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.

<ol><li>Sutliff, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Contribution+of+impaired+mobility+to+patient+burden+in+multiple+sclerosis%5BTitle%5D)+AND+%22Curr+Med+Res+Opin%22%5BJournal%5D)">Contribution of impaired mobility to patient burden in multiple sclerosis.</a> Curr Med Res Opin. 26 (1), 109-119 (2010).</li>
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<li>Zackowski, K. M., Wang, J. L., McGready, J., Calabresi, P. A., Newsome, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Quantitative+sensory+and+motor+measures+detect+change+over+time+and+correlate+with+walking+speed+in+individuals+with+multiple+sclerosis%5BTitle%5D)+AND+%22Mult+Scler+Relat+Disor.4%281%29%3A67-71%22%5BJournal%5D)">Quantitative sensory and motor measures detect change over time and correlate with walking speed in individuals with multiple sclerosis.</a> Mult Scler Relat Disor.4(1):67-71. 4 (1), 67-71 (2015).</li>
<li>Keller, J. L., Wang, J. I., Kang, J. Y., Hanson, J. A., Kamath, P., Swain, J. O., Raymond, G. V., Zackowski, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Strength%3A+A+relevant+link+to+functional+performance+in+the+neurodegenerative+disease+of+adrenomyeloneuropathy%5BTitle%5D)+AND+%22Neurorehabil+Neural+Repair%22%5BJournal%5D)">Strength: A relevant link to functional performance in the neurodegenerative disease of adrenomyeloneuropathy.</a> Neurorehabil Neural Repair. 26 (9), 1080-1088 (2012).</li>
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<li>Motl, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Physical+activity+and+irreversible+disability+in+multiple+sclerosis%5BTitle%5D)+AND+%22Exerc+Sport+Sci+Rev%22%5BJournal%5D)">Physical activity and irreversible disability in multiple sclerosis.</a> Exerc Sport Sci Rev. 38 (4), 186-191 (2010).</li>
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<li>Gutierrez, G. M., Chow, J. W., Tillman, M. D., McCoy, S. C., Castellano, V., White, L. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Resistance+training+improves+gait+kinematics+in+persons+with+multiple+sclerosis%5BTitle%5D)+AND+%22Arch+Phys+Med+Rehabil%22%5BJournal%5D)">Resistance training improves gait kinematics in persons with multiple sclerosis.</a> Arch Phys Med Rehabil. 86 (9), 1824-1829 (2005).</li>
<li>Kjølhede, T., Vissing, K., de Place, L., Pedersen, B. G., Ringgaard, S., Stenager, E., Petersen, T., Dalgas, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Neuromuscular+adaptations+to+long-term+progressive+resistance+training+translates+to+improved+functional+capacity+for+people+with+multiple+sclerosis+and+is+maintained+at+follow-up%5BTitle%5D)+AND+%22Mult+Scler%22%5BJournal%5D)">Neuromuscular adaptations to long-term progressive resistance training translates to improved functional capacity for people with multiple sclerosis and is maintained at follow-up.</a> Mult Scler. 21 (5), 599-611 (2015).</li>
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<li>Dalgas, U., Stenager, E., Jakobsen, J., Petersen, T., Hansen, H. J., Knudsen, C., Overgaard, K., Ingemann-Hansen, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Resistance+training+improves+muscle+strength+and+functional+capacity+in+multiple+sclerosis%5BTitle%5D)+AND+%22Neurology%22%5BJournal%5D)">Resistance training improves muscle strength and functional capacity in multiple sclerosis.</a> Neurology. 73 (18), 1478-1484 (2009).</li>
<li>Kurtzke, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+new+scale+for+evaluating+disability+in+multiple+sclerosis%5BTitle%5D)+AND+%22Neurology%22%5BJournal%5D)">A new scale for evaluating disability in multiple sclerosis.</a> Neurology. 5 (8), 580-583 (1955).</li>
<li>Kurtzke, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Rating+neurologic+impairments+in+multiple+sclerosis%3A+an+expanded+disability+status+scale+%28EDSS%29%5BTitle%5D)+AND+%22Neurology%22%5BJournal%5D)">Rating neurologic impairments in multiple sclerosis: an expanded disability status scale (EDSS).</a> Neurology. 33 (11), 1444-1452 (1983).</li>
<li>Sahrmann, S. A. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aSahrmann%2C+SA+%22Diagnosis+and+Treatment+of+Movement+Impairment+Syndromes%22">Diagnosis and Treatment of Movement Impairment Syndromes</a>. , Mosby. St. Louis, MI. (2002).</li>
<li>Bohannon, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reference+values+for+extremity+muscle+strength+obtained+by+hand-held+dynamometry+from+adults+aged+20+to+79+years%5BTitle%5D)+AND+%22Arch+Phys+Med+Rehabil%22%5BJournal%5D)">Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years.</a> Arch Phys Med Rehabil. 78 (1), 26-32 (1997).</li>
<li>Newsome, S. D., Wang, J. Y., Kang, J. Y., Calabresi, P. A., Zackowski, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Quantitative+measures+detect+sensory+and+motor+impairments+in+multiple+sclerosis%5BTitle%5D)+AND+%22J+Neuro+Sci%22%5BJournal%5D)">Quantitative measures detect sensory and motor impairments in multiple sclerosis.</a> J Neuro Sci. 305 (1-2), 103-111 (2011).</li>
<li>Hackney, M., McKee, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Community-based+adapted+tango+dancing+for+individuals+with+Parkinson%27s+Disease+and+older+adults%5BTitle%5D)+AND+%22JoVE%22%5BJournal%5D)">Community-based adapted tango dancing for individuals with Parkinson's Disease and older adults.</a> JoVE. (94), e1-e12 (2014).</li>
</ol>

