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REVIEW ARTICLE (META-ANALYSIS)| Volume 102, ISSUE 12, P2464-2481.e33, December
2021
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Physical Activity and the Health of Wheelchair Users: A Systematic Review in
Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury
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PHYSICAL ACTIVITY AND THE HEALTH OF WHEELCHAIR USERS: A SYSTEMATIC REVIEW IN
MULTIPLE SCLEROSIS, CEREBRAL PALSY, AND SPINAL CORD INJURY
* Shelley S. Selph, MD, MPH
Shelley S. Selph
Correspondence
Corresponding author Shelley S. Selph, MD, MPH, Oregon Health & Science
University, 3181 Southwest Sam Jackson Park Rd, Mail Code BICC, Portland, OR
97239.
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Pacific Northwest Evidence-based Practice Center, Department of Medical
Informatics and Clinical Epidemiology, Oregon Health and Science University,
Portland, Oregon
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* Andrea C. Skelly, PhD, MPH
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Aggregate Analytics Inc, Fircrest, Washington
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* Ngoc Wasson, MPH
Ngoc Wasson
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Pacific Northwest Evidence-based Practice Center, Department of Medical
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Open AccessPublished:October 12,
2021DOI:https://doi.org/10.1016/j.apmr.2021.10.002
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ABSTRACT
OBJECTIVE
To understand the benefits and harms of physical activity in people who may
require a wheelchair with a focus on people with multiple sclerosis (MS),
cerebral palsy (CP), and spinal cord injury (SCI).
DATA SOURCES
Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied
Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November
2020).
STUDY SELECTION
Randomized controlled trials, nonrandomized trials, and cohort studies of
observed physical activity (at least 10 sessions on 10 days) in participants
with MS, CP, and SCI.
DATA EXTRACTION
We conducted dual data abstraction, quality assessment, and strength of
evidence. Measures of physical functioning are reported individually where
sufficient data exist and grouped as “function” where data are scant.
DATA SYNTHESIS
No studies provided evidence for prevention of cardiovascular conditions,
development of diabetes, or obesity. Among 168 included studies, 44% enrolled
participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may
be improved with treadmill training and multimodal exercises; function may be
improved with treadmill, balance exercises, and motion gaming; balance is likely
improved with balance exercises and may be improved with aquatic exercises,
robot-assisted gait training (RAGT), motion gaming, and multimodal exercises;
activities of daily living (ADL), female sexual function, and spasticity may be
improved with aquatic therapy; sleep may be improved with aerobic exercises and
aerobic fitness with multimodal exercises. In CP, balance may be improved with
hippotherapy and motion gaming; function may be improved with cycling,
treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT.
CONCLUSIONS
Depending on population and type of exercise, physical activity was associated
with improvements in walking, function, balance, depression, sleep, ADL,
spasticity, female sexual function, and aerobic capacity. Few harms of physical
activity were reported in studies. Future studies are needed to address evidence
gaps and to confirm findings.
KEYWORDS
* Activities of daily living
* Cerebral palsy
* Exercise
* Mental health
* Multiple sclerosis
* Physical fitness
* Rehabilitation
* Spinal cord injuries
* Wheelchairs
LIST OF ABBREVIATIONS:
ADL (activities of daily living), AHRQ (Agency for Healthcare Research and
Quality), CP (cerebral palsy), MS (multiple sclerosis), RCT (randomized
controlled trial), RAGT (robot-assisted gait training), SCI (spinal cord
injury), Vo2peak (peak oxygen consumption)
The benefits of regular physical activity for the general population include
reduced risk of heart disease, stroke, type 2 diabetes, dementia, depression,
and various cancers (eg, breast, colon, lung cancer).
1
Physical Activity Guidelines Advisory Committee. 2008 Physical Activity
Guidelines for Americans. Available at: https://health.gov/paguidelines/2008/.
Accessed February 27, 2020.
* Google Scholar
Although routine physical activity combining aerobic exercise with strength and
balance training is recommended for people with physical disabilities,
2
2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity
Guidelines Advisory Committee Scientific Report. Available at:
https://health.gov/paguidelines/second-edition/report/pdf/PAG_Advisory_Committee_Report.pdf.
Accessed February 27, 2020.
* Google Scholar
less is known about the specific benefits and potential harms for this diverse
population. In particular, the various populations using wheelchairs because of
their physical disabilities is broad and poorly captured in the literature on
physical activity; thus, we expanded our criteria for study inclusion beyond
“wheelchair users.” This review includes 3 diverse conditions commonly
associated with wheelchair use: multiple sclerosis (MS), cerebral palsy (CP),
and spinal cord injury (SCI). One survey estimated that 45% of patients with MS
have difficulties with mobility shortly after diagnosis and almost all have
mobility issues after 10 years.
3
* van Asch P
Impact of mobility impairment in multiple sclerosis 2—patient perspectives.
Eur Neurol Rev. 2011; 6: 115-120
* Crossref
* Google Scholar
One study found 29% of children aged 3-18 years used a wheelchair indoors and
41% used a wheelchair outdoors.
4
* Rodby-Bousquet E
* Hägglund G
Use of manual and powered wheelchair in children with cerebral palsy: a
cross-sectional study.
BMC Pediatr. 2010; 10: 59
* Crossref
* PubMed
* Scopus (42)
* Google Scholar
Depending on the level and extent of spinal cord injury, many persons with SCI
require a wheelchair for all mobility.
These 3 conditions not only represent different etiologies and pathophysiologies
but different populations as well. Studies enrolling a population with MS are
often in adult women, studies enrolling people with SCI are largely in adult
men, and studies enrolling participants with CP are often in children and
adolescents.
The review was conducted to inform a National Institutes of Health Pathways to
Prevention Workshop and guideline development on “Can Physical Activity Improve
the Health of Wheelchair Users?” to evaluate evidence on the benefits and risks
of physical activity for potential and current wheelchair users
(https://prevention.nih.gov/research-priorities/research-needs-and-gaps/pathways-prevention/can-physical-activity-improve-health-wheelchair-users)
and was nominated to the Agency for Healthcare Research and Quality (AHRQ), who
funded this review (AHRQ contract no. HHSA290201500009I). AHRQ did not
participate in the literature search, determination of study eligibility
criteria, data analysis, or interpretation of findings.
METHODS
This systematic review summarizes and synthesizes current research on the
specific benefits and potential harms of physical activity for people with MS,
CP, and SCI, regardless of current use of a wheelchair. This topic was nominated
by the Director of the National Center for Medical Rehabilitation Research and
supported by the National Institute of Child Health and Human Development, the
National Institute of Neurological Disorders and Stroke, the National Institutes
of Health Office of Disease Prevention, and the National Institutes of Health
Medical Rehabilitation Coordinating Committee, along with other federal partners
for a Pathways to Prevention workshop to assess the benefits and harms of
physical activity on the physical and mental health of adults, children, and
adolescents using a wheelchair or who may benefit from using a wheelchair in the
future. Prior to conducting this review, the Evidence-based Practice Center
refined the preliminary Key Questions and PICOTS (Populations, Interventions,
Comparators, Outcomes, Timing, Studies, Settings) with the AHRQ Task Order
Officer and representatives from National Institutes of Health (tables 1 and 2).
In considering studies related to physical activity among 3 representative
populations, we prioritized certain outcomes. These include long-term health
outcomes, function, activities of daily living, and quality of life, among
others. We considered walking, balance, activities of daily living (ADL), and
other outcomes individually when data permitted. When data were sparse, we
grouped different outcomes under the umbrella term “function” to determine
whether an intervention was beneficial or not overall. Individual study findings
can be found in the supplemental tables S1-4 (available online only at
http://www.archives-pmr.org/). We also specify the type of function involve in
the summary of evidence table 3 (eg, mobility includes standing, stepping,
walking, running, and jumping). Specific outcomes included in each function
domain are found in supplemental table S5 (available online only at
http://www.archives-pmr.org/). We evaluated outcomes of diverse physical
activity interventions, inclusion/exclusion criteria, and research methodologies
to identify future research needs. The protocol was published on the AHRQ
website
(https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/wheelchair-users-amended-protocol.pdf).
The protocol for this review was also submitted to the PROSPERO systematic
review registry (CRD42019130060). Comprehensive methods including the search
strategies, evidence tables, and study quality ratings are in the full report
(in press to be available at https://effectivehealthcare.ahrq.gov/).
Table 1PICOTS—inclusion and exclusion criteria
PICOTSInclusionExclusionPopulationsPatients using a wheelchair or those who may
benefit from using a wheelchair in the future because of MS, CP, or SCI. All
ages included.• Other populations
• Studies of mixed populations with <80% MS, CP, SCIInterventionsAny gross motor
intervention with a defined period of directed physical activity that is
expected to increase energy expenditure. Intervention must have a minimum of 10
sessions of activity on 10 d or more in a supervised or group setting. Include
aerobic exercise, strength training, standing, balance, flexibility, and
combination interventions.
Included activities (not exhaustive, additional activities may qualify):
Balance/flexibility
• Stretching/flexibility
• Yoga or Pilates
• Martial arts (eg, tai chi)
• Hippotherapy (equine-assisted therapy)
Physical/aerobic exercise
• Arm ergometry
• Cycling (stationary, recumbent, arm)
• Weight lifting/strength training
• Functional electronic stimulation
• Robot-assisted gait training
• Swimming
• Aquatic therapy
• Group exercise
• Team sports
• Treadmill (including with body weight support)
Strength/resistance training
• Resistance bands
• Weight lifting• Interventions with <10 sessions
• Interventions over a period lasting <10 d
• Unobserved physical activity
• Family- or caregiver-observed physical activity
• Patient-recalled physical activity
• Postoperative physical activity
• Intervention focused on improving reaching
• Interventions without whole body effect (eg, targeting one joint)
• Intervention reported in only one studyComparatorsComparisons with no physical
activity or other types of physical activity or behavioral counseling.• All
other active controlsOutcomesCardiovascular
• Cardiovascular mortality, myocardial infarction, stroke, all-cause mortality,
resting heart rate, resting blood pressure, lipid profile
Respiratory
• Pulmonary function tests, V̇o2max/Vo2peak, spirometry
Endocrine
• Development of diabetes, Hb A1c, fasting blood glucose, development of
metabolic syndrome, metabolic rate
Gastrointestinal
• Bowel function, bowel impaction
Genitourinary
• Bladder function, urinary tract infection
Musculoskeletal
• Fracture, bone mineral density, muscle strength, rotator cuff injury, shoulder
pain, range of motion
Reproductive
• Sexual function• Outcomes not used to make clinical decisions (eg, estradiol)
• Other outcomes (eg, head pitch and roll, kinematic variables, stepping
kinematics, reaching, muscle thickness, muscle quality, blood flow restriction,
premotoneuronal control)
• Hospitalization or length of stay
• Cognition
• Pain other than shoulder painIntegumentary
• Decubitus ulcers
Body composition
• Weight, BMI, development of obesity, waist circumference, % body fat
Mental health
• Depression, quality of life, anxiety, stress, sleep
General function
• Walking, falls, wheelchair use, function scales, disability, ADL, balance,
physical fitness
Neurologic
• Autonomic dysreflexia, spasticity, thermodysregulation, carpal tunnel
syndromeTimingAt least 10 d with at least 1 session of physical activity per
day.• Acute SCI, undergoing stabilization
• Immediate postoperative periodSettingAny setting, including, clinic, home, or
community setting (eg, gym or athletic class). Physical activity occurring in
the home must still be observed by medical, research, or athletic staff.• Non-US
applicable studiesStudy designs• Randomized controlled trials published since
2008
• Controlled observational studies published since 2008
• Systematic reviews published since 2014 to review for additional studies
meeting inclusion criteria
• Potentially include pre-post studies in the absence of clinical trials and
controlled observational studies
• Studies with the following sample sizes: MS (N≥30), CP (N≥20), SCI (N≥20).•
All other study designs (eg, case series, case reports)
• Studies published before 2008
• Systematic reviews published before 2015
Abbreviations: BMI, body mass index; Hb A1c, glycosylated hemoglobin; US, United
States; V̇o2max, maximum oxygen consumption.
* Open table in a new tab
Table 2Overview of included studies by intervention category and population
*
Studies with multiple interventions appear more than once on the table. Studies
with only intermediate outcome(s) appear in full report tables.
CategoryInterventionMultiple Sclerosis
n=74
(85 Publications)Cerebral Palsy
n=63
(73 Publications)Spinal Cord Injury
n=31
(39 Publications)Total Studies
N=168
(197 Publications)Aerobic exerciseAerobics4 RCTs
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No studiesn=8
6 RCTs
2 quasi-experimental studiesAerobic exerciseAquatics6 RCTs
13
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19 RCTs
1 cohort study
1 quasi-experimental study
Abbreviations: PRE, progressive resistance exercise.
Studies with multiple interventions appear more than once on the table. Studies
with only intermediate outcome(s) appear in full report tables.
