Name: adapted resistance training improves strength in eight weeks in individuals with multiple sclerosis
Uploaded: 2016-01-29T15:00:00
Description: Watch this Scientific Journal Video about Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis at JoVE.com

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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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 ...

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