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 muscles in appropriate alignment (e.g., hip abduction with hips extended). The protocol can be individualized to accommodate for asymmetric weakness, profound weakness, or individuals with mild weakness. By contrast, traditional gym equipment often allows for substitution of stronger muscles without optimizing muscle alignment for functional performance (e.g., hip abduction with hips flexed). While resistance bands are inexpensive relative to gym equipment they may stretch out over time, losing their resistance. However, we found that one set of bands was effective for the 12-week exercise program, for groups of 4 people. Other advantages of the protocol are that it is inexpensive, feasible to do in a small group setting, and requires minimal equipment. Lastly, we emphasize pre- and post-tests using a quantitative device such as a hand held dynamometer to better evaluate for subtle but significant changes in individuals as well as for group comparisons.
These preliminary results, taken from a larger ongoing study, demonstrate that significant strength improvements occur within 8 weeks of training. This is important because participants often want to know when to expect to see improvements from their rehabilitation efforts. This information can be valuable in motivating participants and obtaining funding. Participant testimonials were reflective of this, an example is shown in highlighted textbox. Finally, in designing clinical trials testing pharmacologic or rehabilitative interventions, seeing change in 8-weeks allows for expedient results.
MS is characterized by heterogeneous signs and symptoms in which weakness occurs in combination with other symptoms (i.e., cognitive, sensory, spasticity, ataxia). For successful use of this protocol, individualizing the program based on daily performance is essential. Each participant was supervised by a rehabilitation professional within their group, ensuring that: proper alignment was used; the exercises were of adequate intensity; and safety was maintained throughout the program. One modification to the protocol in order to ensure adequate supervision was to enroll participants sequentially (one per week). Professional clinical judgment is valuable for careful attention to skin integrity, safety with ambulation between stations to prevent falls, whole body alignment to prevent secondary pain complications with exercise, and for monitoring adequate environmental temperature control. As with other intervention studies, participant compliance both with frequency and quality of performance is a potential issue so should be addressed proactively. Effective strategies used in this protocol include offering monthly make up sessions and allowing 10%-15% longer duration to complete the required number of training sessions. Direct supervision as well as the group dynamic provides a means for accountability and camaraderie to optimize compliance.
As part of the larger study, we will be assessing for longevity, application to walking, functional performance, and quality of life in a controlled study, which was one of the limitations of the current study. In the future, application of this protocol to home or community environments would provide greater access for participants to benefit from this program. Better access to this protocol could allow the application to rare neurodegenerative disorders that also have leg weakness as a key symptom. Ideally, a program such as this could be optimized for the community under the instruction of non-clinically trained individuals as has been done for interventions in Parkinson&#8217;s Disease22. More research is needed to generalize this information safely while maintaining the fidelity of the program.
Participant Testimonial: One participant (Figure 2A) reports, &#8220;I have a step-stool in my kitchen, and I used to have trouble climbing on it to put dishes away. Now it&#8217;s easy, I just hop right up there!&#8221; And, &#8220;I went to my granddaughter&#8217;s birthday party over the weekend and both of my daughters commented on how much better I look. They noticed that I wasn&#8217;t as tired, didn&#8217;t need breaks and could walk and move around better. It&#8217;s nice when other people start to notice!&#8221;