* Open table in a new tab
Table 3Summary of evidence
CategoryInterventionNo. of Studies; Study Design; Participants (n)Key
PointsStrength of EvidenceKQ 1. Prevention of cardiovascular conditions,
diabetes, and obesityNo studiesNANANANAKQ 2. Benefits and harms of physical
activity vs usual care, attention control, waitlist control, no
interventionAerobic exerciseAerobicsMS: 2 RCTs (77)
MS/CP: 2 RCTs (81)Improved sleep scores
Improved function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
Low
LowAquaticsMS: 2 RCTs (62)
MS: 1 RCT (73)
MS: 1 RCT (60)
MS: 1 RCT (73)Improved balance
Improved ADL
Improved female sexual function
Improved spasticityLow
Low
Low
LowCyclingMS: 6 RCTs (277)
CP: 2 RCTs (85)No clear benefit on function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Low
LowRobot-assisted gait trainingMS: 2 RCTs (97)
MS: 2 RCTs (97)
SCI: 2 RCTs (176)
SCI: 3 RCTs (170)No clear benefit on function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
Improved balance
Improved ADL
No clear benefit on function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Low
Low
Low
LowTreadmillMS: 2 RCTs (50)
CP: 2 RCTs (53)Improved walking
Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Low
LowPostural control interventionsBalance exercisesMS: 7 RCTs (369)
MS: 10 RCTs (553)
MS: 2 RCTs (128)Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Improved balance
Improved fall riskLow
Moderate
LowHippotherapyCP: 5 RCTs, 2 QENRS (333)
CP: 1 RCT, 2 QENRS (150)Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Improved balanceLow
LowTai chiMS, CP, SCIAny included outcomeInsufficientMotion gamingMS: 4 RCTs
(177)
MS: 3 RCTs (94)Improved function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
Improved balanceLow
LowWhole body vibrationMS, CP, SCIAny included outcomeInsufficientYogaMS: 4 RCTs
(215)No clear benefit on function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
LowStrength interventionsMuscle strength exercisesMS: 8 RCTs (332)
MS: 5 RCTs (178)
MS: 3 RCTs (100)
MS: 6 RCTs (319)
MS: 1 RCT (71)
CP: 3 RCTs (140)
CP: 3 RCTs (134)Improved walking
No clear benefit on function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
No clear benefit on quality of life
No clear benefit on balance
No clear benefit on spasticity
No clear benefit on walking
No clear benefit on function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Low
Low
Low
Low
Low
Low
LowMultimodal interventionsPRE or strength exercise plus aerobic or balanceMS: 4
RCTs (176)
MS: 4 RCTs (224)
MS: 2 RCTs (123)
CP: 3 RCTs (135)
CP: 2 RCTs (107)Improved walking
Improved balance
Improved cardiovascular fitness
No clear benefit on function (motor)
‡
Motor outcomes measure gross motor or upper extremity function (Gross Motor
Function Measure-66, Gross Motor Function Measure-88, Quality of Upper Extremity
Skills Test).
No clear benefit on quality of lifeLow
Low
Low
Low
LowAll ExerciseMS: 10 RCTs (448)
MS: 25 RCTs (1436)
MS: 17 RCTs (906)
MS: 15 RCTs (743)
CP: 11 RCTs (500)
CP: 2 QENRS (54)
SCI: 3 RCTs (171)
SCI: 4 RCTs (129)
SCI: 2 RCTs/1 Cohort study (88)Improved depression scores
Improved walking
Improved balance
No clear benefit on function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Improved cardiovascular fitness
No clear benefit on depression scores
Improved function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Improved cardiovascular fitnessModerate
High
Moderate
Moderate
Low
Low
Low
Low
LowBenefits and harms of physical activity vs another physical activityAerobic
exerciseRobot-assisted gait training vs overground walking
Treadmill training vs overground walkingMS: 1 RCT (72)
MS: 1 RCT (72)
MS: 1 RCT (72)
CP: 5 RCTs (130)
CP: 4 RCTs (109)No clear benefit on function (mobility)
*
Mobility outcomes involve standing, stepping, walking, running, jumping.
No clear benefit on quality of life
No clear benefit on balance
No clear benefit on walking
No clear benefit on function (multifactorial)
†
Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
Low
Low
Low
Low
LowKQ 3. Patient factors affect the benefits and harms of physical activityMS: 1
RCT (69)
MS: 1 RCT (89)
CP: 1 RCT (39)
SCI: 2 RCTs (58)
Greatest strength improvement in women who were least strong at baseline
Improvements in walking, function, and Vo2 peak with multimodal exercise
compared with a waitlist control, but these differences were not statistically
significant after adjustment for baseline disability
6-7 year olds had improved sitting scores with hippotherapy compared with no
hippotherapy, whereas children aged 8-12 years had similar scores, but there was
no difference in the effect of the intervention based on disability level at
baseline
Better baseline function and more recent injury were associated with greater
improvements in walkingNA
NA
NA
NAKQ 4. Methodological weaknesses or gapsNo studiesNANANANA
NOTE. Specific instruments/measures that comprised function outcomes can be
found in supplemental table S5.
Abbreviations: KQ, key question; NA, not applicable; PRE, PRE, progressive
resistance exercise; QENRS, quasi-experimental nonrandomized studies.
Mobility outcomes involve standing, stepping, walking, running, jumping.
† Multifactorial outcomes include outcomes from multiple domains or scales that
assess multiple domains (activities of daily living, balance, participation,
motor skills, mobility).
‡ Motor outcomes measure gross motor or upper extremity function (Gross Motor
Function Measure-66, Gross Motor Function Measure-88, Quality of Upper Extremity
Skills Test).
* Open table in a new tab
The key questions for this report include the following:
* 1.
What is the evidence base on physical activity interventions to prevent
obesity, diabetes, and cardiovascular conditions, including evidence on harms
of the interventions in people with MS, CP, or spinal cord injury?
* 2.
What are the benefits and harms of physical activity interventions for people
with MS, CP, or spinal cord injury?
* 3.
What are the patient factors that may affect the benefits and harms of
physical activity in patients with MS, CP, or spinal cord injury?
* 4.
What are methodological weaknesses or gaps that exist in the evidence to
determine benefits and harms of physical activity in patients with MS, CP, or
spinal cord injury?
For the search strategy a research librarian searched MEDLINE, Cumulative Index
to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, Embase, Rehabilitation
and Sports Medicine Source, and ClinicalTrials.gov. We limited the search to
studies published since 2008, when the first United States Department of Health
and Human Services physical activity guidelines were published,
1
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Technical Expert Panel members were asked to provide suggestions about
unpublished literature, and authors of studies were contacted for information
(no additional information was provided).
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Center Program Methods Guidance
(https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and are
detailed in the full report (in press to be available at
https://effectivehealthcare.ahrq.gov/).
The criteria for selection of studies to be included in the review were
preestablished and used to determine eligibility for inclusion and exclusion of
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We included studies from countries with a very high or high score on the Human
Development Index because results from these studies are more likely similar to
studies conducted in the United States. Using these predefined eligibly
criteria, 2 independent investigators reviewed abstract and full-text articles.
Systematic reviews were used to identify additional studies.
Interventions with a defined period of observed physical activity (movement
using more energy than rest) with a minimum of 10 sessions of activity on 10
days or more in a supervised or group setting were included (fig 1). Observed
sessions were required to ensure the physical activity intervention took place.
Unobserved sessions were allowed as long as 10 sessions were observed. We
required studies to have analyzed a minimum of 30 participants in MS and 20
participants in CP and SCI (differences in required sample sizes was because of
fewer participants in CP and SCI studies and a desire not to exclude a bulk of
the evidence).
Fig 1Analytic framework diagram. The analytic framework for physical activity
and the health of wheelchair users with multiple sclerosis, cerebral palsy, and
spinal cord injury concepts are illustrated based on key questions and clinical
outcomes as well intermediate outcomes and are described in detail in the full
report. Evidence base descriptions are of studies that evaluate prevention of
obesity, diabetes, cardiovascular conditions, and harms. Abbreviations: BMI,
body mass index; Hb A1c, glycosylated hemoglobin; KQ, key question; V̇o2max,
maximum oxygen consumption.
Show full caption
*Outcomes are specified in the Methods section
†Studies that evaluate prevention of obesity, diabetes, cardiovascular
conditions, and harms.
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
The findings are summarized in evidence tables indicating study characteristics
and outcome results and study quality ratings and are included in summary tables
of the key findings (see tables 2 and 3, detailed in the full report). Findings
are organized by the intervention categories: aerobic exercise (eg, aquatics,
cycling, robot-assisted gait training [RAGT]), postural control (eg, balance
exercises, hippotherapy, motion gaming, yoga), and strength exercises and
multimodal exercise with strength as a major component. Results for each of
these categories are reported by etiology of disability (ie, MS, CP, SCI). Study
quality was independently assessed by 2 investigators and rated as good, fair,
or poor using predefined criteria; disagreements were resolved by consensus.
We conducted quantitative synthesis involving pooling of study findings in
meta-analyses when studies were homogeneous enough to provide meaningful
combined estimates to summarize data from multiple studies and to obtain more
precise and accurate estimates of effects.
Meta-analyses were conducted using STATA 14.0/14.2a and RevMan v5.3.b
Because of the large number of potential outcomes, quantitative synthesis
focused on outcomes previously prioritized for strength of evidence rating
(table 4) with the addition of the Berg Balance Scale, which was not a
prioritized outcome but was the outcome with the most evidence.
Table 4Effects of physical activity interventions compared with usual care
Intervention
Category
InterventionMultiple Sclerosis
Studies
Strength of Evidence
(Direction of Finding)Cerebral Palsy
Studies
Strength of Evidence
(Direction of Finding)Spinal Cord Injury
Studies
Strength of Evidence
(Direction of Finding)Aerobic exercise
dance (1 RCT in MS and 1 RCT in CP)
*
Strength of evidence based on combining the 2 populations, multiple sclerosis
and cerebral palsy.
Low
(function improvement)Low
(function improvement)InsufficientAerobic exercise
AerobicsLow
(sleep improvement)InsufficientInsufficientAerobic exercise
AquaticsLow
(balance, ADL improvement, female sexual
function)InsufficientInsufficientAerobic exercise
CyclingLow
(no clear benefit on walking)Low
(function improvement)InsufficientAerobic exercise
Robot-assisted gait trainingLow
(balance improvement)
Low
(no clear benefit in function)InsufficientLow
(ADL improvement)
Low
(no clear benefit on function)Aerobic exercise
TreadmillLow
(walking, function, balance improvement)Low
(function improvement)InsufficientPostural control
Balance exercisesModerate
(balance improvement)InsufficientInsufficientPostural control
Balance exercisesLow
(fall risk improvement)InsufficientInsufficientPostural control
Balance exercisesLow
(function improvement)InsufficientInsufficientPostural control
HippotherapyInsufficientLow
(balance and function improvement)InsufficientPostural control
Tai chiInsufficientInsufficientInsufficientPostural control
Motion gamingLow
(function, balance improvement)Low
(balance improvement)InsufficientPostural control
Whole body vibrationInsufficientInsufficientInsufficientPostural control
YogaLow
(no clear benefit on function)InsufficientInsufficientStrength interventions
Muscle strength exerciseLow
(no clear benefit on walking, function, balance, quality of life, spasticity)Low
(no clear benefit on walking and function)InsufficientMultimodal exercise
Progressive resistance or strength exercise plus aerobic and/or balance
exerciseLow
(walking, balance, V̇o2 improvement)Low
(no clear benefit on function, quality of life)InsufficientAll types of
exerciseHigh
(walking improvement)Low
(function)Low
(function)Moderate
(balance, depression improvement, no clear benefit on function)Low
(V̇o2 improvement)Low
(V̇o2 improvement, increased episodes of autonomic dysreflexia,
†
Whole body exercise versus exercise limited to upper body.
no clear benefit on depression)
Abbreviation: V̇o2, peak/max (studies reported either peak or max which are
slightly different).
Strength of evidence based on combining the 2 populations, multiple sclerosis
and cerebral palsy.
† Whole body exercise versus exercise limited to upper body.
* Open table in a new tab
RESULTS
The literature search and selection resulted in 19,247 potentially relevant
articles. After dual review of abstracts and full text, we included 168 studies
(N=7511), of which 146 were randomized controlled trials (RCTs), 15 were
quasi-experimental studies, and 7 were cohort studies. Figure 2 indicates the
literature flow, and included studies with primary outcomes are listed in table
2 and supplemental figure 1 (available online only at
http://www.archives-pmr.org/).
Fig 2Literature flow diagram. The diagram indicates the number of abstracts and
full-text articles reviewed for inclusion and subsequently included or excluded
and the final studies included for each population. *Interventions with <10
sessions/<10 d, or only family/caregiver observed. †Case reports and case series
are not included because of methodological limitations. ‡Studies before January
2008 and systematic reviews from 2014 or older are outside of the search dates.
§Studies with sample sizes <30 for multiple sclerosis and cerebral palsy and <20
for spinal cord injury. ‖Systematic reviews not used because they did not meet
all inclusion criteria but checked for includable studies.
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
Seventy-four studies enrolled participants with MS (44%), 63 studies enrolled
participants with CP (38%), and 31 studies enrolled participants with SCI (18%).
The average number of participants per study was 45 (range, 20-242), with only 3
studies having a sample size of 100 or more. In MS, the mean number of physical
activity sessions was 25 over a mean of 9 weeks, with a mean of 28 sessions over
10 weeks in CP and 68 sessions over 17 weeks in SCI. Studies compared one
physical activity intervention with another physical activity intervention,
usual care and/or standard physical therapy, attention control, waitlist
control, or no intervention. Some studies had more than 1 comparator arm. Age
and sex of study participants varied by population enrolled (ie, MS, CP, SCI).
Reporting of baseline disability also varied by population. Fifty-five MS
studies reported baseline scores on the Expanded Disability Status Scale
(average study mean 3.6±1.77, representing moderate disability); most studies in
CP (63%) reported scores on the Gross Motor Function Classification System, with
disability levels I to III most frequently studied (average Gross Motor Function
Classification System study mean 2.40±0.87, representing mild to moderate
disability). Reporting of baseline impairment status in SCI studies varied, with
studies reporting specific spinal injury levels, proportion with paraplegia vs
tetraplegia, proportion with complete vs incomplete injury, and proportion with
each American Spinal Injury Association Impairment Scale score. Studies were
conducted most often in Iran (26 studies), Turkey (19 studies), and the United
States (15 studies). Most studies were conducted in an outpatient setting (51%)
or an inpatient hospital or rehabilitation center (14%); the study location was
not specified in 20% of studies. Eight percent (n=13) of the studies were
considered good quality, two-thirds of the studies were rated fair quality
(n=113), and one-fourth were poor quality (n=42). Studies were downgraded
because of unclear randomization methods, lack of blinding of outcome assessors,
and high attrition.
