatigue (2/3 of subjects), 10
m walk,
No change lung or resp
muscle function.
Increased walk distance &
speed post aerobic training
(AT) also sig increase in
peak VO2 & max work rate.
Max ex tolerance increased
post AT & neuro rehab (NR)
?MSQOL mixed results –
Mc
Cullagh et
al 2008
Long term benefits of
exercising on quality of
life & fatigue in MS
patients with mild
disability: a pilot study
RCT
PEDro 4/10
24 ind mob
RRMS or
SPMS
Shultz et
al 2004
Impact of aerobic
training on immuneendocrine
parameters,neurotrophic
factors, quality of life
and coordinative
function in multiple
sclerosis.
Randomized controlled
trial of yoga and
exercise in multiple
sclerosis
Longitudinal
randomised
study
5/10 PEDro
15 in
study 1,
23 in
study 2
EDSS <5
Parallel
group RCT
comparing
exercise ,
yoga ,
control
group
PEDro 4/10
Experimenta
l design
Oken et al
2004
White &
Mayston
2008
The effect of Pilates
classes on balance &
well being in people
with MS: a pilot study
3 mths
2 x weekly 50 mins
1x weekly 40-60
mins. 4 stations
mainly aerobic
Convenience
sample. No
blinding. Less
Physio contact
with control
group. No
intention to treat
analysis
8 weeks bicycle
Small sample,
tailored
? how selected
programme
1/3 withdrew
2 x weekly 30 mins Waiting list
low intensity
control
MFIS
MSIS 29
FAMS
Heart rate &
RPE
At 3 & 6 mths
57
EDSS < or
equal to 6
6 mths 1 x weekly
90 mins + home
practice
encouraged
12
ind mob
6 weeks, 12 1 hour
classes
SF36,POMS,
MFI,MSFC,
CESD
10(Cognitive
memory,attent
ion,
sleepiness,
anxiety tests)
MSIS 29
Berg balance
scale
V small sample,
no control group
Hamburg
QoL, POMS,
HADS,SF36,
MSSES, VO2
max, HR,
lactate level
some improvements, partial
effect with AT. Most
disabled benefited more
QoL increased & maintained
at 6 mths (FAMS but not
MSIS)
Fatigue lower & at 6 mths
Poor adherence
Claims inc ex tol (RPE &
HR) but full tests not done
& not maintained at 6 mths
Inc fitness but only with
lactate response.
QoL inc in Hamburg QoL
scale
17% dropout, 65%
attendance ex group, 68%
yoga
Interventions better than
control in SF36 vitality
scale, MFI general fatigue.
No effect cog function or
alertness
No statistically significant
improvements but good
adherence & no detrimental
effects
Combined programmes
Art Author
Title
Study design
Participants
Intervention
Romberg
et al 2004
Effects of a 6 month
exercise program on
patients with MS: a
randomised study
RCT
95 (114)
EDSS1-5.5
6 months - 3 wk
supervised
(5 resistance & 5
aerobic sessions)
then 23 wks
progressive
resistance home
ex 4 phone
contacts
Surakka et
al 2004
Effects of aerobic &
strength exercise on
motor fatigue in men
& women with MS: a
RCT
RCT
n=95 Ex
group 47,
control 48
(normal
living)
6 months - 3 wk
supervised (5
resistance & 5
aerobic sessions)
then 23 wks PRE
home ex
8 weeks, 3 x
weekly Aerobic
(cycling),
stretching,
strengthening,
balance,
4 wks supervised,
4 wks home
exercise
programme
tailored &
Hale et al
2003
PEDro 4/10
Effect of a combined Pilot study
exercise programme
for people with MS: a
case series
4 pts
EDSS < 6.5
Limitations
Outcome
measures
Unclear what
Walking speed
aerobic ex done
25 ft & 500m
at home (aquatics Strength LL &
in first 3 wks)
UL
Different
Exercise test
exercise type
Equiscale
used for testing
balance
& training
Randomised
before eligibility
confirmed
NB Same study
FSS,
as above
Ambulatory
Romberg
fatigue index
No blinding, no
Fatigue index
intention to treat of knee
analysis
muscles
Very small pilot
Berg balance
study.
scale
No controls
TUG, 10m
walk test
Muscle
strength
testing, HR
response to
exercise,
MSSSE,
Performance
Results
Good overall
adherence(93%) but only
59% for strength training
based on self report
Sig improvement in upper
extremity endurance
Improved walking speed
12& in 25 ft test & 6% in
500m test (6% & no
change in controls)
Reduced motor fatigue in
women (25% higher
exercise activity)
EDSS higher in males &
more progressive MS
Good adherence, subjective
evaluation good
All 4 improved in TUG,
Berg scale, 3 improved
walk test
MSSE & Performance
scale improved, strength
gains
progressive
Bjarndottir MS & brief moderate
et al 2007 exercise. A RCT
Freeman
& Allison
2004
RCT
PEDro 6/10
Group exercise
Pre & post
classes in people with test pilot
MS: a pilot study
study
16 pts < 50
yrs old in
Iceland mild
MS (RR)
ambulatory
EDSS <4
Exercise (6)
or control
(10) group –
normal
activity.