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><tbody><tr><td>microFET2</td><td>Hoggan Scientific, LLC</td><td></td><td>Digital hand held muscle tester</td></tr><tr><td>REP Bands (all colors)</td><td>Power Systems</td><td>5600-011</td><td>Resistance bands for the exercise program</td></tr><tr><td>TheraBand Latex-Free Exercise Bands (all colors)</td><td>TheraBand</td><td>11726-11730</td><td>Resistance bands for the exercise program</td></tr><tr><td>8&#039;&#039; Cable Ties</td><td>Lowes Home Improvement</td><td>76329</td><td>Tied into the resistance bands to provide places for the carabiner to clip onto</td></tr><tr><td>Door Anchor</td><td>GoFit</td><td></td><td>Anchors the REP bands to doors</td></tr><tr><td>Hollow-Braid Poly Rope</td><td>Home Depot</td><td>140538</td><td>Anchors REP bands to table legs/other fixtures</td></tr><tr><td>Zinc-Plated Steel Hang All</td><td>Home Depot</td><td>550768</td><td>Thigh straps for the hip exercises</td></tr><tr><td>Neoprene Ankle Strap</td><td>TKO</td><td>106 BK</td><td>Ankle strap for leg exercises</td></tr><tr><td>Positron Carabiner</td><td>Black Diamond</td><td>BD2102610000ALL1</td><td>Carabiners to link ankle/thigh strap to REP bands</td></tr><tr><td>Fitness Gear 3mm Mat</td><td>Dick&#039;s Sporting Goods</td><td>41857546</td><td>Yoga mat for exercises on the ground</td></tr><tr><td>1/2 inch, 2 by 2 Exercise Tiles</td><td>FoamTiles</td><td></td><td>Gym matting for exercies on the ground</td></tr><tr><td>Spirit LT Portable Massage Table</td><td>EarthLite</td><td></td><td>Table for hip extension and other exercises that required a raised platform</td></tr><tr><td>Performa Treatment Table</td><td>Sammons Preston</td><td>553736</td><td>Heavy treatment table for testing/anchoring REP bands</td></tr><tr><td>STATA SE 11</td><td>STATA</td><td></td><td>Software for statistical analysis</td></tr><tr><td>STATISTICA</td><td>Dell Software</td><td></td><td>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 for all hip muscles). For hip flexion, statistically significant improvements were first made following 8-weeks of training (p=0.013), with additional improvement at the end of 12-weeks. Individual muscle groups were compared using paired t-tests with the p-value set at 0.017 to control for multiple comparisons. When we assess each individual&#8217;s strength change from pre-intervention to post-intervention, we see varied responses with most showing good improvement: more than half improved strength by more than 44 N. To demonstrate this, Figure 2 shows three examples of participants who improved their strength despite hip muscles having different degrees of weakness to start with. Figure 2A shows an example of an individual with asymmetric hip strength (left weaker than right) at baseline, this person presented with a hemi-paretic walking pattern. Following strength training, this person specifically gained hip flexion strength on the weaker, left side. By contrast, hip abductor and extensor muscles were more symmetric and both sides gained strength post intervention. Note: this person (2A) started on the right for hip flexion at 1 level 5 band at loop 3 for a total of 40 N at 100% stretch and progressed to 1 level 5 and 1 level 3 band at loop 2 (1/3 shorter overall length), for a total of 67 N at 100% stretch.&#160;Figure 2B shows an individual with very weak hip muscles compared to control values (hip flexion: 195 &#177; 44 N)5. This individual gained strength in all three muscles and on both the right and left sides even with profound initial weakness. Note: this person (2B) started on the right for the hip flexion exercise in side-lying without bands and progressed to doing the exercise in supine without bands. Figure 2C shows an individual who is relatively strong in his hip muscles at baseline, relative to control values (hip flexion: 304 &#177; 52 N)5. Though this person had only very mild weakness, all muscles show improvements on the order of 22-44 N following the strength training intervention. Note this person (2C) started on the right for hip flexion with 2 level 5 bands and 2 level 3 bands at loop 4 for a total of 146 N at 100% stretch and progressed to 1 level 5 band and 1 level 2 and all three tubes doubled at loop 4 length for a total of 469 N at 100% stretch.
<img alt="Figure 2" src="/files/ftp_upload/53449/53449fig1.jpg" />
Figure 1. Hip flexion strength. Line graph from 26 individuals with MS showing mean values + standard deviation for strength of the hip flexor muscles in Newtons. (A) summed hip flexion strength. (B) summed hip abduction strength. (C) Summed hip extension strength. Base: baseline measure; pre-intervention; 4 wk: mean after 4 weeks of the intervention; 8 wk: mean after 8 weeks of the intervention; 12 wk: mean value after 12 weeks of the intervention.
<img alt="Figure 2" src="/files/ftp_upload/53449/53449fig2.jpg" />
Figure 2. Three representative examples of strength change, before and after the resistance strength training program. The bar graphs show the mean strength measure for the right and left sides of the hip flexor, hip extensor and hip abductor muscles for three MS participants. The dark columns are left hip flexion and the lighter columns are right hip flexion measures. (A) participant with notable hip flexor asymmetry at baseline (age: 46, female, symptom duration: 4 yrs, EDSS: 1) (B) participant with notably weak hip muscles at baseline (age: 58, female, symptom duration: 34 yrs, EDSS: 6). (C) participant with very mild weakness in hip muscles at baseline (age: 37, male, symptom duration: 1 yrs, EDSS: 2). The y-axis is strength, in Newtons. The x-axis indicates the right and left muscle strength for visit 1 and visit 2 for the three hip muscles. Pre, is baseline or pre training; Post, is 12-week or post-training.