KEY QUESTION 1. PREVENTION OF CARDIOVASCULAR CONDITIONS, DIABETES, AND OBESITY
No studies on the effects of physical activity in participants with MS, CP, or
SCI assessed the prevention of cardiovascular conditions (eg, myocardial
infarction, stroke, development of hypertension) or the development of diabetes
or obesity.
KEY QUESTION 2. BENEFITS AND HARMS OF PHYSICAL ACTIVITY
AEROBIC EXERCISE INTERVENTIONS
Aerobic interventions included aerobic exercises, aquatics, cycling, RAGT, and
treadmill training. Individual study findings can be found in the supplemental
tables S1-4 (available online only at http://www.archives-pmr.org/).
In studies that enrolled participants with MS, compared with usual care or
attention control, we found evidence that aerobic exercise may improve sleep.
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Postural control or balance interventions included balance exercises,
hippotherapy, tai chi, motion gaming, whole body vibration, and yoga.
Hippotherapy involved riding a horse or horse simulator. Motion gaming used body
movement rather than a mouse or game controller to play a game using a computer
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HARMS OF PHYSICAL ACTIVITY
Harms of physical activity were infrequently reported. One trial reported an
increased risk of autonomic dysreflexia in SCI with whole body exercises
compared with upper body exercises.
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Although fractures, falls, and other adverse events were reported by a few
studies, they were not always reported by study group and were not always study
related, making it impossible to determine if a particular exercise was
associated with increased risk of harms or adverse events compared with usual
care or no treatment.
KEY QUESTION 3. EFFECTS OF PATIENT FACTORS ON THE BENEFITS AND HARMS OF PHYSICAL
ACTIVITY
Limited evidence in MS found greatest improvements in core strength in those who
were least strong compared with those with less disability.
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One MS study found improvements in walking, function, and Vo2peak with
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One CP study analyzed the effects of the exercise intervention according to
demographic characteristics and found that younger children aged 6 and 7 years
had improved sitting scores with hippotherapy compared with no hippotherapy,
whereas children aged 8 through 12 years had similar scores, but there was no
difference in the effect of the intervention based on disability level at
baseline.
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Limited evidence in participants with incomplete SCI found having better
function and more recent injury at baseline associated with better response to
aerobic interventions than those with worse function and longer time since
injury.
82
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* et al.
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195
* Jones ML
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results from a secondary analysis to determine responsiveness to therapy.
Arch Phys Med Rehabil. 2014; 95: 2247-2252
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* Full Text
* Full Text PDF
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* Scopus (0)
* Google Scholar
,
196
* Jones ML
* Evans N
* Tefertiller C
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Activity-based therapy for recovery of walking in individuals with chronic
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Arch Phys Med Rehabil. 2014; 95: 2239-2246
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KEY QUESTION 4. METHODOLOGICAL WEAKNESSES AND GAPS IN THE EVIDENCE
This is covered in the discussion section and more thoroughly in the report (in
press to be available at https://effectivehealthcare.ahrq.gov/).
DISCUSSION
The average study sample size was 45 (range, 20-242), including 3 studies with
samples sizes of 100 or more. Most studies were rated fair quality or as having
moderate risk of bias. The bulk of the evidence was in participants with MS. In
participants with MS, walking ability may be improved with treadmill training
and multimodal exercise regimens; function may be improved with treadmill
training, balance exercises, and motion gaming; balance is likely improved with
balance exercises (which may also reduce risk of falls) and may be improved with
aquatic exercises, RAGT, motion gaming, and multimodal exercises; ADL,
spasticity, and female sexual function may be improved with aquatic therapy;
sleep may be improved with aerobic exercises; and cardiovascular fitness may be
improved with multimodal exercises. In participants with CP, balance may be
improved with hippotherapy and motion gaming and function may be improved with
cycling, hippotherapy, and treadmill training. In participants with SCI,
evidence suggests that ADL may be improved with RAGT. When RCTs were pooled
across types of exercise, physical activity interventions were found to improve
walking in MS, were to likely improve balance and depression in MS, and may
improve aerobic fitness and function in participants with CP or with SCI. When
populations were combined, dance may improve function in participants with MS
and CP. The majority of this evidence is low strength. Evidence on long-term
health outcomes was not found. Evidence was also lacking on the role sex, age,
race and ethnicity, socioeconomic status, patient comorbidities, and other
patient characteristics may play on the effects of physical activity. There was
inadequate reporting of control group activities and adverse events in many
trials. However, more intense physical activity was associated with increased
autonomic dysreflexia episodes in SCI compared with less intense activity.
IMPLICATIONS FOR PRIMARY CARE PROVIDERS WITH PATIENTS WITH MS, CP, AND SCI
Broadly speaking, in patients with MS, CP, and SCI, moving the body in an effort
to improve cardiovascular fitness is desired. In patients with SCI,
consideration should be given to monitoring the patient's cardiovascular and
thermodynamic response to ensure a particular cardiovascular activity at a
specific intensity is safe so as to avoid serious episodes of autonomic
dysreflexia, which could be life threatening. We found benefits in all 3
included populations with aerobic exercise.
Strength exercises should also be an included part of any exercise routine for
patients with MS, CP, and SCI. Although this review found support for improved
walking with combined strength and aerobic exercises in study participants with
MS but insufficient evidence for benefit in CP and SCI, a 2019 systematic review
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found improved function (gross motor function measure scores) in children with
CP. Cardiovascular fitness and muscle strength may be improved with aerobic and
resistance training based on a 2019 systematic review of systematic reviews in
people with SCI.
Balance exercises may also prove beneficial additions to a physical exercise
program for people with MS, CP, and SCI. This review found that balance training
may improve balance, function, and/or quality of life in MS and CP. While the
evidence was too sparse to draw a conclusion regarding balance training in SCI,
a 2019 RCT
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that enrolled people with chronic SCI reported improved balance with a
combination of aerobic, strength, and core stability training.
Physical activity guidelines from the National Multiple Sclerosis Society
recommend at least 150 minutes per week of exercise and/or lifestyle physical
activity based on abilities, preferences, and safety.
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least 150 minutes of moderate physical activity weekly and muscle strengthening
at least 2 days per week.
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For adults with SCI, the Spinal Cord Injury Research Evidence Community
recommends at least 30 minutes of moderate to vigorous intensity aerobic
activity twice per week for cardiorespiratory fitness (3 times per week for
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Although we do not specify a recommended “dose” of any particular exercise, both
aerobic activity and strength training are important elements of any exercise
program, including programs for people with MS, CP, and SCI, and should be
encouraged by primary care providers.
IMPLICATIONS FOR PRIMARY CARE PROVIDERS WITH PATIENTS WITH OTHER DISABILITIES
Although we limited this review to evidence in MS, CP, and SCI, other medical
illnesses and injuries may respond similarly to physical activity as our
included populations. For instance, patients with Parkinson disease or Lyme
disease may have similar issues and challenges as patients with MS. Patients
with intellectual disability and motor impairment owing to other neurologic
disease or inborn errors of metabolism may face similar challenges as patients
with CP. Patients with stroke, patients with arthritis, or wheelchair-using
elderly persons may have issues and challenges similar to those with SCI. As
long as physical exercise can be performed safely, aerobic, strength, and
balance training may benefit these populations as well.
Several systematic reviews of the effects of physical exercise on the health of
people with other conditions have found benefits to exercise. For example, a
2016 review
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found that home-based exercise improved balance and gait speed in people with
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found improved depression scores with exercise in adult patients with arthritis.
APPLICABILITY AND GENERALIZABILITY
This review included patients with 1 of 3 conditions to represent the diversity
of wheelchair users and potential users. Most studies enrolled participants with
less disability (including ambulatory participants), although there was a wide
range of ability levels across studies. This report also focused on supervised
exercise training and excluded all leisure time and lifestyle physical activity
interventions, which may have greater and more sustained short as well as
long-term health effects. Challenges facing people with MS, CP, and SCI may be
similar to people with other conditions such as Parkinson disease, stroke, and
arthritis. Elderly persons often face mobility challenges and may eventually
require a use of a wheelchair. Although study participants were required to
engage in 10 observed physical activity sessions over a minimum of 10 days, a
wide variety of exercise modalities and outcomes were included.
STUDY LIMITATIONS
The majority of evidence is low strength because of small sample sizes and
heterogeneity of interventions and outcomes studied. No evidence for the
prevention of cardiovascular events, development of diabetes, or obesity was
identified. Studies rarely provided data on intensity of physical activity or
reported the proportion of wheelchair users enrolled, and those that did failed
to stratify results by wheelchair use. Reporting of control group activities and
adverse events was inadequate.
Larger, well-conducted RCTs are needed in MS, CP, and SCI to address evidence
gaps and to confirm current findings. Large, controlled cohort studies (which
are often longer in duration than RCTs) could provide data on long-term outcomes
and on potential harms of the intervention. Larger sample sizes would enable
subgroup analyses based on patient characteristics and comorbidities.
CONCLUSIONS
Physical activity was associated with improvements in walking ability, general
function, balance (including fall risk), depression, aerobic capacity, ADL,
female sexual function, spasticity, and sleep, depending on population and type
of physical activity. No studies reported long-term cardiovascular or metabolic
disease health outcomes.
SUPPLIERS
* a
Stata 14.0/14.2; StataCorp.
* b
RevMan v5.3; Cochrane.
ACKNOWLEDGMENTS
We thank the following individuals for their contributions to this project:
Erica Hart, MST, Shelby Kantner, BA, Elaine Graham, MLS, Mark Junge, BA, Tracy
Dana, MLS, and David W. Niebuhr, MD, MPH, MSc, AHRQ Task Order Officer; Keisha
Shropshire, MPH, Health Science Policy Analyst, Public Health Analyst P2P
Coordinator and Carrie Klabunde, PhD, P2P Scientific Advisor, NIH Office of
Disease Prevention (ODP) Working Group and NIH partners; Meera Viswanathan
(Associate Editor); Christine Chang, MD, MPH, Acting Director, Evidence-based
Practice Center Program, Center for Evidence and Practice Improvement, AHRQ;
Technical Expert Panel members; Peer Reviewers; Leah Williams, B.S.,
publications editor; Roger Chou, MD, FACP, Pacific Northwest EPC Director.
SUPPLEMENTAL APPENDIX FIGURES AND TABLES
.
Supplemental Figure 1Overview of included studies by population and intervention
Show full caption
A stacked bar chart illustrating the proportion of included studies by
intervention for each population: multiple sclerosis or MS, cerebral palsy or
CP, spinal cord injury or SCI.
Footnote:
*Studies with multiple interventions appear more than once.
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
Supplemental Figure 26MWT meta-analysis of all randomized controlled trials
versus no treatment/usual care
Show full caption
Forest plot examining the 6 minute walk test scores for all randomized
controlled trials comparing exercise with no treatment or usual care.
Abbreviations:
Δ = change; 6MWT = 6-Minute Walk Test; AC = attention control; Aerob = aerobic
exercise; Aqua = aquatic exercise; Bal = balance training; CI = confidence
interval; Cond. = condition; CP = cerebral palsy; ex = exercise; MD = mean
difference; MS = multiple sclerosis; PL = profile likelihood; PRE = progressive
resistance exercise; Previous = continuation of previous activities;
PT = physical therapy; SCI = spinal cord injury; Stretch = stretching exercise;
UC = usual care (not otherwise specified); WL = waitlist
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
Supplemental Figure 3BBS meta-analysis of all randomized controlled trials
versus no intervention/usual care
Show full caption
Forest plot examining BBS scores comparing exercise with no intervention or
usual care.
Abbreviations:
Δ = change; Aerob = aerobic exercise; Aqua = aquatic exercise; BBB = Berg
Balance Scale; Bal = balance training; C&C = Cawthorne and Cooksey exercises;
CI = confidence interval; CoDuSe = core stability, dual task and sensorimotor
challenges; Cond. = condition; Conv. = conventional; CP = cerebral palsy;
ex = exercise; MD = mean difference; MS = multiple sclerosis; NOS = not
otherwise specified; PC = personal computer; PL = profile likelihood;
PRE = progressive resistance exercise; Previous = continuation of previous
activities; Rehab = rehabilitation; SCI = spinal cord injury; WL = waitlist
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
Supplemental Figure 4Effect of exercise versus usual care on depression scores
in multiple sclerosis
Show full caption
Forest plot examining depression scale scores for all randomized controlled
trials comparing exercise with no treatment or usual care
Abbreviations:
Δ = change; AC = attention control; Aerob = aerobic exercise; Bal = balance
training; CI = confidence interval; Cond. = condition; Conv. = conventional;
ex = exercise; MD = mean difference; MS = multiple sclerosis; PL = profile
likelihood; PRE = progressive resistance exercise; Previous = continuation of
previous activities; PT = physical therapy; RAGT = robotic assisted gait
training; SMD = standardized mean difference; WL = waitlist
* View Large Image
* Figure Viewer
* Download Hi-res image
* Download (PPT)
Supplemental Table 1Studies of the Benefits and Harms of Physical
Activity—Aerobic Exercise Interventions
Author, Year
Intervention
Study Design
Study QualityIntervention and ComparisonPopulationResultsAerobics—Multiple
SclerosisAl-Sharman, 2019
6
* Al-Sharman A
* Khalil H
* El-Salem K
* et al.