5 wks 3 x weekly
60 mins. 15-20
mins static bike
based on ACSM ,
5 mins stretching,
resistance exs x
13 15 reps , inc to
20 if possible
Convenience
sample
Small nos & 3
drop outs during
intervention –
lack of
motivation,
exacerbation
(also 1 in control
group), illness
n =10
EDSS 3-6.5
10 weeks
Once weekly 1
hour (30 mins
standing
exercises, 30
mins Pilates type
exercises)
Small pilot study
No control
Convenience
sample
scale, Borg
RPE scale
SF36, Borg
RPE scale,
Graded
exercise test
Berg balance
scale
MSIS
6 min walk
test
FIS
Physiological
cost index
(PSI)
12 item MS
walking scale
Tendancy towards
improved QOL in 5 of 8
subscales, stat sig in
vitality
Improved physical fitness:
Increase of 14.7% in VO2
peak, 18.2% in peak
workload, 27.3% in
anaerobic threshold in ex
group post ex no change
control
No inc symptoms
Significant improvement in
Berg scale, 6 min walk,
FIS (physical component)
MSIS scale (motor
component), MS walking
scale
Scores maintained at
follow up 4 weeks later
Quality of life
Art Author
Title
6
Phys activity &
QOL in MS:
possible roles of
social support,
self efficacy &
functional
limitations
196 pts in US
ind mobile
predominantly
female &
RRMS
Factors
influencing
QOL in MS
patients:
disability,
depressive
mood, fatigue &
sleep quality
Long term
exercise
improves
functional
impairment but
not QOL in MS
Postal
504 MS pts in
questionnaire Austria
Control 1049
healthy
subjects
EDSS 0-8
38
Motl et al
2007
Lobentanz
et al 2004
Romberg
et al 2005
14
Forbes et
al 2004
Health
problems &
health related
quality of life in
people with
MS.
Study design
Participants
RCT
47
PEDRO 6/10 intervention
group 48 in
control
3 wks rehab
then 23 wks at
home
Cross
929 pwMS in
sectional
7 treatment
postal survey centres in UK
Intervention
Limitations
Convenience
sample
Can’t say if causal
rel
Diff measures used.
Sample v biased to
women, RRMS &
all mobile
6 mths
progressive ex
prog of
resistance
training
Practice effects of
MSQOL-54 + floor
ceiling
No blinding, no
placebo
Outcome
measures
Pedometer &
accelerometer
7 days
Social
provisions
scale
Results
Phys activity correlated with
QOL, indirect effect accounted
for by self efficacy & functional
capacity (mod association with
functional limitations)
Late-Life
Function
and Disability
Inventory 2 X self
efficacy scales Sat
with life scale
QOL index
SDS – self
rating
depression
FSS
Pittsburgh
sleep quality
index
MSFC,EDSS,
FIM
MSQOL54
CES-D
depression
scale
MSIS 29
SF36
5 pt ordinal
scales for MS
related
problems
Mildly disabled had normal
QOL otherwise all subscales
lower than controls. Strong assn
between fatigue & depressive
mood & on occupational
functioning – 41 % lower than
controls. Considerable impact of
fatigue & reduced sleep overall
Intervention group improved
MSFC (mainly leg function &
ambulation), controls
deteriorated. Stat significant
change between groups
No effect on EDSS, FIM,
MSQOL-54, CES-D
74% experienced 4 or more
problems. Fatigue, pain,
employment, depression,
relationship problems neg
impact on SF 36, most
compromised in pts with
multiple problems
Health Promotion
Art Author
Ennis et
all 2006
Title
RCT of a health
promotion
education
programme for
pwMS
Study
design
Single
blind
RCT
Participants Intervention
Limitations
62 adults
(32 Rx 30
control)
EDSS 1-7
Self selecting
sample
Subjects not
blinded
8 wks MDT
out patient
programme in
health
promotion
Weekly group
session 3 hrs
education &
taster sessions
Outcome
measures
Health
promoting
lifestyle
profile
SF36
Self rated
abilities
for health
practices
Results
Significantly higher levels of
health promotion activity & self
efficacy, sustained at least 3
mths after programme
Improvement in areas of QOL
(physical, mental & general
health) > controls. Attendance
approx 94% Increase in leisure
activities 6 to 40 % of subjects
Fatigue studies
Author
Title
5
Navipour
2006
Improved
fatigue with
short term self
care programme
44
Graham
2006
RCT of anti
fatiguing res ex
for inds with
MS
Fragoso et
Positive effects
Study design
RCT
Participants Intervention
Limitations
34 in
Tehran
Ind mob
No control group
Lacks details of exs
/ strategies used or
how much pts did
them. Calls it
graded ex but is it?
