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From Masku Neurological Rehabilitation Centre (A. Romberg and Dr. Ruutiainen), Masku; Research Department (A. Virtanen and S.-L. Karppi), Social Insurance Institution, Turku; Laboratory of Population Research (Dr. Aunola, M. Vaara, and J. Surakka), Department of Health and Functional Capacity, Public Health Institute, Turku; Rehabilitation Unit of Orton (Dr. Pohjolainen), the Invalid Foundation, Helsinki; and Health and Income Security Department (Dr. Seppänen), Social Insurance Institution, Helsinki, Finland.
Address correspondence and reprint requests to Anders Romberg, Masku Neurologic Rehabilitation Centre, PO Box 15, FIN-21251 Masku, Finland; e-mail: anders.romberg{at}ms-liitto.fi
Objective: To improve walking and other aspects of physical function with a progressive 6-month exercise program in patients with multiple sclerosis (MS).
Methods: MS patients with mild to moderate disability (Expanded Disability Status Scale scores 1.0 to 5.5) were randomly assigned to an exercise or control group. The intervention consisted of strength and aerobic training initiated during 3-week inpatient rehabilitation and continued for 23 weeks at home. The groups were evaluated at baseline and at 6 months. The primary outcome was walking speed, measured by 7.62 m and 500 m walk tests. Secondary outcomes included lower extremity strength, upper extremity endurance and dexterity, peak oxygen uptake, and static balance. An intention-to-treat analysis was used.
Results: Ninety-one (96%) of the 95 patients entering the study completed it. Change between groups was significant in the 7.62 m (p = 0.04) and 500 m walk tests (p = 0.01). In the 7.62 m walk test, 22% of the exercising patients showed clinically meaningful improvements. The exercise group also showed increased upper extremity endurance as compared to controls. No other noteworthy exercise-induced changes were observed. Exercise adherence varied considerably among the exercisers.
Conclusions: Walking speed improved in this randomized study. The results confirm that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.
Received February 13, 2004. Accepted in final form July 26, 2004.
Dr. Aunola was an employee of Social Insurance Institution from 1974 through 2003.
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