The effects of aerobic exercise on sleep quality measures and sleep-related
biomarkers in individuals with multiple sclerosis: a pilot randomised controlled
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* Crossref
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Aerobics
RCT
PoorA. Moderate-intensity exercise with stair stepper, 18 sessions over 6 weeks
(n=17)
B. Home exercises (n=13)A vs. B
Age: 39 vs. 32
Female: 76% vs. 77%
EDSS: 2.1 vs. 1.9A vs. B, mean (SD), p-value is between groups:
PSQI: 8.0 (3.8) to 4.6 (2.3) vs. 8.9 (4.3) to 7.1 (3.2), p<0.001
ISI: 12.8 (5.3) to 6.6 (4.08) vs. 10.3 (3.3) to 8.7 (5.1), p=0.04
Total Sleep Time: 333.38 (84.6) to 372.4 (59.4) vs. 325.9 (84.5) to 320 (54),
p=0.05Aydin, 2014
7
* Aydin T
* Akif Sariyildiz M
* Guler M
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Evaluation of the effectiveness of home based or hospital based calisthenic
exercises in patients with multiple sclerosis.
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Aerobics
RCT
FairA. Callisthenic exercises (in clinic): 60 sessions, over 12 weeks, (n=16)
B. Callisthenic exercises (home-based): 60 sessions, over 12 weeks, (n=20)A vs.
B
Age: 32.6 vs. 33
Female: 56% vs. 55%
EDSS: 3.6 vs. 3.4A vs. B, mean (SD)
10MWT:
10.81 (2.15) vs. 9.95 (1.92), p=0.211 (baseline)
9.47 (1.56) vs. 9.02 (1.78), p=0.386 (postintervention)
Pre-post exercise intra-group comparison: Difference1.34 (1.26) vs. 0.93 (1.12),
p=0.442
MusiQoL:
63.69 (17.00) vs. 59.75 (14.06), p=0.293 (baseline)
76.00 (18.81) vs. 69.00 (15.11), p= 0.119 (postintervention)
Pre-post exercise intra-group comparison: Difference12.31 (7.45) vs. 9.25
(6.99), p=0.146
BBS:
47.56 (6.57) vs. 48.95 (5.38) (baseline)
50.94 (4.97) vs. 50.40 (5.27) (postintervention), p=0.031Kara, 2017
9
* Kara B
* Kucuk F
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Aerobics
Quasiexperimental
PoorA. Aerobic exercise 16 sessions over 8 weeks (n=28)
B. Pilates 16 sessions over 8 weeks (n=9)A vs. B
Age: 43 vs. 50
Female: 65% vs. 67%
EDSS: 3.2 vs. 2.85A vs. B mean difference between groups:
TUG right:
–0.47, 95% CI –2.98 to 2.04, p=0.71
TUG left:
–3.07, 95% CI –6.34 to 0.20), p=0.07
BBS:
–0.67, 95% CI –10.56 to 9.22, p=0.89Keser, 2011
10
* Keser I
* Meric A
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Aerobic exercise
Quasiexperimental
PoorA. Calisthenics, 18 sessions over 6 weeks (n=15)
B. Neuro-rehabilitation 18 sessions over 6 weeks (n=15)A vs. B
Age: 36 vs. 35
Female: 53% vs. 47%
EDSS: 2.9 vs. 2.8A vs. B, mean change, p=between groups:
MSFC: –0.002 (0.44) vs. 0.02 (0.23), p>0.05
SF-36: 0.20 (5.67) vs. 1.73 (7.75), p>0.05
BBS: –1.73 (3.03) vs. –1.80 (2.67), p>0.05
Sadeghi Bahmani, 2019
8
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* et al.
Compared to an active control condition, in persons with multiple sclerosis two
different types of exercise training improved sleep and depression, but not
fatigue, paresthesia, and intolerance of uncertainty.
Mult Scler Relat Disord. 2019; 36101356
* Abstract
* Full Text
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Aerobics
RCT
FairA. Endurance training (treadmill, cycling, walking, jogging), 24 sessions
over 8 weeks (n=26)
B. Attention control, 24 sessions over 8 weeks (n=21)A vs. B
Age: 38 vs. 38
Female: 100%
EDSS: 2.46 vs. 2.02A vs. B, mean (SD), p=between groups:
EDSS: 2.46 (1.50) to 2.27 (1.64) vs. 2.02 (1.84) to 1.98 (1.70), p>0.05
ISI: 11.62 (5.23) to 8.81 (5.41) vs. 1.71 (5.43) to 11.14 (5.39), p>0.05Young,
2019
5
* Young HJ
* Mehta TS
* Herman C
* et al.
The effects of M2M and adapted yoga on physical and psychosocial outcomes in
people wth multiple sclerosis.
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* Abstract
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Aerobic exercise
RCT
FairA. Movement to Music, 36 sessions over 12 weeks (n=27)
B. Waitlist control (n=28)A vs. B
Age: 50 vs. 47
Female: 81% vs. 86%
White: 44 vs. 61%
PDDS 0: 30% vs. 21%
PDDS 3: 15% vs. 14%
PDDS 6: 11% vs. 11%A vs. B mean difference between groups:
TUG: –1.89, 95% CI –3.30 to –0.48, p=0.01
6MWT: 40.98, 95% CI 2.21 to 79.75, p=0.04
5x Sit-to-Stand: –1.00, 95% CI –2.58 to 0.55, p=0.38Aerobics—Cerebral
PalsyGibson, 2018
12
* Gibson N
* Chappell A
* Blackmore AM
* et al.
The effect of a running intervention on running ability and participation in
children with cerebral palsy: a randomized controlled trial.
Disabil Rehabil. 2018; 40: 3041-3049
* Crossref
* PubMed
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* Google Scholar
Aerobics
RCT
GoodA. Running and running exercises, 48 sessions over 12 weeks (n=21)
B. Usual care (n=21)A vs. B
Age: 12.4 vs. 12.5
Female: 33% vs. 38%
GMFCS I: 57% vs. 60%
GMFCS II: 38% vs. 40%
GMFCS III: 5% vs. 0%A vs. B, mean difference between groups:
Shuttle Run Test (min): 0.9, 95% CI –0.3 to 2.2, p=0.142
HiMat: 0.8, 95% CI –2.7 to 4.3, p=0.651
10X5 sprint (sec): –1.3, 95% CI –5.4 to 2.8, p=0.535Teixeira-Machado, 2018
11
* Teixeira-Machado L
* Azevedo-Santos I
* Desantana JM
Dance improves functionality and psychosocial adjustment in cerebral palsy: a
randomized controlled clinical trial.
Am J Phys Med Rehabil. 2017; 96: 424-429
* Crossref
* PubMed
* Scopus (15)
* Google Scholar
Aerobic exercise
RCT
FairA. Dance exercise 24 sessions over 12 weeks (n=13)
B. Kinesiotherapy exercises 24 sessions over 12 weeks (n=13)A vs. B
Age: 18 vs. 17.07
Female: 54% vs. 62%
GMFCS II: 46% vs. 23%
GMFCS III: 23% vs. 38%
GMFCS IV: 23% vs. 31%
GMFCS V: 8% vs. 8%A vs. B mean change scores:
FIM: 1.7 vs. 0.03, p<0.001
ICF: –44.56 vs. 14.90, p<0.001Aerobics—Spinal Cord InjuryNo studies
identified———Aquatics—Multiple SclerosisCastro-Sanchez, 2012
13
* Castro-Sanchez AM
* Mataran-Penarrocha GA
* Lara-Palomo I
* et al.
Hydrotherapy for the treatment of pain in people with multiple sclerosis: a
randomized controlled trial.
Evid Based Complement Alternat Med. 2012; 473963: 1-8
* Crossref
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* Google Scholar
Aerobic Exercise
RCT
GoodA. Ai-Chi aqua therapy with Tai-Chi music, 40 sessions over 20 weeks (n=36)
B. Relaxation exercises on exercise mat without music, 40 sessions over 20 weeks
(n=37)A vs. B
Age: 46 vs. 50
Female: 72% vs. 65%
EDSS: 6.3 vs. 5.9
PPMS: 17% vs. 24%
SPMS: 25% vs. 32%A vs. B, median (SD), p-value=between groups:
MSIS-29 Physical: 48 (15.91) to 41 (12.37) vs. 46 (18.34) to 45 (17.14), p=0.014
MSIS-29 Psychological: 34 (29.47) to 21 (15.73) vs. 30 (23.53) to 25 (19.36),
p=0.023
Barthel Index: 91 (7.12) to 86 (9.23) vs. 87 (10.34) to 88 (8.92), p>0.05
Differences in MSIS-29 maintained at 30 weeksKargarfard, 2018
15
* Kargarfard M
* Shariat A
* Ingle L
* et al.
Randomized controlled trial to examine the impact of aquatic exercise training
on functional capacity, balance, and perceptions of fatigue in female patients
with multiple sclerosis.
Arch Phys Med Rehabil. 2018; 99: 234-241
* Abstract
* Full Text
* Full Text PDF
* PubMed
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* Google Scholar
Aerobic Exercise
RCT
FairA. Aquatic exercise, 24 sessions over 8 weeks (n=17)
B. Waitlist control group (n=15)A vs. B
Age: 36.5 vs. 36.2
Female: 100%
EDSS 3.4 vs. 3.7
A vs. B, mean change scores:
6MWT: –52 vs. 29, p<0.001
Sit to Stand: 4.2 vs. –5.9, p<0.001
BBS: –1.6 vs. 2.1, p<0.001
Kooshiar, 2015
19
* Kooshiar H
* Moshtagh M
* Sardar MA
* et al.
Fatigue and quality of life of women with multiple sclerosis: a randomized
controlled clinical trial.
J Sports Med Phys Fitness. 2015; 55: 668-674
* PubMed
* Google Scholar
Aerobic Exercise
RCT
FairA. Aquatic exercise, 24 sessions over 8 weeks (n=20)
B. Usual care (n=20)A vs. B
Age: 29.24 (<46 years)
Female: 100%
EDSS: 2.5
RRMS: 75.7%
PPMS: 16.2%
SPMS: 8.1%A vs. B, mean change scores:
MQLIM: –16.93 vs. –1.04, p<0.001Marandi, 2013
16
* Marandi SM
* Nejad VS
* Shanazari Z
* et al.
A comparison of 12 weeks of Pilates and aquatic training on the dynamic balance
of women with mulitple sclerosis.
Int J Prev Med. 2013; 4: S110-S117
* PubMed
* Google Scholar
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17
* Marandi SM
* Shahnazari Z
* Minacian V
* et al.
A comparison between Pilates exercise and aquatic training effects on mascular
strength in women with mulitple sclerosis.
Pak J Med Sci. 2013; 29: 285-289
* Google Scholar
Aerobic Exercise
RCT
PoorA. Aquatics: 36 sessions over 12 weeks (n=15)
B. Usual care (n=15)A vs. B
Age: Unclear
Female: 100%
Ambulatory: 100%
EDSS: <4.5A vs. B, Six Spot Step Test: Adjusted mean difference between groups:
Right leg dynamic balance: –5.88 (SE 1.4), p<0.001
Left leg dynamic balance: –6.23 (SE 1.2), p<0.001Aquatics—Cerebral PalsyAdar,
2017
20
* Adar S
* Dundar U
* Demirdal ÜS
* et al.
The effect of aquatic exercise on spasticity, quality of life, and motor
function in cerebral palsy.
Turk J Phys Med Rehabil. 2017; 63: 239-248
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
FairA. Aquatic exercise, 30 sessions over 6 weeks (n=17)
B. Land-based exercise, 30 sessions over 6 weeks (n=15)A vs. B
Age:10.1 vs. 9.3
Female: 53% vs. 40%
Spastic diplegia: 65% vs. 67%
Hemiplegia: 35% vs. 33%
GMFCS: Median 2 vs. 2A vs. B, mean change scores:
TUG: –0.13 (0.14) vs. –0.16 (0.13), p=0.664
GMFM-88: 0.05 (0.05) vs. 0.05 (0.03), p=0.451
WeeFIM motor: 0.04 (0.04) vs. 0.06 (0.06),p=0.860
WeeFIM total: –0.13 (0.14) vs. –0.16 (0.13), p=0.287Lai, 2015
21
* Lai CJ
* Liu WY
* Yang TF
* et al.
Pediatric aquatic therapy on motor function and enjoyment in children diagnosed
with cerebral palsy of various motor severities.
J Child Neurol. 2015; 30: 200-208
* Crossref
* PubMed
* Scopus (30)
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Aerobic exercise
Cohort study
FairA. Aquatic therapy, 24 sessions over 12 weeks, rehab exercises, 24-36
sessions over 12 weeks (n=11)
B. Rehab exercises, 24-36 sessions over 12 weeks (n=13)A vs. B
Age: 7.6 vs. 6.6
Female: 64% vs.31%
Diplegia: 27% vs. 46%
Quadriplegia 45% vs. 31%
Hemiplegia 27% vs. 23%
GMFCS: 2.7 vs. 2.6A vs. B, mean difference between groups:
GMFM-66: 5.0 vs. 0.7, p=0.007
CPQoL scales for Social, Functioning, Participation, Emotional, Access, Pain and
Disability, and Family Health: All NSAquatics—Spinal Cord InjuryNo studies
identified———Cycling—Multiple SclerosisBaquet, 2018
26
* Baquet L
* Hasselmann H
* Patra S
* et al.
Short-term interval aerobic exercise training does not improve memory
functioning in relapsing-remitting multiple sclerosis-a randomized controlled
trial.
PeerJ. 2018; 6: e6037
* Crossref
* PubMed
* Scopus (17)
* Google Scholar
Aerobic exercise
RCT
FairA. Bicycle ergometry, 24-36 sessions over 12 weeks (n=34)
B. Waitlist control group (n=34)A vs. B
Age: 38.2 vs. 39.6
Female: 62% vs. 74%
EDSS: 1.7 vs. 1.8
RRMS: 100%A vs. B mean difference between groups:
6MWT: 4.0, 95% CI –36.5 to 44.5, p=0.85
25 foot walk: –0.1, 95% CI –0.4 to 0.2, p=0.49
MSWS-12: –0.3, 95% CI –2.1 to 1.6, p=0.78
HAQUAMS: –0.4, 95% CI –4.5 to 3.7, p=0.84Collett, 2011
31
* Collett J
* Dawes H
* Meaney A
* et al.
