The authors would like to thankfully acknowledge Rhul Marasigan and all of the participants in the study. The exercise illustrations were provided by Tziporah Thompson.

NOTE: The institutional review boards at Johns Hopkins University School of Medicine and Kennedy Krieger Institute approved this work. All participants provided written consent before participating.
1. Training
<ol>
	<li>Ensure that the instructor is adequately trained in the use of hand held dynamometry and specifics of exercise details prior to initiating this protocol. 
	NOTE: Test a mix of individuals with varying strength levels to assure competence and consistency following the sp...

<ol>
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Financial disclosure/conflict of interest: there are no conflicts of interest to report.
Funding sources: A research grant from the National Multiple Sclerosis Society.

The protocol describes a progressive resistance training program using isolated muscle strengthening with resistance bands for people with MS. This protocol has unique features for individuals with degenerative conditions whose strength limitations may be compromising their ability to ambulate and maintain their quality of life. The focus is on improving proximal muscle strength in the lower extremities that is important for walking speed in MS21;4. One advantage of this protocol is that it emphasizes isolated...

In MS, compromised neural function typically leads to motor dysfunction, resulting in weakness. It is known that muscle weakness contributes to reduced daily activity in people with MS and inactivity further compromises functional ability1;2. Our lab has shown that weak hip flexor muscles in individuals with MS affect walking speed3, particularly in the weakest individuals4. The significance of weak proximal hip muscles to walking has been shown in MS as well as in other neurodegenerative conditions4;5. This vicious cycle contributes to increased disability and reduced quality of life6;7. Regular exercise can improve daily activity8, cardiovascular fitness8;9, muscle strength10, and fatigue8;11 in people with MS12. Strength training is known to promote neural adaptations that can lead to favorable functional outcomes in MS participants13-16.&#160;Since physical rehabilitation is often the only treatment offered to individuals with MS for recovery of function, it is critical to determine what is the most efficient way to improve strength.
Resistance strength training has been evaluated with no clear consensus on the minimal amount of time needed to see significant changes in muscle strength or the best method for optimizing strengthening. A current review reports that resistance training studies have varied in length from 3 to 26 weeks, mainly targeting the lower extremities in persons with MS suffering from low to moderate impairments (with an Expanded Disability Status Scale of 0-6.5)14;17;18. These studies primarily use isokinetic devices for training with direct supervision in a gym location. The use of isokinetic equipment is one way to isolate and strengthen single muscles, but it limits a person&#8217;s ability to complete the exercises without use of expensive equipment that is not always accessible. Resistance bands offer the advantage of controlling the direction of resistance as well as the placement of the resistance on the limb, thereby avoiding stresses to distal joints. Resistance bands also offer the opportunity to grade the resistance in finer increments then with other equipment such as with cuff weights.
Alignment and movement patterns are carefully addressed in the training of athletes, yet little attention is given to these factors in individuals with chronic degenerating conditions, in part because their limitations are so complex (e.g., sensory, motor control, cognition). The need to address alignment in exercises, as well as in everyday activities is critical19. Simple, but well-selected exercises that are precisely performed aid in the resolution of musculoskeletal syndromes in individuals with intact nervous systems19. Although many generic exercise programs are available, they do not address the specific impairments in MS that affect mobility and modifications necessary, given the progressive nature of the disease. For this program, we emphasize postural alignment, as well as specific exercises that are done in a position that is most optimal for how the muscle is used functionally.
The goal in this study was to create an accessible, inexpensive, resistance training program for the hip muscles that is generalizable to individuals with variable degrees of disability. Simple but precisely described hip strengthening exercises are adapted here emphasizing the strengthening of isolated muscles and guidelines are provided for individuals to further adapt the exercises depending on their current muscle strength. Recommendations are made so individuals can exercise with resistance bands in a systematic way that is easily adaptable to the home and details needed to replicate the program are specified.