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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16.8K Views.  Kennedy Krieger Institute. 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.

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

Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression1. Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients2,3. Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life4. Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population.

The present article presents the details pertaining to the application of resistance training associated to vascular occlusion in IBM patients.

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise ...

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional capacity. Transcutaneous surface stimulation of skeletal muscle involves a current flow between a cathode and an anode, thereby inducing excitement of the motor unit and the surrounding muscle fibers. 
NMES is an attractive modality to evaluate skeletal muscle adaptive responses for several reasons. First, it provides a reproducible experimental model in which physiological adaptations, such as myofiber hypertophy and muscle strengthening6, angiogenesis7-9, growth factor secretion9-11, and muscle precursor cell activation12 are well documented. Such physiological responses may be carefully titrated using different parameters of stimulation (for Cochrane review, see 13). In addition, NMES recruits motor units non-selectively, and in a spatially fixed and temporally synchronous manner14, offering the advantage of exerting a treatment effect on all fibers, regardless of fiber type. Although there are specified contraindications to NMES in clinical populations, including peripheral venous disorders or malignancy, for example, NMES is safe and feasible, even for those who are ill and/or bedridden and for populations in which rigorous exercise may be challenging. 
Here, we demonstrate the protocol for adapting commercially available electrodes and performing a NMES protocol using a murine model. This animal model has the advantage of utilizing a clinically available device and providing instant feedback regarding positioning of the electrode to elicit the desired muscle contractile effect. For the purpose of this manuscript, we will describe the protocol for muscle stimulation of the anterior compartment muscles of a mouse hindlimb.

A murine model of neuromuscular electrical stimulation (NMES), a safe and inexpensive clinical modality, to the anterior compartment muscles is described. This model has the advantage of modifying a readily available clinical device for the purpose of eliciting targeted and specific muscle contractions in mice.

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional ...

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Behavior

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals. Ten older people living with HIV were enrolled in an exergame intervention. Patients performed balance exercises such as weight shifting, ankle reaching, and obstacle crossing. Real-time visual/audio lower-extremity joint motion feedback was provided using wearable sensors to assist feedback and encourage subjects to accurately execute each exercise task. Patients trained twice a week for 45 min for 6 weeks. Changes in balance, gait, psychosocial parameters and quality of life parameters were assessed at the beginning, midterm and at conclusion of the training program. Ten patients completed the study and their results analyzed. The mean age was 57.2 &#177; 9.2 years. The participants showed a significant reduction in center of mass sway (78.2%, p = .045) during the semi-tandem balance stance with eyes closed and showed a significant increase in gait speed during a dual task motor-cognitive assessment (9.3%, p = .048) with an increase in stride velocity of over 0.1 m/sec. A significant reduction in reported pain occurred (43.5%, p = .041). Preliminary results of this exergame intervention show promise in improving balance and mobility while requiring older people living with HIV to be more active. The exergame can be continued at home and may have long term as well as short-term benefits for ameliorating frailty associated with HIV infection.

Persons infected with HIV are often frail, depressed and live a sedentary lifestyle for which conventional exercise is too taxing. Here, we present an exercise protocol that ameliorates aspects of frailty in HIV-infected persons. An exergame integrating cognitive control was developed using biosensors that measured balance, weight-shifting and obstacle crossing.