Exercise for multiple sclerosis: a single-blind randomized trial comparing three
exercise intensities.
Mult Scler. 2011; 17: 594-603
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
Poor
A. Combined intermittent and continuous static cycling, 24 sessions over 12
weeks (n=20)
B. Intermittent static cycling, 24 sessions over 12 weeks (n=21)
C. Continuous static cycling, 24 sessions over 12 weeks (n=20)A vs. B vs. C
Age: 55 vs. 50 vs. 52
Female: 53% vs. 78% vs. 80%
Ambulatory: 100%
Change postintervention: no data provided
2MWT, SF-36 total, TUG: All NS
Heine, 2017
29
* Heine M
* Verschuren O
* Hoogervorst EL
* et al.
Does aerobic training alleviate fatigue and improve societal participation in
patients with multiple sclerosis? A randomized controlled trial.
Mult Scler. 2017; 23: 1517-1526
* Crossref
* PubMed
* Scopus (33)
* Google Scholar
Aerobic exercise
RCT
FairA. Leg cycling, 48 sessions over 16 weeks (n=43)
B. MS nurse consultation, 3 consultations over 16 weeks (n=46)A vs. B
Age: 43.1 vs. 48.2
Female: 74% vs. 72%
Ambulatory: 100%
EDSS: 2.5 vs. 3.0
RRMS: 72% vs. 74%
SPMS: 7% vs. 11%
PPMS: 21% vs. 15%A vs. B, mean difference (SE) between groups:
IPA autonomy indoors: –0.11 (0.088), p=0.203
IPA family role: –0.082 (0.1222), p=0.502
IPA autonomy outdoors: –0.097 (0.125), p=0.438
IPA Social Relations: –0.138 (0.092), p=0.135
IPA Work/education: 0.225 (0.167), p=0.181Hebert, 2011
27
* Hebert JR
* Corboy JR
* Manago MM
* et al.
Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and
upright postural control: a randomized controlled trial.
Phys Ther. 2011; 91: 1166-1183
* Crossref
* PubMed
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* Google Scholar
Aerobic Exercise
RCT
FairA. Bicycle ergometry, 12 sessions for 6 weeks (n=12)
B. Vestibular rehab (n=13)
C. Waitlist control (n=13)A vs. B vs. C
Age: 46.8 vs. 42.6 vs. 50.2
Female: 75% vs. 85% vs. 85%
Ambulatory: 100%
Mean difference between groups:
6MWT:
A vs. B: 39.1, 95% CI –105 to 183, p=1.00
A vs. C: 62.7, 95% CI –81 to 2.7, p=1.00
B vs. C: 23.6, 95% CI –117 to 165, p=1.00
Hochsprung, 2017
25
* Hochsprung A
* Granja Dominguez A
* Magni E
* et al.
Effect of visual biofeedback cycling training on gait in patients with multiple
sclerosis.
Neurologia (Engl Ed). 2020; 35: 89-95
* Crossref
* PubMed
* Scopus (2)
* Google Scholar
Aerobic exercise
RCT
PoorA. Visual biofeedback cycling training, 12 sessions over 12 weeks plus home
exercise program (n=30)
B. Home exercise program (n=31)A vs. B
Female: 66% vs. 50%
Ambulatory: 100%
RRMS: 37% vs. 52%
PPMS: 20% vs. 26%
SPMS: 43% vs. 23%A vs. B mean change scores:
FAP:
3.036 (p=0.002) vs. –1.06 (p=0.289)
No comparison between groups provided
Negaresh, 2019
24
* Negaresh R
* Motl R
* Mokhtarzade M
* et al.
Effect of short-term interval excercise training on fatigue, depression, and
fitness in normal weight vs. overweight person with multiple sclerosis.
Explore (NY). 2019; 15: 134-141
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
Fair
A. Normal BMI cycling UE/LE, 24 sessions over 8 weeks (n=18)
B. Normal BMI control (n=15)
C. Overweight cycling UE/LE, 24 sessions over 8 weeks (n=17)
D. Overweight control (n=13)A vs. B vs. C vs. D
Age: 31.2 vs. 29.1 vs. 32.1 vs. 2.1
Female: 64% vs. 64% vs. 64% vs. 69%
EDSS: <4
RRMS: 100%
A vs. B vs. C vs. D, mean difference between groups (scores are estimates from
graph):
TUG: –3.8 vs. –0.1 vs. –2.5 vs. 0, p=0.001
Interaction between Weight and Exercise p=0.52
Niwald, 2017
32
* Niwald M
* Redlicka J
* Miller E
The effects of aerobic training on the functional status, quality of life, the
level of fatigue and disability in patients with multiple sclerosis-a
preliminary report.
Aktualnosci Neurol. 2017; 17: 15-22
* Crossref
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Aerobic exercise
Quasiexperimental
FairA. Cycle ergometry, 60 sessions over 4 weeks plus 480 min of rehab exercises
over 4 weeks (n=21)
B. 480 min of rehab exercises 480 over 4 weeks (n=32)A vs. B
Age: 57 vs. 60
Female: 62% vs. 65%
Race: NR
Ambulatory: 100%
EDSS: 6.33 vs. 6.20A vs. B, mean difference between groups:
EDDS: 0.01, 95% CI –0.61 to 1.29, p=0.48
WHOQOL-Bref Physical: 1.45, 95% CI –0.72 to 3.62, p=0.19
WHOQOL-Bref Psychological: 3.05, 95%CI 1.30 to 4.80 to, p=0.001
WHOQOL-Bref Social: 0.60, 95% CI –0.64 to 1.84, p=0.34
WHOQOL-Bref Environmental: 2.56, 95% CI 0.20 to 4.92, p=0.03Tollar, 2020
28
* Tollar J
* Nagy F
* Toth BE
* et al.
Exercise effects on multiple sclerosis quality of life and clinical-motor
symptoms.
Med Sci Sports Exerc. 2020; 52: 1007-1014
* Crossref
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Aerobic exercise
RCT
FairA. Stationary cycling, 25 sessions over 5 weeks (n=14)
B. Usual PT, 25 sessions over 5 weeks (n=12)A vs. B
Age: 48.1 vs. 44.4
Female: 93% vs. 92%
EDSS median: 5.0 vs. 5.0
RRMS: 64% vs. 67%A vs. B, mean difference between groups:
MSIS-29: –6.3 (8.07) vs. 1.0 (3.46), p=0.008
6MWT: 32.1 (44.58) vs. 6.3 (49.27), p=0.174
BBS: 2.5 (2.62) vs. –0.2 (2.62), p=0.015
EQ-5 Sum score:–1.4 (1.7) vs. 0.0 (1.13), p=0.023Cycling—Cerebral PalsyBryant,
2013
33
* Bryant E
* Pountney T
* Williams H
* et al.
Can a six-week exercise intervention improve gross motor function for
non-ambulant children with cerebral palsy? A pilot randomized controlled trial.
Clin Rehabil. 2013; 27: 150-159
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
FairA. Static bike group, 18 sessions over 6 weeks (n=11)
B: No intervention control (n=12)
A vs. B
Age: 14.3 vs. 13.8
Female: 45% vs. 58%
Race: NR
Ambulatory: 0%
Wheelchair user: 100%
Bilateral CP: 100%
GMFCS: 4.3 vs. 4.4A vs. B mean difference between groups:
GMFM-66: 0.70, 95% CI –1.43 to 2.83, p=0.52
GMFM-88-D: 5.4, 95% CI 1.23 to 9.57, p=0.01
GMFM-88-E: 2.3, 95% CI 0.20 to 4.40, p=0.03
Demuth, 2012
34
* Demuth SK
* Knutson LM
* Fowler EG
The PEDALS stationary cycling intervention and health-related quality of life in
children with cerebral palsy: a randomized controlled trial.
Dev Med Child Neurol. 2012; 54: 654-661
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Fowler, 2010
35
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* Demuth SK
* et al.
Pediatric endurance and limb strengthening (PEDALS) for children with cerebral
palsy using stationary cycling: a randomized controlled trial.
Phys Ther. 2010; 90: 367-381
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
Fair
A. Stationary cycling, 30 sessions over 12 weeks (n=31)
B. No intervention control (n=31)
A vs. B
Age: 10.7 vs. 11.2
Female: 42% vs. 65%
Race: African-American: 16% vs. 10%
White: 58% vs. 48%
Asian: 3% vs. 16 %
Other: 23% vs. 26%
Ambulatory: 100%
GMFCS: 2.0 vs. 2.3A vs. B
GMFM-66:
Change from baseline: 1.2, 95% CI 0.5 to 1.8 vs. 0.5, 95% CI –0.2 to 1.3,
between groups p=0.23
600-Yard Walk-Run Test:
Change from baseline: 5.6, 95% CI 1.6 to 9.5 vs. 2.5, 95% CI –1.1 to 6.0, p=0.24
Peds Quality of Life Total Score:
Mean difference between groups:
3.5, 95% CI –2.0 to 8.8, p=0.21Cycling—Spinal Cord InjuryAkkurt, 2017
37
* Akkurt H
* Karapolat HU
* Kirazli Y
* et al.
The effects of upper extremity aerobic exercise in patients with spinal cord
injury: a randomized controlled study.
Eur J Phys Rehabil Med. 2017; 53: 219-227
* Crossref
* PubMed
* Scopus (25)
* Google Scholar
Aerobic exercise
RCT
Fair
A. Arm ergometer, 36 sessions over 12 weeks plus 120 sessions general exercises
over 12 weeks (n=17)
B. General exercises, 120 sessions over 12 weeks (n=16)A vs. B
Age: 33 vs. 37
Female: 5% vs. 19%
Ambulatory: 41% vs. 50%
Wheelchair user: 59% vs. 50%
Paraplegia:100% vs. 94%A vs. B, mean change scores:
FIM: 0.5 vs. –0.5, p=1.00
CHART-sf, p>0.05
WHOQOL-Bref, p>0.05
Sadowsky, 2013
38
* Sadowsky CL
* Hammond ER
* Strohl AB
* et al.
Lower extremity functional electrical stimulation cycling promotes physical and
functional recovery in chronic spinal cord injury.
J Spinal Cord Med. 2013; 36: 623-631
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
Cohort study
PoorA. cycle ergometry, 3 sessions per week over a mean of 120 weeks (n=25)
B. Rehabilitation care, not specified (n=20)A vs. B
Age: 37.2 vs. 34.6
Female: 12% vs. 20%
Quadriplegia: 52% vs. 75%A vs. B, mean change scores:
Total FIM: 80% vs. 60%, p<0.001
With significant improvement with FES in subscales: self-care, sphincter
control, transfer, and locomotion
SF-36: total and composite scores NR
Significant improvement in physical function and role limit physical with FES,
no difference in mental health subscales
Robot-assisted gait training—Multiple SclerosisCalabro, 2017
46
* Calabro RS
* Russo M
* Naro A
* et al.
Robotic gait training in multiple sclerosis rehabilitation: can virtual reality
make the difference? Findings from a randomized controlled trial.
J Neurol Sci. 2017; 377: 25-30
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (53)
* Google Scholar
Aerobic exercise
RCT
GoodA. Lokomat-Pros (RAGT + VR), 40 sessions over 8 weeks (n=20)
B. Lokomat-Nanos (RAGT), 40 sessions over 8 weeks (n=20)A vs. B
Age: 44 vs. 41
Female: 65% vs. 60%
EDSS: 4.40 vs. 4.75A vs. B, mean difference between groups:
TUG: –0.064, 95% CI –0.408 to 0.536, p=0.3
FIM: –0.054, 95% CI –1.73 to 2.839, p=0.5
BBS: –0.019, 95% CI –2.403 to 2.365, p=0.8
Pompa, 2017
45
* Pompa A
* Morone G
* Iosa M
* et al.
Does robot-assisted gait training improve ambulation in highly disabled multiple
sclerosis people? A pilot randomized control trial.
Mult Scler. 2017; 23: 696-703
* Crossref
* PubMed
* Scopus (26)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT, 12 sessions over 4 weeks (n=21)
B. Conventional Walking Training, 12 sessions over 4 weeks (n=22)A vs. B
Age: 47 vs. 50
Female: 48% vs. 55%
PPMS: 0% vs. 13.6%
EDSS: 6.62 vs. 6.50A vs. B, mean difference between groups:
2MWT: 6.07, 95% CI –6.51 to 18.65, p=0.34
FAC:
0.66, 95% CI –0.07 to 1.39, p=0.08
Rivermead Mobility Index:
0.73, 95% CI –0.85 to 2.31, p=0.37
EDSS: 0.14, 95% CI –0.13 to 0.41, p=0.30
mBI: 3.99, 95% CI –6.69 to 14.67, p=0.46Russo, 2018
42
* Russo M
* Dattola V
* De Cola MC
* et al.
The role of robotic gait training coupled with virtual reality in boosting the
rehabilitative outcomes in patients with multiple sclerosis.
Int J Rehabil Res. 2018; 41: 166-172
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
Fair
A. RAGT, 18 sessions over 6 weeks then 36 sessions of rehabilitation exercises
over 12 weeks (n=30)
B. Rehabilitation exercises, 54 sessions over 18 weeks (n=15)A vs. B
Age: 42 vs. 41
Female: 53% vs. 67%
A vs. B, mean difference between groups:
TUG 6 weeks: 0.20, 95% CI –3.40 to 3.80, p=0.91
TUG 18 weeks: 0.20, 95% CI –2.90 to 3.30, p=0.90
FIM 6 weeks: –2.10, 95% CI –2.75 to –1.45, p<0.001
FIM 18 weeks: –2.20, 95% CI –2.85 to –1.55, p<0.001
TBS 6 weeks: –1.00, 95% CI –1.75 to –0.66, p<0.001
TBS 18 weeks: –0.50, 95% CI –1.10 to 0.10, p=0.10Straudi, 2016
43
* Straudi S
* Fanciullacci C
* Martinuzzi C
* et al.
