Treadmill exercise in early mutiple sclerosis: a case series study

AIM: The effect of specific exercise therapy programs on the management of balance and walking disorders in multiple sclerosis (MS) patients have not been fully explained yet. Reproducible measurement systems are especially required to show their efficacy. The aim of the present case series study was to explore the feasibility of an aerobic treadmill rehabilitation protocol (endurance training protocol) and its effects on walking parameters, muscular activity and postural balance. An adequate instrumental measure set was adopted to provide evidence of minimal motor dysfunction, not quantifiable by means of standard clinical examination. METHODS: Three minimally impaired MS patients were enrolled. The patients underwent endurance training on a treadmill for four weeks. Posturographic assessment, energy cost measurement and gait analysis by basography and surface electromyography recordings were used as outcome measures. RESULTS: Energy cost during treadmill walking was generally reduced in the three patients after exercise. Indexes of both sway path and sway area used for postural stability measurement were reduced after exercise in two patients, particularly with eyes closed. Minor changes were observed in gait pattern in terms of foot placement. Muscular activity pattern tended to normalize after training. CONCLUSION: The aerobic treadmill exercise is feasible, safe and it may improve early anomalies of posture and gait in early MS patients. In the context of an impairment oriented rehabilitation approach, the set of instrumental measurements proposed seems to be able to identify subclinical anomalies in a very low degree of functional involvement on an individual basis.