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in elderly people performing short-term resistance training (RET). Supervised progressive resistance training for 1 h three times a week over 8 weeks was performed by RET participants (71&#177;1 years, range 65-80). Compared to a control group without training, the RET showed improvements on the measures used to indicate strength, power, glucose tolerance, and several parameters of muscle aerobic capacity. Strength training was performed in a gym with only robust fitness equipment. An isokinetic dynamometer for knee extensor strength permitted the measurement of concentric, eccentric, and static strength, which increased for the RET group (8-12% post- versus pre-test). The power (rate of force development, RFD) at the initial 0-30 ms also showed an increase for the RET group (52%). A glucose tolerance test with frequent blood glucose measurements showed improvements only for the RET group in terms of blood glucose values after 2 h (14%) and the area under the curve (21%). The blood lipid profile also improved (8%). From muscle biopsy samples prepared using histochemistry, the amount of fiber type IIa increased, and a trend towards a decrease in IIx in the RET group reflected a change to a more oxidative profile in terms of fiber composition. Western blot (to determine the protein content related to the signaling for muscle protein synthesis) showed a rise of 69% in both Akt and mTOR in the RET group; this also showed an increase in mitochondrial proteins for OXPHOS complex II and citrate synthase (both ~30%) and for complex IV (90%), in only the RET group. We demonstrate that this type of progressive resistance training offers various improvements (e.g., strength, power, aerobic capacity, glucose tolerance, and plasma lipid profile).

The effect of short-term resistance training on elderly people was investigated through the simultaneous use of several methods. Compared to a control group, many improvements were seen, including on muscle aerobic capacity, glucose tolerance, strength, power, and muscle quality (i.e., protein involved in cell signaling and muscle fiber type composition).

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in ...

Dosage-Adjusted Resistance Training in Mice with a Reduced Risk of Muscle Damage

Progressive resistance training (PRT), which involves performing muscle contractions against progressively greater external loads, can increase muscle mass and strength in healthy individuals and in patient populations. There is a need for precision rehabilitation tools to test the safety and effectiveness of PRT to maintain and/or restore muscle mass and strength in preclinical studies on small and large animal models. The PRT methodology and device described in this article can be used to perform dosage-adjusted resistance training (DART). The DART device can be used as a standalone dynamometer to objectively assess the concentric contractile torque generated by the ankle dorsiflexors in mice or can be added to a pre-existing isokinetic dynamometry system. The DART device can be fabricated with a standard 3D printer based on the instructions and open-source 3D print files provided in this work. The article also describes the workflow for a study to compare contraction-induced muscle damage caused by a single bout of DART to muscle damage caused by a comparable bout of isometric contractions (ISOM) in a mouse model of limb-girdle muscular dystrophy type 2B/R2 (BLAJ mice). The data from eight BLAJ mice (four animals for each condition) suggest that less than 10% of the tibialis anterior (TA) muscle was damaged from a single bout of DART or ISOM, with DART being less damaging than ISOM.

The present protocol describes a unique technique called dosage-adjusted resistance training (DART), which can be incorporated into precision rehabilitation studies performed in small animals, such as mice.

Progressive resistance training (PRT), which involves performing muscle contractions against progressively greater external loads, can increase muscle ...

Neuroscience

Assessing Strength Exercise Volume and Its Impact on Insulin Sensitivity in Obesity

Randomized Controlled Trial to Study the Acute Effects of Strength Exercise on Insulin Sensitivity in Obese Adults

An acute session of strength exercise (SE) ameliorates insulin sensitivity (IS) for several hours; however, the effects of SE volume (i.e., number of sets) have not been studied thoroughly. Although it is intuitive that some SE is better than none, and more is better than some for the improvement of IS, high-volume sessions might be challenging for diseased populations to complete, especially obese adults, for whom even a brisk walk can be challenging. This protocol details a randomized clinical trial to assess the acute effects of SE on IS in obese adults. The inclusion criteria are body mass index &#62;30 kg/m2, central obesity (waist circumference &#62;88 cm and &#62;102 cm for women and men, respectively), and age &#62;40 years. Participants will be familiarized with the SE (7 exercises targeting major muscle groups) and then will perform three sessions in a randomized order: session 1 - high-volume session (3 sets/exercise); session 2 - low-volume session (1 set/exercise); session 3 - control session (no exercise). Diet will be controlled the day before and on the day of the sessions. Sessions will be completed at night, and an oral glucose tolerance test will be performed the next morning, from which several indexes of IS will be derived, such as the area under the curve (AUC) of glucose and insulin, the Matsuda index, the Cederholm index, the muscle IS index, and the Gutt index. Based on pilot studies, we expect ~15% improvement in IS (insulin AUC, and Matsuda and Cederholm indexes) after the high-volume session, and ~8% improvement after the low-volume session compared to the control session. This study will benefit individuals who find high-volume SE sessions challenging but still aim to improve their IS by investing 1/3 of their time and effort.