The effects of robot-assisted gait training in progressive multiple sclerosis: a
randomized controlled trial.
Mult Scler. 2016; 22: 373-384
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
GoodA. RAGT, 12 sessions over 6 weeks (n=27)
B. Conventional physiotherapy, 12 sessions over 6 weeks (n=25)A vs. B
Age: 52 vs. 54
Female: 63% vs. 68%
EDSS: 6.43 vs. 6.46
PPMS: 33% vs. 28%
SPMS: 67% vs. 72%
A vs. B, mean change scores:
TUG: 2.66 (13.79) vs. –3.96 (10.50), p=0.95
6MWT: 23.22 (32.23) vs. –0.75 (26.40), p=0.01
SF 36-PCS: 1.67 (7.74) vs. 1.84 (6.77), p=0.99
SF 36-MCS: 5.37 (9.58) vs. 1.60 (9.41), p=0.14
BBS: 3.24 (4.99) vs. 0.87 (6.45), p=0.19Straudi, 2019
44
* Straudi S
* Manfredini F
* Lamberti N
* et al.
Robot-assisted gait training is not superior to intensive overground walking in
multiple sclerosis with severe disability (the RAGTIME study): a randomized
controlled trial.
Mult Scler. 2020; 26: 716-724
* Crossref
* PubMed
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* Google Scholar
Aerobic exercise
RCT
Good
A. RAGT, 12 sessions over 4 weeks (n=36)
B. Overground walking, 12 sessions over 4 weeks (n=36)A vs. B
Age: 56 vs. 55
Female: 67% vs. 69%
EDSS: 6.5 vs. 6.5
PPMS: 50% vs. 45%
SPMS: 50% vs. 55%A vs. B, mean difference between groups:
6MWT: 4, 95% CI –10 to 18, p=0.86
25FWT: 0, 95% CI –0.06 to 0.05, p=0.98
TUG: 7.8, –0.2 to 15.8, p=0.25
BBS: 0, 95% CI –2 to 2, p=0.91
MSIS-29 motor: –3, 95% CI –9 to 3, p=0.31
MSIS-29 psychological: –2, 95% CI –5 to 1, p=0.22
SF-36 PCS: –1, 95% CI –4 to 3, p=0.13
SF-36 MCS: 1, 95% CI –2 to 4, p=0.94Robot-assisted gait training—Cerebral
PalsyAras, 2019
51
* Aras B
* Yasar E
* Kesikburun S
* et al.
Comparison of the effectiveness of partial body weight-supported treadmill
exercises, robotic-assisted treadmill exercises, and anti-gravity treadmill
exercises in spastic cerebral palsy.
Turk J Phys Med Rehabil. 2019; 65: 361-370
* Crossref
* PubMed
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Aerobic exercise
RCT
FairA. RAGT, 20 sessions over 4 weeks (n=10)
B. Partial body-weight supported treadmill training, 20 sessions over 4 weeks
(n=10)
C. Anti-gravity treadmill training, 20 sessions over 4 weeks (n=9)A vs. B
Age: NR
Female: 40% vs. 40% vs. 33.3%
GMFCS II: 90% vs. 70% vs. 88.9%
Hemiplegic: 30% vs. 30% vs. 33.3%A vs. B vs. C, mean change (SD):
6MWT: 39.6 (40.4) vs. 37.6 (20.2) vs. 48.3 (25.1), p>0.05 for all pairwise
comparisons
6MWT (3-month followup): 45.2 (44.4) vs. 48.6 (37.8) vs. 58.2 (22.9), p>0.05 for
all pairwise comparisons
GMFM-D: 3.6 (2.5) vs. 4.6 (4.6) vs. 3.5 (2.5), p>0.05 for all pairwise
comparisons
GMFM-D (3-month followup): 3.6 (2.5) vs. 4.6 (4.6) vs. 3.5 (2.5), p>0.05 for all
pairwise comparisons
GMFM-E: 2.4 (2.0) vs. 2.6 (1.7) vs. 3.7 (1.9), p>0.05 for all pairwise
comparisons
GMFM-E (3-month followup): 2.6 (1.8) vs. 2.6 (1.7) vs. 3.7 (1.9), p>0.05 for all
pairwise comparisonsKlobucka, 2020
52
* Klobucka S
* Klobucky R
* Kollar B
Effect of robot-assisted gait training on motor functions in adolescent and
young adult patients with bilateral spastic cerebral palsy: a randomized
controlled trial.
NeuroRehabilitation. 2020; 47 (495-50)
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
PoorA. RAGT, 20 sessions over 4 to 6 weeks (n=21)
B. Conventional therapy (n=26)A vs. B
Age: 18.3 vs. 23.4
Female: 48% vs. 39%
GMFCS I: 4.8% vs. 0%
GMFCS II: 14.3% vs. 15.4%
GMFCS III: 42.9% vs. 46.2%
GMFCS IV: 38.1% vs. 38.5%
Mechanical wheelchair: 23.8% vs. 53.8%
Electric wheelchair: 0% vs. 15.3%A vs. B, mean change scores, p=between groups:
Total GMFM: MD 9.43, 95% CI 6.989 to 11.891 vs. MD 0.80, 95% CI 0.154 to 1.446,
p<0.001
GMFM D: MD 8.30, 95% CI 4.699 to 11.901 vs. MD 1.09, 95% CI -0.438 to 2.619,
p<0.001
GMFM E: MD 9.32, 95% CI 5.329 to 13.310 vs. MD 0.53, 95% CI -0.208 to 1.268,
p<0.001Peri, 2017
53
* Peri E
* Turconi AC
* Biffi E
* et al.
Effects of dose and duration of robot-assisted gait training on walking ability
of children affected by cerebral palsy.
Technol Health Care. 2017; 25: 671-681
* Crossref
* PubMed
* Scopus (14)
* Google Scholar
Aerobic exercise
Quasiexperimental
PoorA. RAGT plus TOP (20 sessions each over 10 weeks (n=10)
B. Personalized RAGT plus TOP, 20 sessions each over 4 weeks (n=12)
C. TOP 40 sessions over 10 weeks (n=10)
D. RAGT 40 sessions over 10 weeks (n=12)A vs. B vs. C vs. D
Age: 6.8 vs. 10.8 vs. 9.3 vs. 8
Female: 60% vs. 42% vs. 50% vs. 50%
Spastic bilateral CP: 100%
Ambulatory: 100% with or without aid
A vs. B vs. C vs. D, mean (SD):
6MWT (meters, T0 to T1 to T2):
285.2 (219.2) to 300.9 (201.9) to 309.0 (214.9) vs. 222.1 (237.6) to 208.5
(252.7) to 225.0 (193.7) vs. 378.2 (182.6) to 381.7 (159.3) to 364.1 (179.8) vs.
324.4 (110.2) to 345.0 (92.4) to 346.5 (84.3)
GMFM-66:
66.0 (12.1) to 67.0 (12.7) to 69.2 (10.4) vs. 66.2 (6.3) to 67.1 (6.2) to 68.1
(6.3) vs. 66.4 (13.4) to 68.2 (11.9) to 69.2 (9.7) vs. 68.5 (8.8) to 68.9 (8.6)
to 69.2 (9.7)
No differences between groupsYazici, 2019
54
* Yazici M
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* Gucuyener K
* et al.
Effects of robotic rehabilitation on walking and balance in pediatric patients
with hemiparetic cerebral palsy.
Gait Posture. 2019; 70: 397-402
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (7)
* Google Scholar
Aerobic exercise
Cohort
PoorA. RAGT, 36 sessions over 12 weeks (n=12)
B. Physiotherapy assumed, 36 sessions over 12 weeks assumed (n=12)A vs. B
Age: 8.8 vs. 9.5
Female: 50% vs. 50%
GMFCS I or II: 100%
A vs. B, mean or median (SD), MD calculated as if all are means, p=between
groups
6MWT: 409.58 (49.1) to 475.17 (47.7) vs. 437.00 (55.0) to 459.17 (53.75); MD
43.42, 95% CI 19.64 to 67.21, p<0.001
GMFM-88: 253.00 (8.81) to 256.17 (8.23) vs. 253.67 (7.70) to 255.25 (7.94), MD
1.59, 95% CI –2.19 to 5.37, p=0.410
GMFM-88-D: 36.08 (2.27) to 36.92 (1.73) vs. 36.75 (2.22) to 37.42 (1.98), MD
0.17, 95% CI –0.79 to 1.13, p=0.729
GMFM-88-E: 64.00 (6.90) to 66.25 (6.78) vs. 64.08 (6.43) to 64.92 (6.72), MD
1.14, 95% CI –1.69 to 4.51, p=0.373
BBS: 50.08 (2.43) to 52.08 (2.68) vs. 50.25 (2.93) to 51.00 (3.30), MD 1.25, 95%
CI –0.07 to 2.57, p=0.064Wallard, 2017
49
* Wallard L
* Dietrich G
* Kerlirzin Y
* et al.
Robotic-assisted gait training improves walking abilities in diplegic children
with cerebral palsy.
Europ J Paediatr Neurol. 2017; 21: 557-564
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
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50
* Wallard L
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* Kerlirzin Y
* et al.
Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in
the gait of children with cerebral palsy.
Gait Posture. 2018; 60: 55-60
* Crossref
* PubMed
* Scopus (22)
* Google Scholar
Aerobic exercise
RCT
PoorA. RAGT, 20 sessions over 4 weeks (n=14)
B. Usual care, 20 sessions over 4 weeks (n=16)A vs. B
Age: 8.3 vs. 9.6
Female: 43% vs. 56%
Ambulatory: 100%
Ambulatory without aids: 57% vs. 63%
GMFCS II: 100%
A vs. B, mean difference between groups:
GMFM-66-D: 4.73, 95% CI –6.14 to 15.60, p=0.39
GMFM-66-E: 7.54, 95% CI –2.64 to 17.42, p=0.15Wu, 2017b
47
* Wu M
* Kim J
* Arora P
* et al.
Effects of the integration of dynamic weight shifting training into treadmill
training on walking function of children with cerebral palsy: a randomized
controlled study.
Am J Phys Med Rehabil. 2017; 96: 765-772
* Crossref
* PubMed
* Scopus (11)
* Google Scholar
(effects of)
Aerobic exercise
RCT
Fair
A. RAGT (resistive force), 18 sessions over 6 weeks (n=11)
B. Treadmill training, 18 sessions over 6 weeks (n=12)A vs. B
Age: 11.3 vs. 10.5
Female: 45% vs. 33%
Race: nonwhite: 54.5% vs. 58%
GMFCS I: 9% vs. 17%
GMFCS II: 55% vs. 25%
GMFCS III: 27% vs. 42%
GMFCS IV: 9% vs. 17%A vs. B, mean difference between groups:
GMFM-66 total: –5.1, 95% CI 13.62 to 3.42, p=0.24
GMFM-66-D: 3.6, 95% CI –5.40 to 12.60, p=0.43
GMFM-66-E: 0.2, 95% CI –17.79 to 19.19, p=0.98
PODCI self: 7.5, 95% CI –10.48 to 25.48, p=0.41
PODCI parent: 5.5, 95% CI –8.96 to 19.96, p=0.46Wu, 2017a
48
* Wu M
* Kim J
* Gaebler-Spira DJ
* et al.
Robotic resistance treadmill training improves locomotor function in children
with cerebral palsy: a randomized controlled pilot study.
Arch Phys Med Rehabil. 2017; 98: 2126-2133
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT with resistance, 18 sessions over 6 weeks (n=12)
B. RAGT with assistance,18 sessions over 6 weeks (n=11)A vs. B
Age: 10.6 vs. 10.8
Female: 50% vs. 45%
GMFCS I: 8% vs. 0%
GMFCS II: 42% vs. 45%
GMFCS III: 42% vs. 36%
GMFCS IV: 8% vs. 18%A vs. B, mean difference between groups:
6MWT: 49.8, 95% CI –49.85 to 149.45, p=0.33
GMFM-66 total: 0.10, 95% CI –7.74 to 7.94, p=0.98
GMFM-66-D: 0.10, 95% CI –8.55 to 8.75, p=0.98
GMFM-66-E: 0.10, 95% CI –16.32 to 16.52, p=0.99
PODCI self: –3.5, 95% CI –20.80, 13.80, p=0.69
PODCI parent: 9.7, 95% CI –6.29 to 25.69, p=0.23Robot-assisted gait
training—Spinal Cord InjuryDuffell, 2014
63
* Duffell LD
* Niu X
* Brown G
* et al.
Variability in responsiveness to interventions in people with spinal cord
injury: do some respond better than others?.
Conf Proc IEEE Eng Med Biol Soc. 2014; 2014: 5872-5875
* Google Scholar
Aerobic exercise
RCT
PoorA. RAGT, 12 sessions over 4 weeks (n=23)
B. No intervention (n=29)A vs. B
Age: NR
Female: NR
Incomplete: 100%A vs. B, p=between groups
10MWT achieved minimal important difference (0.13m/s): 13% vs. 8%, p>0.05
6MWT and TUG: p>0.05Esclarin-Ruz, 2014
55
* Esclarin-Ruz A
* Alcobendas-Maestro M
* Casado-Lopez R
* et al.
A comparison of robotic walking therapy and conventional walking therapy in
individuals with upper versus lower motor neuron lesions: a randomized
controlled trial.
