Multiple sclerosis and exercise in people with minimal gait impairment – a review.

Objectives: The objectives of this review are to describe the effect of exercise on body structure and function, activities and participation in people with multiple sclerosis (MS) with mild gait dysfunction, to evaluate the quality of research in this area and to guide therapists in determining which parameters of exercise programmes could be used. Methods: A systematic search of the literature was conducted. Quality was assessed using a simple method to evaluate bias. All trials since 2004 that have included people who walk with at most one stick have been included (i.e. EDSS ≤6). Results: Aerobic, progressive resistance exercise (PRE), combined exercises and other interventions appear to have positive effects on body structure and function, activities and participation in people with mild MS. No harmful effects were seen in any intervention. Both aerobic exercise and PRE have very defined and reproducible parameters. A combination of aerobic exercise and PRE is feasible and potentially offers the most favourable results in terms of the negative symptomology and physiological profile. Yoga and aqua aerobics also had positive effects and are feasible for this population. However, there is a moderate to high risk of bias in studies conducted since 2004 limiting their validity. Discussion: The effectiveness of interventions for patients with different impairments remains unclear due to the levels of bias in studies evaluating exercise in people with MS. Future studies should focus on the randomised controlled trial (RCT) paradigm. A high quality, RCT comparing a combined exercise programme, yoga and a control, with a long term follow up, is required. [ABSTRACT FROM AUTHOR]