ClinicSpeak: progressive resistance training

Physical therapy improves fatigue, muscle endurance and balance in MS. #ClinicSpeak #MSBlog #MSResearch

“Another home physical therapy programme augmented with an electrical device to improve physical functioning in MSers with walking difficulties. Not surprisingly participants noticed an improvement in fatigue levels as well. Other positives included improved muscle endurance and balance. It would be interesting to find-out if the latter could transfer to better outcome in terms of reduced falls and fractures. The problem with this programme is that it needs a technology, neuromuscular electrical stimulation, and hence is not accessible to most MSers. It is obvious that this is quite a specialised intervention and will only be provided by specialist units. If you think you would benefit from this therapy you should discuss it with your physiotherapist. The latter is another problem in that most MSers don’t have regular physio, nor do they have a named therapist.”

Coote et al. A pilot randomized trial of progressive resistance exercise augmented by neuromuscular electrical stimulation for people with Multiple Sclerosis who use walking aids. Arch Phys Med Rehabil. 2014 Oct 9. pii: S0003-9993(14)01128-9.

OBJECTIVE: To investigate the feasibility and preliminary outcomes of a home progressive resistance training program augmented by neuromuscular electrical stimulation.

DESIGN: Randomized, controlled, pilot trial 

SETTING: Participants home 

PARTICIPANTS: People with Multiple Sclerosis (n=37) who use a walking aid.

INTERVENTIONS: Twelve week home PRT program or the same augmented by neuromuscular electrical stimulation (NMES). 

MAIN OUTCOME MEASURES: Strength using hand held dynamometry, repeated sit to stand test, Berg balance scale, Timed Up and Go test (TUG), MS walking scale 12, MS Impact Scale 29v2, modified Fatigue Impact Scale (MFIS) and the NMES group completed a device usability questionnaire.

RESULTS: Only change in MFIS score was significantly greater in the NMES than the PRT group (p=0.012). The NMES group improved significantly in quadriceps endurance (median of change 8.5, p=0.043), balance (3.5, p=0.001), physical impact of MS (-8.3, p=0.001) and impact of fatigue (-17, p=0.001). Participants rated the device as highly usable.

CONCLUSION: This pilot study suggests that a home PRT program with NMES is feasible and the Kneehab device is usable by this population. Only the reduction in impact of fatigue was greater in the NMES than the PRT group.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Fantastic this helps for people with walking difficulties and fatigue. I'm not in a position where I need this (hopefully I never will but nothing is certain with MS) but it is a tragedy that those that do, don't have easy access. A named therapist..perhaps some people do but I suspect most who need this, do not.

  • I'm still doing physio prescribed exercises and last strength check showed improvement..such a shame that "most MSers don't have regular physio, nor do they have a named therapist."

  • I could access £56,000 of MS drugs I don't want but unfortunately my wonderful neurorehabilitation therapist can't help me as she has only 18 hours allocated per week to cover 380 MS patients – thanks for nothing NICE

  • Is this a fancy Stim? If so then isn't the patient going to be expected to pay for the attendance of specialists? We can foresee a need for precise physiological measurements, and the calibration of instruments to be made – I wouldn't want just anyone pulsing current into me ( I'm sure you're familiar with the Asch experiments)?
    Should the outcome be to train MS patients how to effectively use devices like TENS and STIMs to address the problems caused by deconditioning, and spasticity in addition to pain?

  • I made the decision ten years ago to spend money on private neurophysio and have 30 mins weekly in a hydrotherapy pool on a one-to-one basis. It's good on so many levels – a) overall strength, stamina and fitness tested b) precise identification of affected muscle groups, so ongoing targeted exercises c) week-by-week variations/problems quickly dxd and addressed. Over the years, there have been many little ups and downs but so far, physio has sorted it all and (I am told) I haven't lost ground. My physio has worked in tandem with the team at FES and my hospital's orthotist. Paying for physio has meant less money on other things but I can't think of a better investment. I also do and very much value Pilates, which I reckon is first cousin to physio and is accessible to more people. Importantly, if you can get your musculo-skeletal issues addressed, you're better able to do regular exercise.

  • I had my first physio appointment this week. The physio had a student with her observing which I was fine with. She began by asking me loads of questions I said I like being questioned alot. Sometimes she repeated a question, just asked it in a different way. This I thought was great and she was very thorough.
    I said I had clonus in my left ankle and she tested both ankles and now it seems I have it in both ankles.
    I have a few exercises to do each day now to hopefully help me get better.

By Prof G



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