Author Spotlight: Exploring the Impact of Reduced Resistance Exercise Volume on Metabolic Health 

This study describes a randomized controlled trial protocol aiming at assessing the acute effects of strength exercise volume on insulin sensitivity in obese individuals.

An acute session of strength exercise (SE) ameliorates insulin sensitivity (IS) for several hours; however, the effects of SE volume (i.e., number of ...

Versatility of Protocols for Resistance Training and Assessment Using Static and Dynamic Ladders in Animal Models

Resistance training is a physical exercise model with profound benefits for health throughout life. The use of resistance exercise animal models is a way to gain insight into the underlying molecular mechanisms that orchestrate these adaptations. The aim of this article is to describe exercise models and training protocols designed for strength training and evaluation of resistance in animal models and provide examples. In this article, strength training and resistance evaluation are based on ladder climbing activity, using static and dynamic ladders. These devices allow a variety of training models as well as provide precise control of the main variables which determine resistance exercise: volume, load, velocity, and frequency. Furthermore, unlike resistance exercise in humans, this is a forced exercise. Thus, aversive stimuli must be avoided in this intervention to preserve animal welfare. Prior to implementation, a detailed design is necessary, along with an acclimatization and learning period. Acclimatization to training devices, such as ladders, weights, and clinical tape, as well as to the manipulations required, is necessary to avoid exercise rejection and to minimize stress. At the same time, the animals are taught to climb up the ladder, not down, to the resting area on the top of the ladder. Resistance evaluation can characterize physical strength and permit adjusting and quantifying the training load and the response to training. Furthermore, different types of strength can be evaluated. Regarding training programs, with appropriate design and device use, they can be sufficiently versatile to modulate different types of strength. Furthermore, they should be flexible enough to be modified depending on the adaptive and behavioral response of the animals or the presence of injuries. In conclusion, resistance training and assessment using ladders and weights are versatile methods in animal research.

The present protocol describes resistance training and testing using static and dynamic ladders in animal models.

Resistance training is a physical exercise model with profound benefits for health throughout life. The use of resistance exercise animal models is a way ...

Biology

Combined Intervention Training for Children with Spastic Cerebral Palsy 

Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial magnetic stimulation (rTMS) and action observation training (AOT) intervention methods on spasticity, balance function, and motor function in children with spastic cerebral palsy (SCP). The study aimed to investigate whether the combination of the two interventions produces greater improvement than either treatment alone or conventional treatment.
Subject children in this study, in accordance with the random number table, were randomly divided into four groups: conventional group, rTMS group, AOT group, and combined intervention group. All the children in the four groups received conventional rehabilitation treatment, on the basis of which they were given different therapeutic programs of rehabilitation measures. The conventional group had no other treatment while the rTMS group received rTMS, the AOT group received AOT and the combined intervention group was given a combined intervention of rTMS and AOT. They were trained five days per week for 12 weeks. Changes in scores of spasticity, balance function, walking ability, and gross motor function were assessed at the onset of the training program and upon completion of 12 weeks of treatment.
A total of 64 Children with SCP completed the study, and their results were analyzed. The total gross motor function efficiency of 87.50% in the experimental group was significantly higher than that of 25.00% in the conventional group, 62.50% in the rTMS group, and 68.75% in the AOT group. The preliminary results showed that combined intervention of rTMS and AOT could effectively improve the balance function and motor function of children, and the therapeutic effect of the combined intervention was better than that of conventional treatment, rTMS or AOT alone. Finally, clinical efficacy and optimal treatment parameters of the combined intervention were clarified to provide a clinical basis for therapists to conduct lower limb function rehabilitation for children with SCP.

Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy

Children with spastic cerebral palsy (SCP) have limb spasticity, movement disorders, and abnormal posture due to injury to the cerebral cortex motor area, resulting in inability to stand and walk normally. Therefore, alleviating limb spasticity and enhancing gross motor function in children with SCP have become important therapeutic goals.

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial ...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...