Individuals with multiple sclerosis (MS) often have muscular weakness, fatigue, ataxia and balance impairments. This can often negatively contribute to their walking ability, especially walking speed. This systematic review aimed to investigate the effects of lower limb resistance training on walking speed in individuals with MS.
Seven databases were searched for randomised controlled trials (RCTs) published in English. The databases included CINAHL, Medline, The Allied and Complimentary Medicine Database, Web of Science, Physiotherapy Evidence Database (PEDro), PsycINFO, and Sports Medicine and Education Index. Full text articles were screened by two reviewers and disagreements resolved by a third reviewer. Eligible studies included people aged ≥ 18 years with a diagnosis of MS (disease duration, phenotype of MS and disability level was disregarded), resistance training interventions for the lower limbs (with or without supervision, regardless of duration of intervention or training session frequency, duration, intensity, volume) and outcomes included 1 or more objective measure of walking speed. Resistance training was any type of exercise using a variable amount of external resistance completed over one or more sets of a certain number of repetitions. Excluded studies were interventions that combined resistance training with other interventions, outcomes of overall functional mobility (e.g., timed up and go test). The comparator was active control (hatha yoga, mobility exercise, home based neurofunctional training, balance and motor control training, circuit endurance training) or no-intervention control. The outcome was walking speed, measured by standardised walking test measures. The methodological quality of included studies was assessed using the PEDro scale for RCTs, independently evaluated by two reviewers. and any disagreements resolved by a third reviewer.
Twelve studies, involving 425 participants were included . The Expanded Disability Status Scale was used to assess disability, ranging from 1.0 to 6.0, indicating mild to moderate disability. Of those studies who reported MS phenotypes, 322 had relapsing-remitting MS, 35 had secondary progressive MS, and 22 had primary progressive MS. Six studies recruited relapsing-remitting MS participants only. Of all participants, 180 participants received resistance training, 139 participants received no interventions and 85 participants received an active control. Across all studies, five outcome measures were used: 10-Meter Walk Test (10MWT), Timed 25-Foot Walk Test (T25FWT), 50-Meter Walk Test (50MWT), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT). Seven articles included lower body exercises, four articles included upper and lower body exercises of which two studies also included core exercises. One study compared a high intensity concentric resistance training program of the less affected/stronger ankle dorsiflexor muscles to one training the more affected/weaker ankle dorsiflexor muscles. The methodological quality of the trials ranged from 3 to 8 on the PEDro scale.
Of the 12 studies, eight studies found a within-group improvement for the effect of resistance training on at least one measure of walking speed. Six studies compared the effects of resistance training with no-intervention controls but only one study found a significant between-group difference between post intervention favouring the resistance training group. No studies found significant between changes favouring the resistance training group when compared with the active control group. Seven studies that compared the effects of resistance training with no-intervention controls were included in a meta-analysis. When results were pooled within a random effects model, a significant improvement in walking speed of 0.10m/s (95% CI 0.01 to 0.19) was found favouring the intervention (p < 0.05 with high heterogeneity (I2 = 83%). As a result, a sensitivity analysis involving results from short walking tests (10MWT, T25FWT, 50MWT) showed a larger overall effect on walking speed (0.13 m/s, 95% CI 0.04 to 0.23, p < 0.05). Comparatively, results from longer walking tests (2MWT, 6MWT) showed a smaller improvement in walking speed (0.09 m/s, 95% CI 0.01 to 0.17, p < 0.05).
Resistance training improves walking speed compared to active control and no-intervention controls among people with MS.
McManaman, C., Novak, B., Paul, L., & Rooney, S. (2025). Changes in walking speed following resistance training in people with multiple sclerosis: A systematic review and meta-analysis. PM & R : the journal of injury, function, and rehabilitation, 17(2), 222–237. https://doi.org/10.1002/pmrj.13255
