Total Body Recumbent Stepper Training in Progressive MS: An Alternative Training Therapy for Patients With Impaired Mobility
Total Body Recumbent Stepper Training in Progressive MS: An Alternative Training Therapy for Patients With Impaired Mobility
This project will evaluate a new therapy for patients with a severe form of MS known as progressive MS. These patients are severely limited in their ability to walk and function in everyday life. The exercise therapy we are proposing is a recumbent cross trainer which allows patients to be seated and move their arms and legs at the same time against resistive foot pedals and arm levers. The recumbent cross trainer is safe and easy to use for people with disabilities and is more cost-effective compared with other rehabilitation equipment. Before the recumbent trainer can become part of mainstream MS therapy, it is important to determine if it is as effective as other exercise therapies in improving functional performance and quality of life. In this study we will compare the effects of the recumbent cross training with supported treadmill walking on functional and psychological outcomes. Further, since this is a new therapy for progressive MS patients, we also want to determine if it is safe and enjoyable to use.
We hypothesize that recumbent stepper training will be safe and well-tolerated by progressive MS patients. Both training interventions will be beneficial in improving walking function and psychosocial outcomes. Recumbent stepper straining will likely have greater effects on upper extremity function, while supported treadmill walking will have greater effects on lower extremity function.
We are proposing to evaluate the clinical utility and efficacy of a new therapeutic exercise modality for patients with progressive MS with severe functional impairments.
Progressive MS patients have limited treatment options and reach higher disability levels at a faster rate than relapsing remitting MS patients. Consequently, finding solutions to maintain function and improve quality of life of patients with progressive MS is essential.
A traditional training modality for patients with limited mobility is body-weight supported treadmill training (BWSTT). Our preliminary results support the efficacy of BWSTT in progressive MS patients; however, the financial burden and labour-intensive nature of BWSTT does not make it a viable option for most settings. For the aforementioned reasons, we are proposing total body recumbent stepper training (TBRST) as an alternative therapy for progressive MS patients with mobility impairments. TBRST is advantageous over BWSTT in that it has low set-up and maintenance costs, is easily used by patients with limited mobility and requires minimal assistance to operate. TBRST has the potential to become part of conventional MS treatment programs and could easily be incorporated into home and community settings. The primary aim of this investigation is to establish safety and satisfaction with TBRST in progressive MS patients. Second, we plan to determine if TBRST is as effective as a BWSTT as a therapeutic modality.
Twenty patients with progressive MS (primary and secondary) of high disability level (EDSS 6.0-8.0) will be recruited to participate in this study. Both primary and secondary MS patients will be included due to similarities in disease progression and a lack of available alternative treatments for this population. Patients will be randomized to either the TBRST or BWSTT intervention; there will be 10 patients in each group. Patients in the TBRST program will train using the Nustep (TRS 4000) recumbent cross trainer. The recumbent cross trainer allows patients to move their legs in a natural stepping motion with bilateral reciprocal movement of the arms from a seated position. Foot straps, leg stabilizers and hand stabilizers may be used for added control and proper body alignment when necessary. Patients in the BWSTT group will exercise using the Woodway Loco-system which allows a portion of the patient's body-weight to be off-loaded by an overhead pulley system. Treadmill therapists will guide the patients' legs through a proper gait motion and assist with lower limb control.
Participants in both interventions will complete three weekly exercise sessions of 30min, for the duration of 12 weeks. Perceived exertion will be used as an indicator of exercise intensity and will guide program progression. Both intervention groups will maintain a perceived exertion of 5-7 on the Borg CR10 Scale throughout the exercise program. All patients will be evaluated at baseline and following 12 weeks on a variety of outcome measures. Primary outcome measures will be safety and satisfaction with TBRST. Secondary outcomes will be functional ability using the EDSS and MSFC, quality of life using the MSQOL-54, fatigue using the MFIS and MS self-efficacy using the MSSE. The proposed research will take place over one year with enrolment and intervention programs commencing in a graded manner.
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