Resistance Training Shows Promise for Improving Muscle Strength in MS

Implementing resistance and motor control training has been demonstrated to benefit muscle strength and walking capacity in patients with multiple sclerosis (MS), according to a study published in Journal of Clinical Medicine.¹

Elder Man Exercising With Resistance Band | image credit: Degimages - stock.adobe.com

Muscle fatigue and weakness are very common symptoms of MS and can take effect anywhere throughout the body. Some individuals living with MS may experience this weakness due to demyelination that impacts neural impulses, while in others it can arise due to trending disuse as they manage their disease.² Identifying the underlying cause of muscle weakness is crucial for patient care because managing nerve damage or lack of use requires different approaches. For example, in cases of disuse, physical exercise can go a long way to strengthen patients’ muscles and improve quality of life; however, if the root cause of weakness stems from demyelination and nerve damage, exercise and tiring out muscles can worsen weakness.

The authors of the present study note that symptoms arising from lack of physical activity (muscle weakness, fatigue, imbalance, tightness, or spasticity) are more common in middle-aged or older adults with MS (aged 44 years and up).¹ To counteract these symptoms, they add, research in this area has continually recognized the benefits of prescribed exercise on patients’ mental health, physical fitness, experienced disability, and overall quality of life. Among this literature, previous studies have supported the implementation of resistance-based and motor control training as a viable route for mitigating fatigue symptoms brought on by MS. To survey the effectiveness of this approach, the researchers conducted a systematic review to evaluate associations between these treatments and patients’ functionality and quality of life.

Studies were reviewed between July and August 2023 and used the Web of Science, Scopus, Cochrane, and PubMed databases. Eligible studies included those on randomized control trials (RTCs), resistance training in MS management, at least 1 intervention group, published within 10 years, and those with cohorts of individuals at least 45 years old on average.

A total of 12 studies including 459 patients (207 controls, 252 prescribed a resistance exercise intervention) met the inclusion criteria for the meta-analysis. Participants were aged between 49 and 50 years on average. The primary variable in this analysis was muscle strength, measured with leg press strength, a dynamometer, or isometric maximum voluntary contraction. Secondary variables included fatigue, gait, and quality of life, measured in assessments such as the 2- and 6-Minute Walking Test (2MWT, 6MWT), Fatigue Severity Scale (FSS), MS Impact Scale (MSIS), MS Quality of Life-54 (MSQOL-54), and more.

Six studies investigated muscle strength, with 5 studies finding significant improvements in this measure following resistance training (P < .05), including participants 1-repetition maximum (1RM; P < .05), isometric maximum voluntary contraction in knee extension (P = .08), and hand and ankle dynamometry (P = .01).

Eight studies assessed walking performance, 4 of which reported significant improvements. The average effect size for interventions solely based on resistance training was deemed medium and significant (95% CI, 0.025-0.979; P = .039). In a similar trend, studies that combined resistance training with other types of training also had a medium effect size and had significant effects (95% CI, 0.035-1.319; P = .039).

Of the eligible articles that investigated fatigue levels, only 1 demonstrated significant improvements for patients with MS (P < .05). As for articles assessing quality of life, 2 were included that each showed improvements; however, only 1 reached statistical significance (P < .05).

Overall, the study supports resistance training-based interventions in MS as a means of alleviating or improving the symptoms associated with muscle weakness. As the authors conclude, they emphasize the value of patient-specific plans as opposed to generalized strategies because “when exercise selection is appropriate and aligns with specific goals for each task, there is a greater possibility of achieving the overall objectives outlined by combining different training modalities.”

References

1.Cano-Sánchez J, Aibar-Almazán A, Hita-Contreras F, et al. Is resistance training an option to improve functionality and muscle strength in middle-aged people with multiple sclerosis? A systematic review and meta-analysis. J Clin Med. 2024;13(5):1378. doi:10.3390/jcm13051378

2. Weakness. Multiple Sclerosis Association of America. Updated October 20, 2022. Accessed May 1, 2024. https://mymsaa.org/ms-information/symptoms/weakness/