<table border="0" cellpadding="0" cellspacing="0" width="777">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">microFET2</td>
			<td style="width:169px;">Hoggan Scientific, LLC</td>
			<td style="width:147px;"></td>
			<td style="width:248px;">Digital hand held muscle tester</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">REP Bands (all colors)</td>
			<td style="width:169px;">Power Systems</td>
			<td style="width:147px;">5600-011</td>
			<td style="width:248px;">Resistance bands for the exercise program</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">TheraBand Latex-Free Exercise Bands (all colors)</td>
			<td style="width:169px;">TheraBand</td>
			<td style="width:147px;">11726-11730</td>
			<td style="width:248px;">Resistance bands for the exercise program</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:213px;">8&#39;&#39; Cable Ties</td>
			<td style="width:169px;">Lowes Home Improvement</td>
			<td style="width:147px;">76329</td>
			<td style="width:248px;">Tied into the resistance bands to provide places for the carabiner to clip onto</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">Door Anchor</td>
			<td style="width:169px;">GoFit</td>
			<td style="width:147px;"></td>
			<td style="width:248px;">Anchors the REP bands to doors</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Hollow-Braid Poly Rope</td>
			<td style="width:169px;">Home Depot</td>
			<td style="width:147px;">140538</td>
			<td style="width:248px;">Anchors REP bands to table legs/other fixtures</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">Zinc-Plated Steel Hang All</td>
			<td style="width:169px;">Home Depot</td>
			<td style="width:147px;">550768</td>
			<td style="width:248px;">Thigh straps for the hip exercises</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">Neoprene Ankle Strap</td>
			<td style="width:169px;">TKO</td>
			<td style="width:147px;">106 BK</td>
			<td style="width:248px;">Ankle strap for leg exercises</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Positron Carabiner</td>
			<td style="width:169px;">Black Diamond</td>
			<td style="width:147px;">BD2102610000ALL1</td>
			<td style="width:248px;">Carabiners to link ankle/thigh strap to REP bands</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Fitness Gear 3mm Mat</td>
			<td style="width:169px;">Dick&#39;s Sporting Goods</td>
			<td style="width:147px;">41857546</td>
			<td style="width:248px;">Yoga mat for exercises on the ground</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">1/2 inch, 2 by 2 Exercise Tiles</td>
			<td style="width:169px;">FoamTiles</td>
			<td style="width:147px;"></td>
			<td style="width:248px;">Gym matting for exercies on the ground</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:213px;">Spirit LT Portable Massage Table</td>
			<td style="width:169px;">EarthLite</td>
			<td style="width:147px;"></td>
			<td style="width:248px;">Table for hip extension and other exercises that required a raised platform</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:213px;">Performa Treatment Table</td>
			<td style="width:169px;">Sammons Preston</td>
			<td style="width:147px;">553736</td>
			<td style="width:248px;">Heavy treatment table for testing/anchoring REP bands</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">STATA SE 11</td>
			<td style="width:169px;">STATA</td>
			<td></td>
			<td style="width:248px;">Software for statistical analysis</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:213px;">STATISTICA</td>
			<td style="width:169px;">Dell Software</td>
			<td></td>
			<td style="width:248px;">Software for statistical analysis</td>
		</tr>
	</tbody>
</table>

adapted resistance training improves strength in eight weeks in individuals with multiple sclerosis

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can improve strength in individuals with MS, however; it remains unclear the duration of RST that is needed to make strength gains and how to adapt hip strengthening exercises for individuals of varying strength using only resistance bands. This paper describes the methodology to set up and implement an adapted resistance strength training program, using resistance bands, for individuals with MS. Directions for pre- and post-strength tests to evaluate efficacy of the strength-training program are included. Safety features and detailed instructions outline the weekly program content and progression. Current evidence is presented showing that significant strength gains can be made within 8 weeks of starting a RST program. Evidence is also presented showing that resistance strength training can be successfully adapted for individuals with MS of varying strength with little equipment.

We show results from 26 individuals with MS who participated in a 12-week lower extremity progressive, resistance training (PRT) at our facility. Our participants have varying levels of disability with a median EDSS of 4.0 (range: 1-6.5), are on average 50.0 (11.3) years of age (youngest is 23 years, oldest is 64 years), 17 are female, and have an average symptom duration of 12.5 (8.7) years.
Figure 1 shows that hip strength improved following 12-weeks of training (p&#60;0.005...

Watch this Scientific Journal Video about Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis at JoVE.com

Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis. Isolated muscle strengthening is a useful method to target specific weaknesses. This protocol describes a progressive resistance-training program using exercise bands to increase hip muscle strength.

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can ...

