Proximal Resistance Training for People With Multiple Sclerosis
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      The objective of this study is to pilot a 10-week resistance and functional movement
      intervention targeting proximal muscles in 40 people with MS. The investigators will assess
      implementation feasibility (recruitment, fidelity, retention, satisfaction), collect pilot
      data for key walking function outcomes, and examine movement-pattern and activity behavior
      mechanisms. Walking function will be measured by walking capacity (6-Minute Walk Test - 6MWT)
      and PA quantity (average steps/ day over 10 days). Movement-pattern mechanisms will be
      measured using 3D motion capture analysis (pelvis and trunk kinematics). Activity behavior
      mechanisms will be measured by patient-reported outcome questionnaires (perception of walking
      ability, self-efficacy, and readiness to change).
    

Detailed description: 
      The proposed study will be a prospective cohort in 40 people with MS with one baseline and
      one follow-up assessment after a 10-week functional resistance training intervention. The
      screening and outcome assessments will take place in the CU Interdisciplinary Movement
      Science Lab and intervention will occur in the CU Physical Therapy Program gym. Both
      facilities have the necessary space and equipment for outcomes assessment and intervention,
      respectively. The PI will perform the initial screening and deliver the intervention. In
      order to limit testing bias, all functional tests, patient-reported outcomes, and motion
      capture data collection will be performed by an experienced research assistant.

      Participants will receive 14 one-on-one supervised intervention visits over 10 weeks.
      Intervention frequency will mimic clinical practice, starting at 2x/ week in clinic (2x/ week
      independently) for four weeks and tapering to 1x/ week in clinic (3x/ week independently) for
      the final six weeks. Participants will be prescribed 5 categories of resistance exercises,
      and each category will have a series of exercises to select from. Two will target hip
      abduction (lying down and standing), two will target trunk muscles (sidelying/ forward
      planks, resisted trunk rotation), and one will target functional resistance training for the
      hip and trunk during walking-related tasks such as multi-directional resisted walking. Dosing
      will be based on guidelines for MS. Strengthening exercises will begin with 3 sets of 12-15
      reps at 15 rep-max load (RM) and progress to 3 sets of 8-10 reps at 10-12 RM. Endurance
      exercises requiring a static hold will progress from 3 sets of 15-20 second holds to
      30-second holds. Functional resistance will be dosed to improve muscular endurance: 3 sets of
      15-20 reps based on form fatigue. Progression will be achieved by modifying body position,
      and/or adding cuff weights or resistance bands. Exercises will take 30-45 minutes to
      complete. Upper extremity use to maintain balance will be allowed as needed.
    

Intervention name(s): Proximal Resistance Training
Intervention type(s): Other
Intervention description(s): Participants will be prescribed 5 categories of resistance exercises, and each category will have a series of exercises to select from. Two will target hip abduction, two will target trunk muscles, and one will target functional resistance training for the hip and trunk during walking-related tasks such as multi-directional resisted walking. Dosing will be based on guidelines for MS. Strengthening exercises will begin with 3 sets of 12-15 reps at 15 rep-max load (RM) and progress to 3 sets of 8-10 reps at 10-12 RM. Endurance exercises requiring a static hold will progress from 3 sets of 15-20 second holds to 30-second holds. Functional resistance will be dosed to improve muscular endurance: 3 sets of 15-20 reps based on form fatigue.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Exercise; Hip abduction; Trunk muscles