Highlights
- •High-intensity training is a safe and feasible modality for people with MS.
- •Adults with MS may achieve walking improvements through high-intensity training.
- •Evidence of high-intensity training on balance outcomes remains inconclusive.
- •Inconsistent dosing of high-intensity training hinders optimal prescription in MS.
Abstract
Background
There is growing interest and evidence for high intensity training (HIT) in clinical
populations, including persons with multiple sclerosis (MS). While HIT has been shown
to be a safe modality in this group, it is still unclear what collective knowledge
exists for HIT on functional outcomes. This study examined HIT modalities (e.g., aerobic,
resistance, functional training) on functional outcomes such as walking, balance,
postural control, and mobility in persons with MS.
Methods
High intensity training studies, including RCTs and non-RCTs, that targeted functional
outcomes in persons with MS were included in the review. A literature search was conducted
in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2022. Other literature
search methods were performed via website and citation searching. The methodological
quality of included studies was assessed by TESTEX for RCTs and ROBINS-I for non-RCTs.
This review synthesized the following data: study design and characteristics, participant
characteristics, intervention characteristics, outcome measures, and effect sizes.
Results
Thirteen studies (6 RCTs and 7 non-RCTs) were included in the systematic review. The
included participants (N = 375) had varying functional levels (EDSS range: 0–6.5) and phenotypes (relapsing
remitting, secondary progressive, primary progressive). HIT modalities involving high
intensity aerobic training (n = 4), high intensity resistance training (n = 7), and high intensity functional training (n = 2), revealed a significant and consistent benefit on walking speed and walking
endurance in response to HIT, while the evidence regarding balance and mobility improvement
was less clear.
Conclusion
Persons with MS can successfully tolerate and adhere to HIT. While HIT appears to
be an effective modality for improving some functional outcomes, the heterogeneous
testing protocols, HIT modalities, and exercise doses among the studies preclude any
conclusive evidence for its effectiveness thus necessitating future inquiry.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- High intensity interval training for people with multiple sclerosis: a systematic review.Mult. Scler. Relat. Disord. 2018; 24: 55-63https://doi.org/10.1016/j.msard.2018.06.005
- Objective physical activity levels in people with multiple sclerosis: meta-analysis.Scand. J. Med. Sci. Sports. 2018; 28: 1960-1969https://doi.org/10.1111/sms.13214
- Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.Public Health Rep. 1985; 100: 126-131
- Influence of multiple sclerosis on spatiotemporal gait parameters: a systematic review and meta-regression.Arch. Phys. Med. Rehabil. 2021; 102: 1801-1815https://doi.org/10.1016/j.apmr.2020.12.013
- Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities.Mult. Scler. 2011; 17: 594-603https://doi.org/10.1177/1352458510391836
- Falls in people with multiple sclerosis: risk identification, intervention, and future directions.Int. J. MS Care. 2020; 22: 247-255https://doi.org/10.7224/1537-2073.2020-014
- Exercise as medicine in multiple sclerosis-time for a paradigm shift: preventive, symptomatic, and disease-modifying aspects and perspectives.Curr. Neurol. Neurosci. Rep. 2019; 19: 88https://doi.org/10.1007/s11910-019-1002-3
- High-intensity resistance training in people with multiple sclerosis experiencing fatigue: a randomised controlled trial.Mult. Scler. Relat. Disord. 2022; 68104106https://doi.org/10.1016/j.msard.2022.104106
- High-intensity functional training (HIFT): definition and research implications for improved fitness.Sports (Basel). 2018; 6https://doi.org/10.3390/sports6030076
- Feasibility and effects of structured physical exercise interventions in adults with relapsing-remitting multiple sclerosis: a pilot study.J. Sport. Sci. Med. 2018; 17: 426-436
- Effects of high-intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized controlled trial.J. Neurolog. Phys. Ther. 2011; 35: 2-10https://doi.org/10.1097/NPT.0b013e31820b5a9d
- Exercise therapy for fatigue in multiple sclerosis.Cochr. Datab. Syst. Rev. 2015; 2015Cd009956https://doi.org/10.1002/14651858.CD009956.pub2
- High-intensity functional training improves functional movement and body composition among cancer survivors: a pilot study.Eur. J. Cancer Care (Engl). 2015; 24: 812-817https://doi.org/10.1111/ecc.12338
- Dose-response matters! - a perspective on the exercise prescription in exercise-cognition research.Front. Psychol. 2019; 10: 2338https://doi.org/10.3389/fpsyg.2019.02338
- High-intensity interval training for health benefits and care of cardiac diseases - the key to an efficient exercise protocol.World J. Cardiol. 2019; 11: 171-188https://doi.org/10.4330/wjc.v11.i7.171
- The effect of maximal strength training on strength, walking, and balance in people with multiple sclerosis: a pilot study.Mult. Scler. Int. 2016; 20165235971https://doi.org/10.1155/2016/5235971
- Mediating role of resilience on quality of life in individuals with multiple sclerosis: a structural equation modeling approach.Arch. Phys. Med. Rehabil. 2020; 101: 1152-1161https://doi.org/10.1016/j.apmr.2020.02.010