The goal of this study was to create a progressive resistance training program to strengthen hip muscles in order to improve walking. This protocol provides a solution to address hip weakness which is a primary impairment that affects the quality of life of people with neurodegenerative diseases. The main advantage of this technique is that the program uses resistance bands in a systematic way that is accessible, inexpensive, and can be used in a group setting for people with variable levels of disability.We emphasize isolated muscle strengthening and proper alignment for how the muscle is used in walking. This progressive resistance training program can be individualized to accommodate asymmetric weakness, profound weakness or mild weakness. Demonstrating the procedure with me will Zipporah Thompson, a research coordinator from our laboratory.Begin by explaining the procedure to the participant. Assess baseline strength status for the hip flexor, hip extensor, and hip abductor muscles by using a handheld dynamometer during a break test. During the break test, obtain measures from each side of the body and repeat to obtain two consistent measures for each side within 45 newtons of eachother.Ask the participant to hold each position for four to five seconds at maximal effort and encourage the participant as they complete the test. Record each measure and average the two measures for each side. Begin the break test by measuring hip flexion.Instruct the participant to lie supine on a mat, legs extended, body relaxed, and head resting on a pillow. Have them bend one knee and hip and hold the hip at 90 degrees. Next, place the dynamometer on the distal femur.Instruct the participant to pull their knee toward their nose and to hold as strongly as possible. Then slowly and evenly pull the dynamometer in the direction of the particpant's toes. For the hip extension, instruct the participant to lie prone on a plinth with their legs extended and body relaxed.Ask them to bend one knee to 90 degrees flexion and hold. Then place the dynamometer on the distal femur. Instruct the participant to use their buttocks to lift their knee off the mat.Then hold and do not twist. Push the dynamometer down in the direction of the mat. Finally, for hip abduction, instruct the participant to lie on their side with their shoulders back and hips resting against a wall.Provide the participant with the option to rest their head on the bottom arm or hand. Ask the participant to bend their bottom leg knee and extend the top leg with the heel touching the wall and toes pointing slightly upward. Then instruct them to keep the top leg straight with their heel against the wall, lift the leg up to 45 degrees and hold.Place the dynamometer on the participant's distal femur and push down in the direction of the mat. Prior to each exercise, instruct the participant to look at their exercise log to determine which resistance level to use and to fill in the log after each exercise is complete. Begin with the hip flexion exercise by instructing the participant to lie supine with both hips straight.Ask them to slowly lift one knee towards the chest to end range of hip flexion, all the while keeping the knee close to the midline. Then instruct them to lower the leg with control to the starting position. For weaker participants, provide the option of performing this exercise side-lying with the top leg supported on a low bench placed in front of the participant.Next for hip abduction, instruct the participant to lie side-lying with their bottom leg slightly bent and the top leg straight. Instruct them to lift their top leg toward the ceiling, keeping the leg inline with the trunk and the knee facing straight ahead or slightly turned up toward the ceiling. Then ask them to lower their leg to the starting position.To perform hip extension instruct the participant to lie face-lying with one leg straight and one leg bent. Instruct them to raise the bent thigh off the support surface while keeping the knee bent. For knee flexion, instruct the participant to lie face-lying with both legs straight.Ask the participant to bend their knee as far as possible, keeping the pelvis and thigh still and keeping the hips on the support surface. Next, for hip external rotation, instruct the participant to start in a seated position. Then have them rotate the knee or thigh outward.Instruct stronger participants to perform hip external rotation while standing with their knee resting on a chair and hip maintained in extension. To perform knee extension, instruct the participant to lie supine with their exercise leg straight and resting leg bent. Then instruct them to raise the leg from the hip, keeping the knee straight and stopping at the height of the resting leg knee.Finally, provide each participant an individualized home exercise program for each weekend. Remind each participant to fill out the exercise log immediately following each exercise. In this study, individuals with varying levels of disability for multiple sclerosis participated in lower extremity resistance training in which statistically significant improvements were made in hip strength over the course of 12 weeks.Here, data from an individual with asymmetrical hip strength at baseline is shown. Following strength training, this individual gained hip flexion strength on their weaker left side. Additionally, hip abductor and extensor muscles were more symmetric and stronger post-intervention.These results demonstrate that significant strength improvements occur within eight weeks of training. In designing clinical trials that test pharmacologic or rehabilitative interventions, seeing change in eight weeks allows for expedient results. As with other intervention studies, participant compliance both with frequency and quality of performance is a potential issue.Providing specific feedback to the individual as well as maintaining a motivating group setting is essential for the success of the program. After watching this video, you should have a good understanding at how to quantitatively evaluate progress from a resistance training program. Don't forget that the reliability of the tester in the use of the dynamometer as well as properly instructing and encouraging the participant on giving their best performance is necessary.Resistance exercise is a common intervention used by therapists and has tremendous potential. However, it is necessary to provide appropriate supervision to ensure that proper alignment and safety is maintained throughout the program. Future application of this protocol in the home will provide greater opportunity for more individuals to benefit from this program.

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16.6K Görüntüleme.  Kennedy Krieger Institute. The goal of this study was to create a progressive resistance training program to strengthen hip muscles in order to improve walking. This protocol provides a solution to address hip weakness which is a primary impairment that affects the quality of life of people with neurodegenerative diseases. The main advantage of this technique is that the program uses resistance bands in a systematic way that is accessible, inexpensive, and can be used in a group setting for people with variable levels ...