Convenience
sample
Has control 20
normals & MS
controls.
Only mob pts
73 pwMS
EDSS < or
= 6.5 Mild
to mod
10 - 9 pts
7sessions 4560 mins
teaching exs +
self man
techniques
(tailiored), ed
pack then 6
wks at home
12 wk 4 gps:
Home ex,
supd ex, func
trng, control
Quant prog ex
rehab
20 wks
Convenience
Outcome
measures
Coopersmith
self esteem
VAS ie self
report
Results
16 item test
over 1.5 days
Sig effects on strength, MFIS,
PASA.
Greatest improvement in musc
func in SE gp
Chalder fatigue
Significant improvement in all
Sig improvement in fatigue &
self esteem scores
all 2008
of a physical
activity
programme for
MS pts with
fatigue
completed
Those with
mod /
severe resp
muscle
weakness
excluded
Tailored 4wks
stretching, 10
resistance, 6
combined incl
aerobic
conditioning
Rasova et
al 2006
Comparison of
the influence of
different
rehabilitation
programmes on
clinical,
spirometric
spiroergometric
parameters in
patients with
MS
95 (112)
pts EDSS
0-6.5
Dropouts –
8 relapses,
5 illness, 4
motivation
loss
2 mths 2 x
weekly either
aerobic
training (up to
30 mins),
neuro Physio
(1 hour),
combined
therapy (1
hour) &
control
10 pts
(2male)
RRMS ind
mob
8 week
programme at
Physio gym
3xweekly 1
hour in NZ
Smith et al How does
2008
exercise
influence
fatigue in
people with MS
Qualitative
methodological
design using
Interpretive
Description
methodology
exploring
understanding
& beliefs re ex
& fatigue
sample. 22 pts
dropped out before
start. Disability
level of pts
unknown. In Brazil
No control, no
blinding, v small
group
Convenience
sample, no
randomisation or
group matching –
some groups more
disabled than others
Lacks details of ex
intervention
scale
pts on Chalder scale & in phys
conditioning but ? how
measured
MFIS, EDSS,
BDIS, (Beck
depression),
Barthel index
MSQOL 54,
ESS
(Environmental
status scale),
Borg RPE
Spirometry,
Spiroergometry
Aerobic training – sig
improvement in muscle
performance, pulmonary
ventilation, perception of effort,
FVC fatigue, depression, QOL
Neuro Physio group - sig
improvement in pulmonary
ventilation, fatigue, depression,
neuro impairment on EDSS
Combined – sig aerobic
changes, improved QOL,
fatigue, depression, neuro
impairment on EDSS
Control – some worsening in
aerobic measures
Participants experienced positive
(improved strength, stamina,
balance, sleep quality, positive
feelings)& negative changes
(perceived deterioration in gait,
balance, neg feelings) in fatigue
Identified 5 categories
influencing fatigue: Perceived
control, Listening to your body,
Reaching the edge, Nature of
tiredness, Exercise outcomes
Roehrs et
al 2004
Effects of an
aquatic program
on quality of
life measures
for individuals
with
progressive MS
1 group pre
test, post test
quasi
experimental
19
EDSS
1.8 - 8
12 weeks
aquatic
exercise 2 x
weekly I hour
3 PT students,
PT
supervision
HR Heart rate
PRE Progressive resistance exercise
RPE Rate of perceived exertion
BDIS Beck depression inventory score
MSSE - MS self efficacy scale
Performance scale (Schwartz et al 1999)
PSI - Physiological cost index
LFTs - Lung function test
GNDS – Guys neurological disability scale
MFIS – Modified fatigue impact scale
MSIS-29 – MS impact scale
RMI – Rivermead mobility index
FSS – Fatigue severity scale
FAMS – Functional assessment of MS
FIM – Functional independence measure
EDSS – Expanded disability status scale
MSQOL – 54 - MS Quality of Life 54
PEDro – Physiotherapy Evidence Database (available via www.csp.org.uk)
RRMS - relapsing remitting MS
SF-36 - Medical Outcome Study Short Form-36
VAS - Visual analogue scale
QoL – Quality of Life
RMI Rivermead mobility index
POMS Profile of Moods score
TUG – Timed up & go
Convenience
sample from one
centre
No control group
12 withdrawals, 6
during course, 2
due to impact on
ADLs
SF36,
MSQLI
MFIS
Sig improvements in QOL
domains of social functioning
(SF36 & MSQLI) & fatigue
(MFIS)