- High-intensity resistance training in multiple sclerosis - An exploratory study of effects on immune markers in blood and cerebrospinal fluid, and on mood, fatigue, health-related quality of life, muscle strength, walking and cognition.J. Neurol. Sci. 2016; 362: 251-257
- Efficacy of high-intensity aerobic exercise on common multiple sclerosis symptoms.Acta Neurol. Scand. 2022; 145: 229-238
- Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: a systematic review and meta-analysis.Ann. Phys. Rehabil. Med. 2020; 63: 59-68https://doi.org/10.1016/j.rehab.2019.07.006
- Effect of contralateral strength training on muscle weakness in people with multiple sclerosis: proof-of-concept case series.Phys. Ther. 2016; 96: 828-838https://doi.org/10.2522/ptj.20150299
- Time course of strength adaptations following high-intensity resistance training in individuals with multiple sclerosis.Eur. J. Appl. Physiol. 2017; 117: 731-743https://doi.org/10.1007/s00421-017-3534-z
- Isokinetic predictors of gait speed increase following high-intensity resistance training of the ankle dorsiflexors in people with multiple sclerosis: a pilot study.Clin. Biomech. 2019; 67: 102-106https://doi.org/10.1016/j.clinbiomech.2019.05.008
- Gait changes following direct versus contralateral strength training: a randomized controlled pilot study in individuals with multiple sclerosis.Gait Post. 2020; 78: 13-18https://doi.org/10.1016/j.gaitpost.2020.02.017
- Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.Mult. Scler. 2006; 12: 620-628https://doi.org/10.1177/1352458506070658
- Falls in people with multiple sclerosis compared with falls in healthy controls.PLoS One. 2014; 9e107620https://doi.org/10.1371/journal.pone.0107620
- Lessons learned from clinical trials of exercise and physical activity in people with MS - guidance for improving the quality of future research.Mult. Scler. Relat. Disord. 2022; 68104088https://doi.org/10.1016/j.msard.2022.104088
- Exercise in patients with multiple sclerosis.Lancet Neurol. 2017; 16: 848-856https://doi.org/10.1016/s1474-4422(17)30281-8
- Is there a preferred mode of exercise for cognition enhancement in older age?-A narrative review.Front. Med. (Lausanne). 2019; 6: 57https://doi.org/10.3389/fmed.2019.00057
- Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study.Mult. Scler. 2007; 13: 113-119https://doi.org/10.1177/1352458506071169
- Effect of high-intensity exercise on multiple sclerosis function and phosphorous magnetic resonance spectroscopy outcomes.Med. Sci. Sport. Exerc. 2019; 51: 1380-1386
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71https://doi.org/10.1136/bmj.n71
- Spotlight on postural control in patients with multiple sclerosis.Degener. Neurol. Neuromuscul. Dis. 2018; 8: 25-34https://doi.org/10.2147/dnnd.S135755
- Multiple sclerosis: changes in microarchitecture of white matter tracts after training with a video game balance board.Radiology. 2014; 273: 529-538
- Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults.Arch. Phys. Med. Rehabil. 2013; 94: 1458-1472https://doi.org/10.1016/j.apmr.2013.02.022
- Physical activity is associated with neuromuscular and physical function in patients with multiple sclerosis independent of disease severity.Disabil. Rehabil. 2021; 43: 632-639https://doi.org/10.1080/09638288.2019.1634768
- Outcome measures used in trials on gait rehabilitation in multiple sclerosis: a systematic literature review.PLoS One. 2021; 16e0257809https://doi.org/10.1371/journal.pone.0257809
- Systematic review of exercise studies in persons with multiple sclerosis: exploring the quality of interventions according to the principles of exercise training.Neurol. Ther. 2021; 10: 585-607https://doi.org/10.1007/s40120-021-00274-z
- Rate of perceived stability as a measure of balance exercise intensity in people post-stroke.Disabil. Rehabil. 2022; : 1-7https://doi.org/10.1080/09638288.2021.2022777
- Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX.Int. J. Evid. Based Healthc. 2015; 13: 9-18https://doi.org/10.1097/xeb.0000000000000020
- How does fatigue influence community-based exercise participation in people with multiple sclerosis?.Disabil. Rehabil. 2011; 33: 2362-2371https://doi.org/10.3109/09638288.2011.573054
- ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.BMJ. 2016; 355: i4919https://doi.org/10.1136/bmj.i4919
- A task-oriented circuit training in multiple sclerosis: a feasibility study.BMC Neurol. 2014; 14 (Vol 14 2014, ArtID 124)
- High intensity exercise in multiple sclerosis: effects on muscle contractile characteristics and exercise capacity, a randomised controlled trial.PLoS One. 2015; 10e0133697https://doi.org/10.1371/journal.pone.0133697
- Effectiveness of high-intensity interval training for fitness and mobility post stroke: a systematic review.Pm r. 2019; 11: 868-878https://doi.org/10.1002/pmrj.12154
- Muscle dysfunction and walking impairment in women with multiple sclerosis.Int. J. MS Care. 2019; 21: 249-256https://doi.org/10.7224/1537-2073.2018-020
Article info
Publication history
Published online: May 05, 2023
Accepted:
May 4,
2023
Received in revised form:
April 23,
2023
Received:
December 23,
2022
Footnotes
The authors do not have any relevant financial disclosures.
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
