High intensity dynamic stability gait training for people with multiple sclerosis: a pilot study

Background and Purpose

This report describes the initial results of an ongoing single blinded, randomized clinical trial aimed to improve mobility and balance for people with multiple sclerosis (PwMS) through high intensity dynamic stability gait training. PwMS demonstrate consistent, but relatively small improvements in mobility and balance following exercise interventions,^1-2 which often fall below the minimally clinically important differences (MCID) reported for other clinical populations.³ Based on recommendations for other neurologic populations, more task specific interventions at higher intensities may facilitate greater improvements in mobility and balance.⁴

Methods

PwMS were enrolled in a 10-week trial consisting of three 1-hour visits per week with up to 40 minutes of walking each. Participants walked at either low (LIT) or high (HIT) cardiovascular intensities, in a static or dynamic environment. LIT targeted intensities of 30-50% heart rate reserve (HRR), while HIT targeted 70-80% HRR. Dynamic environments involved discrete reactive balance perturbations every 20 seconds, while static environments did not. Blinded clinical assessments were completed before, midway, and after training. Outcome measure changes were assessed between the first and last completed assessment.

Results

More HIT participants demonstrated changes above the MCID for walking speed assessments (Self Selected Walking Speed, 7/12 HIT, 3/13 LIT; Fast Walking Speed, 8/12 HIT, 5/13 LIT; 25ft Walk Test, 2/12 HIT, 2/13 LIT) and the 6 Minute Walk Test (5/12 HIT, 3/13 LIT) than their LIT counterparts. Similar numbers of participants in the static and dynamic groups met MCIDs for balance measures (Functional Gait Assessment, 4/13 dynamic, 5/14 static; Berg Balance Scale, 0/13 dynamic, 1/14 static; Activities of Balance Confidence Scale, 2/13 dynamic, 2/14 static).

Discussion

PwMS undergoing HIT are more consistently meeting MCIDs for gait speed and endurance than their LIT counterparts, however changes in balance are similar between static and dynamic groups. Changes in reactive balance may be task specific and not captured by the current balance measures.