Arch Phys Med Rehabil. 2014; 95: 1023-1031
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT overground, 40 sessions over 8 weeks (n=44)
B. Overground therapy without RAGT, 40 sessions over 8 weeks (n=44)A vs. B
Age UMN injury: 43.6 vs. 44.9
Age LMN injury: 36.4 vs. 42.7
Female UMN: 29% vs. 29%
Female LMN: 30% vs. 29%
A vs. B, mean (SD):
10MWT: UMN: 0.48 (0.25) to 0.54 (0.31) vs. 0.36 (0.25) to 0.39 (0.31), LMN: 0.24
(0.11) to 0.46 (0.25), vs. 0.28 (0.27) to 0.45 (0.25), p=0.09
6MWT: UMN: 122.3 (49.2) to 187.48 (103.78) vs. 93.3 (53.1) to 119.41 (89.25),
LMN: 82.7 (45.5) to 157.54 (89.51) vs. 94.3 (75.1) to 145.62 (125.15), p=0.047,
favors RAGT
FIM/Motor: UMN: 5 (2.7) to 8.95 (2.96) vs. 4.9 (4.1) to 7.05 (2.62), LMN: 6
(2.9) to 8.9 (2.61) vs. 5 (2.8) to 8.67 (2.65), p=0.09
WISCI-II: UMN: 5.9 (4.5) to 13.47 (5.65) vs. 4.9 (4.1) to 11.04 (5.09), LMN: 6
(3.2) to 12.45 (4.17) vs. 5 (3.7) to 10.8 (4.54), p=0.10
LEMS: UMN: 30 (10.4) to 38.33 (10.6) vs. 27 (10.9) to 32.28 (11.04) vs. LMN: 21
(10.3) to 27.15 (10.8) vs. 20 (9.9) to 22.57 (10.8), p<0.01 favors
RAGTField-Fote, 2011
57
* Field-Fote EC
* Roach KE
Influence of a locomotor training approach on walking speed and distance in
people with chronic spinal cord injury: a randomized clinical trial.
Phys Ther. 2011; 91: 48-60
* Crossref
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* Google Scholar
Kressler, 2013
59
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* Nash MS
* Burns PA
* et al.
Metabolic responses to 4 different body weight-supported locomotor training
approaches in persons with incomplete spinal cord injury.
Arch Phys Med Rehabil. 2013; 94: 1436-1442
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (29)
* Google Scholar
Aerobic exercise
RCT
Fair
A. Treadmill BWS training with manual assistance, 60 sessions over 12 weeks
(n=17)
B. Treadmill BWS training with electrical stimulation,
60 sessions over 12 weeks (n=18)
C. Overground BWS training with electrical stimulation, 60 sessions over 12
weeks (n=15)
D. RAGT treadmill BWS training with robot assistance, 60 sessions over 12 weeks
(n=14)A vs. B
Age: 39.3 vs. 38.5 vs. 42.2 vs. 45
Female: 17.7% vs. 22.2% vs. 13.9% vs. 18%
White: 58.8% vs. 44.4% vs. 40.0% vs. 42.9%
Hispanic: 29.4% vs. 38.9% vs. 40% vs. 35.7%
African American: 11.8% vs. 16.7% vs. 20% vs. 21.4%
Mean difference between groups:
2MWT:
A vs. B: –3.0, 95% CI –17.91 to 11.91, p=0.69
A vs. C: –13.4, 95% CI –36.82 to 10.02, p=0.26
A vs. D: –0.4, 95% CI –12.19 to 11.39, p=0.95
B vs. C: –10.4, 95% CI –34.21 to 13.41, p=0.39
B vs. D: 2.6, 95% CI –9.93 to 15.13, p=0.68
C vs. D: 13.0, 95% CI –8.99 to 34.99, p=0.25
Time X Group Interaction p<0.001
A vs. B vs. C vs. D, mean difference (SD):
2MWT: 0.8 (7.7) vs. 3.8 (6.3) vs. 14.2 (15.2) vs.1.2 (5.1), favors e-stim
Velocity changed scores averaged across speeds: Group X Time Interaction
p=0.004, favors e-stim
A vs. B: NR, NS
A vs. C: 3.66 (0.74) vs. 4.36 (0.74), p=0.15
A vs. D: NR, NS
B vs. C: NR, NS
B vs. D: 4.13 (0.74) vs. 3.33 (0.76), p=0.009
C vs. D: 4.36 (0.74) vs. 3.33 (0.76), p=0.001Kumru, 2016
60
* Kumru H
* Benito-Penalva J
* Valls-Sole J
* et al.
Placebo-controlled study of rTMS combined with Lokomat gait training for
treatment in subjects with motor incomplete spinal cord injury.
Exp Brain Res. 2016; 234: 3447-3455
* Crossref
* PubMed
* Scopus (29)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT with rTMS, 20 sessions over 4 weeks, then RAGT (n=15)
B. RAGT with sham rTMS, 20 sessions over 4 weeks (n=16)A vs. B
Age: 51 vs. 49
Female: 33% vs. 13%
Cervical or thoracic: 100%
Cervical: 53% vs. 38%
A vs. B, p=between groups:
Change in number able to perform 10MWT between groups: 4 vs. 2, p=0.09
Change in WISCI-II between groups, p>0.05
Change in UEMS between groups, p=0.02
Change in LEMS between groups, p=0.001Midik, 2020
64
* Midik M
* Paker N
* Bugdayci D
* et al.
Effects of robot-assisted gait training on lower extremity strength, functional
independence, and walking function in men with incomplete traumatic spinal cord
injury.
Turk J Phys Med Rehabil. 2020; 66: 54-59
* Crossref
* PubMed
* Scopus (2)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT plus conventional rehab, 25 sessions over 5 weeks (n=15)
B. Conventional rehab only, 25 sessions over 5 weeks (n=15)A vs. B
Age: 35.4 vs. 37.9
Female: 0%
AIS C: 40% vs. 67%
AIS D: 60% vs. 33%A vs. B, mean change (SE), p=between groups:
WISCI: 3.9 (0.8) vs. 2.5 (0.5), p=0.178
SCIM: 9.9 (2.5) vs. 7.0 (1.3), p=0.326
LEMS: 1.8 (0.4) vs. 0.6 (0.2), p=0.061
At 3 month followup, change from baseline:
WISC: 4.3 (1.0) vs. 2.5 (0.5), p=0.139
SCIM: 16.5 (3.2) vs. 7.6 (1.5), p=0.127
LEMS: 2.1 (0.5) vs. 0.6 (0.2), p=0.049Shin, 2014
61
* Shin JC
* Kim JY
* Park HK
* et al.
Effect of robotic-assisted gait training in patients with incomplete spinal cord
injury.
Ann Rehabil Med. 2014; 38: 719-725
* Crossref
* PubMed
* Scopus (35)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT, 12 sessions over 4 weeks plus usual physiotherapy, 28 sessions over
4 weeks (n=27)
B. Conventional overground training, 40 sessions over 4 weeks (n=26)A vs. B
Age: 43 vs. 48
Female: 26% vs. 46%
Cervical: 52% vs. 62%
Months since injury:
3.3 vs. 2.7
A vs. B, mean change, p=between groups:
WISCI-II: 8 vs. 5, p=0.01
LEMS: 6 vs. 4, p=0.24
SCiM3-M: 6 vs. 3, p=0.13
Yildirim, 2019
56
* Yildirim MA
* Ones K
* Goksenoglu G
Early term effects of robotic assisted gait training on ambulation and
functional capacity in patients with spinal cord injury.
Turk J Med Sci. 2019; 49: 838-843
* Crossref
* PubMed
* Scopus (3)
* Google Scholar
Aerobic exercise
RCT
FairA. RAGT, 16 sessions over 8 weeks + conventional therapy (n=44)
B. Conventional therapy (n=44)A vs. B
Age: 32 vs. 37
Female: 39% vs. 36%
Tetraplegia: 20% vs. 16%
ASIA Complete: 48% vs. 41%
A vs. B, median (IQR), p-value=between groups:
FIM: 69 (31) to 85 (35) vs. 67 (36) to 77 (24), p=0.022
WISCI II: 5 (9) to 9 (7) vs. 5 (6.7) to 6.5 (5), p=0.011Treadmill—Multiple
SclerosisAhmadi, 2013
66
* Ahmadi A
* Arastoo AA
* Nikbakht M
* et al.
Comparison of the effect of 8 weeks aerobic and yoga training on ambulatory
function, fatigue and mood status in MS patients.
Iran Red Crescent Med J. 2013; 15: 449-454
* Crossref
* PubMed
* Scopus (58)
* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill, 24 sessions over 8 weeks (n=10)
B. Waitlist control (n=10)A vs. B
Age: 37 vs. 37
Female: 100%
EDSS: 2.40 vs. 2.25A vs. B, mean (SD), p-value between groups:
10MWT: 8.68 (1.93) to 7.07 (1.03) vs. 9.16 (1.88) to 9.47 (1.92), p=0.001
2MWT: 120.40 (20.29) to 139.90 (20.78) vs. 121.50 (27.73) to 119.05 (27.12),
p=0.001
BBS: 46.20 (6.32) to 53.80 (2.34) vs. 44.50 (9.43) to 41.70 (8.48),
p=0.001Gervasoni, 2014
65
* Gervasoni E
* Cattaneo D
* Jonsdottir J
Effect of treadmill training on fatigue in multiple sclerosis: a pilot study.
Int J Rehabil Res. 2014; 37: 54-60
* Crossref
* PubMed
* Scopus (14)
* Google Scholar
Aerobic
exercise
RCT
FairA. 30 minutes conventional therapy + 15 minutes treadmill training, 12
sessions over 2 weeks (n=15)
B. 45 minutes conventional therapy, 12 sessions over 2 weeks (n=15)A vs. B
Age: 49.6 vs. 45.7
Female: 40%
Able to walk 6 meters with or without assist device
RRMS: 47.6%
PPMS: 19.0%
SPMS: 33.3%
EDSS (median): 5.5A vs. B, mean change, p=between groups
DGI: 2.16 vs. 2.07, p=0.51
BBS: 4.01 vs. 3.15, p=0.33Jonsdottir, 2018
67
* Jonsdottir J
* Gervasoni E
* Bowman T
* et al.
Intensive multimodal training to improve gait resistance, mobility, balance and
cognitive function in persons with multiple sclerosis: a pilot randomized
controlled trial.
Front Neurol. 2018; 9: 800
* Crossref
* PubMed
* Scopus (19)
* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill walking, 20 sessions over 4 weeks (n=26)
B. Strength training, 16-20 sessions over 4 weeks (n=12)A vs. B
Age: 51.4 vs. 56.7
Female: 48% vs. 29%
EDSS: 5.5 vs. 5.6
RRMS: 85% vs. 58%
PPMS: 8% vs. 17%
SPMS: 8% vs. 25%A vs. B, mean difference between groups:
TUG: –2.83, 95% CI –4.7 to –0.9, p=0.009
DGI: 0.2, 95% CI –1.95 to 2.27, p=0.87
2MWT: 28.3, 95% CI 13.04 to 43.60, p<0.001
SF-12 mental: –3.0, 95% CI –9.43 to 3.38, p=0.34
SF-12 physical: 1.8, 95% CI –2.08 to 5.59, p=0.36
BBS: 1.1, 95% CI –1.4 to 3.7, p=0.39Samaei, 2016
68
* Samaei A
* Bakhtiary AH
* Hajihasani A
* et al.
Uphill and downhill walking in multiple sclerosis: a randomized controlled
trial.
Int J MS Care. 2016; 18: 34-41
* Crossref
* PubMed
* Scopus (19)
* Google Scholar
Aerobic exercise
RCT
Fair
A. Downhill treadmill training, 12 sessions over 4 weeks (n=16)
B. Uphill treadmill training, 12 sessions over 4 weeks (n=15)A vs. B
Age: 33.9 vs. 32.1
Female: 82% vs. 82%
Ambulatory: 100%
A vs. B, mean change between groups:
25FWT: 8.7 (2.4) to 6.1 (1.8) vs. 7.9 (1.1) to 7.0 (1.6), p=0.001
2MWT: 120.01 (23.6) to 160.1 (35.7) vs. 132.6 (32.3) to 147.5 (29.8), p<0.001
TUG: 9.8 (1.7) to 7.5 (1.8) vs. 9.4 (2.3) to 8.9 (0.9), p=0.041
GNDS: 35.4 (9.1) to 21.8 (5.3) vs. 32.1 (8.6) to 27.5 (6.1), p=0.012
Modified Riverman Mobility Index: 10.6 (3.2) to 14.3 (2.7) vs.10.5 (2.3) to 11.9
(2.1), p=0.005Treadmill—Cerebral PalsyAviram, 2017
80
* Aviram R
* Harries N
* Namourah I
* et al.
Effects of a group circuit progressive resistance training program compared with
a treadmill training program for adolescents with cerebral palsy.
Dev Neurorehabil. 2017; 20: 347-354
* Crossref
* PubMed
* Scopus (7)
* Google Scholar
Aerobic exercise
Quasiexperimental
Fair
A. Treadmill walking, 30 sessions over 3 months (n=43)
B. Group resistance training, 30 sessions over 3 months (n=52)A vs. B
Age: 43 vs. 52
Female: 21% vs. 48%
GMFCS II: 72% vs. 75%
GMFCS III: 28% vs. 25%A vs. B, mean (SE) change from baseline and 6 months
postintervention; p-values are between groups
6MWT: 20.9 (4.0) vs. 27.9 (6.7), p=0.31
TUG: –2.82 (0.51) vs. 3.52 (0.60), p=0.014
GMFM-66: 1.98 (0.40) vs. 3.10 (0.44), p=0.001
GMFM-66-D: 5.53 (1.61) vs. 8.36 (1.24), p=0.013
GMFM-66-E: 4.80 (1.33) vs. 7.21 (0.96), p=0.81
10MWT-self-paced: 0.272 (0.045) vs. 0.276 (0.049), p=0.41
10MWT-fast: 0.387 (0.070) vs. 0.374 (0.069), p=0.30Bahrami, 2019
69
* Bahrami F
* Noorizadeh Dehkordi S
* Dadgoo M
The efficacy of treadmill training on walking and quality of life of adults with
spastic cerebral palsy: a randomized controlled trial.
Iran J Child Neurol. 2019; 13: 121-133
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* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill, 16 sessions over 8 weeks (n=15)
B. Physiotherapy, 16 sessions over 8 weeks (n=15)A vs. B
Age: 30 vs. 25
Female: 47% vs. 40%
GMFCS I; 47% vs. 53%
GMFCS II: 13% vs. 13%
GMFCS III: 40% vs. 33%A vs. B, mean (SD); percentage change score, p=between
groups
10MWT: 22.46% change vs. 1.28% change, p<0.05
6MWT: 23.68% change vs. 16.54% change, p>0.05
WHOQOL-Brief: % change 3.83% change vs. 8.94% change, p>0.05Chrysagis, 2012
70
* Chrysagis N
* Skordilis EK
* Stavrou N
* et al.
The effect of treadmill training on gross motor function and walking speed in
ambulatory adolescents with cerebral palsy: a randomized controlled trial.
Am J Phys Med Rehabil. 2012; 91: 747-760
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill training, 36 sessions over 12 weeks (n=11)
B. Conventional PT, 36 sessions over 12 weeks (n=11)A vs. B
Age: 15.90 vs. 16.09
Female: 45% vs. 36%
Ambulatory: 100%
GMFM-D+E: 67.81 vs. 64.45A vs. B, mean change, p=between groups:
GMFM-D+E: 3.87 vs. 0.69, p=0.007
Self-selected walking speed: 8.06 vs. 0.48, p=0.009
Duarte Nde, 2014
78
* Duarte Nde A
* Grecco LA
* Galli M
* et al.
Effect of transcranial direct-current stimulation combined with treadmill
training on balance and functional performance in children with cerebral palsy:
a double-blind randomized controlled trial.
PloS One. 2014; 9e105777
* Crossref
* PubMed
* Google Scholar
Aerobic exercise
RCT
Fair
May share participants with Grecco, 2014
75
* Grecco LA
* de Almeida Carvalho Duarte N
* Mendonca ME
* et al.
Transcranial direct current stimulation during treadmill training in children
with cerebral palsy: a randomized controlled double-blind clinical trial.
Res Dev Disabil. 2014; 35: 2840-2848
* Crossref
* PubMed
* Scopus (51)
* Google Scholar
A. Treadmill + tDCS, 10 sessions over 2 weeks (n=12)
B. Treadmill + sham tDCS, 10 sessions over 2 weeks, (n=12)A vs. B
Age: 8 vs. 8
Female: NR
GMFCS I: 25% vs. 17%
GMFCS II: 50% vs. 57%
GMFCS III: 25% vs. 25%A vs. B, mean (SD), p-value=between groups:
PBS: 40.5 (9.4) to 45.3 (7.9) vs.39.1 (9.8) to 39.7 (8.4); MD 4.2, 95% CI –2.88
to 11.28, p=0.245
PEDI self-care: 46.1 (10) to 48.0 (9.5) vs. 45.0 (9.2) to 45.5 (9.3); MD 1.4,
95% CI –6.21 to 9.01, p=0.718
PEDI mobility: 38.0 (8.5) to 41.7 (7.4) vs. 38.3 (7.4) to 39.5 (7.6); MD 2.5,
95% CI –3.71 to 8.71, p=0.430Emara, 2016
73
* Emara HA
* El-Gohary TM
* Al-Johany AA
Effect of body-weight suspension training versus treadmill training on gross
motor abilities of children with spastic diplegic cerebral palsy.
Eur J Phys Rehabil Med. 2016; 52: 356-363
* PubMed
* Google Scholar
Aerobic exercise
RCT
Fair
A. Treadmill walking, 36 sessions over 12 weeks (n=10)
B. Overground walking with spider cage, 36 sessions over 12 weeks (n=10)A vs. B
Age: 6.6 vs. 6.9
Female: 70% vs. 60%
Spastic diplegic CP: 100%
GMFCS III: 100%A vs. B, mean difference between groups:
10MWT: 0.4 (0.04) to 0.5 (0.04) vs. 0.4 (0.03) to 0.6 (0.04), p=0.12
5XSit-to-Stand: 21.5 (1.3) to 18.9 (1.0) vs. 21.7 (1.5) to 17.7 (0.8), p=0.26
GMFM-88-D: 12.5 (1.6) to 15.8 (1.5) vs.12.0 (0.7) to 19.2 (2.1), p=0.02
GMFM-88-E: 10.9 (1.3) to 14.8 (1.5) vs.10.4 (0.8) to 17.2 (2.1), p=0.05Grecco,
2014
75
* Grecco LA
* de Almeida Carvalho Duarte N
* Mendonca ME
* et al.
Transcranial direct current stimulation during treadmill training in children
with cerebral palsy: a randomized controlled double-blind clinical trial.
Res Dev Disabil. 2014; 35: 2840-2848
* Crossref
* PubMed
* Scopus (51)
* Google Scholar
Aerobic exercise
RCT
Fair
May share participants with Duarte Nde, 2014
78
* Duarte Nde A
* Grecco LA
* Galli M
* et al.
Effect of transcranial direct-current stimulation combined with treadmill
training on balance and functional performance in children with cerebral palsy:
a double-blind randomized controlled trial.
PloS One. 2014; 9e105777
* Crossref
* PubMed
* Google Scholar
A. Treadmill training with transcranial direct current stimulation, 10 sessions
over 2 weeks (n=12)
B. Treadmill training with sham stimulation, 10 sessions over 2 weeks (n=12)A
vs. B
Age: 7.8 vs. 8.0
Female: 75% vs. 67%
GMFCS II: 67% vs. 67%
GMFCS III: 33% vs. 33%
A vs. B, mean difference between groups:
6MWT: MD 1996.6 (133.1 to 266.0) vs. 111.8 (27.1 to 196.4), p<0.05
GMFM-88-D: MD 11.5 (-1.6 to 24.7) vs. MD 3.7 (-2.3 to 9.8), p>0.05
GMFM-88-E: MD 0.8 (-1.5 to 3.2) vs. MD 1.0 (-0.1 to 2.1), p>0.05Grecco 2013
74
* Grecco LA
* Zanon N
* Sampaio LM
* et al.
A comparison of treadmill training and overground walking in ambulant children
with cerebral palsy: randomized controlled clinical trial.
Clin Rehabil. 2013; 27: 686-696
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill walking, 14 sessions over 7 weeks (n=16)
B. Overground walking, 14 sessions over 7 weeks (n=17)A vs. B
Age: 6.8 vs. 6.0
Female: 63% vs. 47%
GMFCS I: 31% vs. 47%
GMFCS II: 50% vs. 41%
GMFCS III: 19% vs. 12%A vs. B, mean change, p=between groups:
6MWT: 149.7 vs. 44.8, p<0.001
TUG: –6.4 vs. –2.0, p=0.004
GMFM-88-D: 23.9 vs. 8.1, p<0.001
GMFM-88-E: 20.1 vs. 8.2, p<0.001
PEDI: 11.0 vs. 4.0, p=0.035
BBS: 11.8 vs. 3.3, p<0.001Johnston, 2011
76
* Johnston TE
* Watson KE
* Ross SA
* et al.
Effects of a supported speed treadmill training exercise program on impairment
and function for children with cerebral palsy.
Dev Med Child Neurol. 2011; 53: 742-750
* Crossref
* PubMed
* Scopus (46)
* Google Scholar
Aerobic exercise
RCT
Fair
A. Partial BWS treadmill training with 20 sessions over 2 weeks, then 50
sessions at home over 10 weeks (n=14)
B. Individualized strength-based PT, 20 sessions over 2 weeks, then 50 session
at home over 10 weeks (n=12)A vs. B
Age: 9.6 vs. 9.5
Female: 50% vs. 42%
GMFCS II: 7% vs. 8%
GMFCS III: 64% vs. 50%
GMFCS IV: 29% vs. 42%
Diplegic CP: 57% vs. 33%
Triplegic CP: 0% vs. 17%
Quadriplegic CP: 43% vs. 50%A vs. B, mean scores (SD), p=between groups:
GMFM: 62.7 (17.5) to 63.3 (16.2) vs. 58.4 (26.9) to 60.1 (25.1), p=0.66
PODCI (global): 50.4 (11.2) to 59.3 (11.4) to 60.0 (10.0) vs. 50.9 (14.9) to,
52.0 (22.6) to 55.4 (21.7), p=0.73
Kim, 2015
77
* Kim OY
* Shin YK
* Yoon YK
* et al.
The effect of treadmill exercise on gait efficiency during overground walking in
adults with cerebral palsy.
Ann Rehabil Med. 2015; 39: 25-31
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Aerobic exercise
RCT
FairA. Treadmill walking, 20 sessions over 1-2 months plus PT (n=14)
B. PT (n=7)A vs. B
Age: 28.6 vs. 24.4
Female: 50% vs. 43%
Ambulatory without gait aid: 100%A vs. B, mean difference between groups:
6MWT on treadmill: 5.71, 95% CI –53.22 to 64.64, p=0.85
6MWT on overground walking: 24.07, 95% CI –46.80 to 94.94, p=0.51Nsenga Leunkeu,
2012
79
* Nsenga Leunkeu A
* Shephard RJ
* Ahmaidi S
Six-minute walk test in children with cerebral palsy gross motor function
classification system levels I and II: reproducibility, validity, and training
effects.
Arch Phys Med Rehabil. 2012; 93: 2333-2339
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (54)
* Google Scholar
Aerobic exercise
Quasiexperimental
FairA. Treadmill walking, 24 sessions over 8 weeks, (n=12)
B. No training, (n=12)A vs. B
Age: 14.2 vs. 14.2
Female: 50% vs. 50%
Hemiplegic CP: 83% vs. 83%
GMFCS I: 67% vs. 67%
GMFCS II: 33% vs. 33%A vs. B, mean change:
(estimates from bar graph)
6MWT: 480 to 601 vs. 450 to 450, no difference in baseline values, significant
difference in postintervention values favoring treatment
Swe, 2015
72
* Swe NN
* Sendhilnnathan S
* van Den Berg M
* et al.
Over ground walking and body weight supported walking improve mobility equally
in cerebral palsy: a randomised controlled trial.
Clin Rehabil. 2015; 29: 1108-1116
* Crossref
* PubMed
* Scopus (12)
* Google Scholar
Aerobic exercise
RCT
GoodA. Partial BWS treadmill walking, 16 sessions over 8 weeks (n=15)
B. Overground walking, 16 sessions over 8 weeks (n=15)A vs. B
Age: 13.03 vs. 13.37
Female: 33% vs. 33%
GMFCS II: 67% vs. 53%
GMFCS III: 33% vs. 47%
6MWT: 233.33 vs. 205.00A vs. B, mean difference between groups:
6MWT: –17.00, 95% CI –89.77 to 55.77, p=0.65
10MWT: –0.013, 95% CI –0.23, 0.21, p=0.91
GMFM-88-D: –2.94, 95% CI –16.42 to 10.64, p=0.67
GMFM-88-E: –2.8, 95% CI –20.02 to 14.42, p=0.75Willoughby, 2010
71
* Willoughby KL
* Dodd KJ
* Shields N
* et al.
Efficacy of partial body weight-supported treadmill training compared with
overground walking practice for children with cerebral palsy: a randomized
controlled trial.
Arch Phys Med Rehabil. 2010; 91: 333-339
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (79)
* Google Scholar
Aerobic exercise
RCT
FairA. Partial BWS treadmill training, 18 sessions over 9 weeks (n=12)
B. Overground walking, 18 sessions over 9 weeks (n=14)A vs. B
Age: 10.35 vs. 11.24
Female: 50% vs. 36%
GMFCS III: 42% vs. 21%
GMFCS IV: 58% vs. 79%A vs. B, mean (SD), p=between groups:
10MWT: 244.33 (115.41) to 219.38 (123.71) vs. 118.36 (89.89) to 135.82 (95.65),
p=0.097
Treadmill—Spinal Cord InjuryAlexeeva, 2011
83
* Alexeeva N
* Sames C
* Jacobs PL
* et al.
Comparison of training methods to improve walking in persons with chronic spinal
cord injury: a randomized clinical trial.
J Spinal Cord Med. 2011; 34: 362-379
* Crossref
* PubMed
* Scopus (75)
* Google Scholar
Aerobic exercise
RCT
Fair
A. BWS treadmill training, max 39 sessions over 13 weeks (n=9)
B. BWS track training, max 39 sessions over 13 weeks (n=14)
C. Structured PT, max 39 sessions over 13 weeks (n=12)A vs. B vs. C
Age: 43 vs. 36 vs. 35
Female: 11% vs. 14% vs. 17%
Cervical: 89% vs. 57% vs. 58%A vs. B vs. C: mean (SD), p=across all groups:
10MWT (m/s): 0.30 (0.26) to 0.46 (0.40) vs. 0.22 (0.20) to 0.44 (0.33) vs. 0.41
(0.34) to 0.51 (0.36), p>0.05
TBS: 9.8 (5.4) to 19.4 (5.0) vs. 10.5 (3.4) to 11.9 (2.5) vs. 10.1(3.6) to 12.9
(2.7), p<0.05, post-hoc group C
improving (p<0.001) and B improving (p<0.01) but not A (p=0.23)
SAWS: 39.3 ((8.3) to 35.2 (8.7) vs. 35.9 (6.9) to 32.4 (7.6) vs. 36.6 (9.9) to
29.0 (7.9), p>0.05Giangregorio, 2012
84
* Giangregorio L
* Craven C
* Richards K
* et al.
A randomized trial of functional electrical stimulation for walking in
incomplete spinal cord injury: effects on body composition.
J Spinal Cord Med. 2012; 35: 351-360
* Crossref
* PubMed
* Scopus (34)
* Google Scholar
Hitzig, 2013
85
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* Craven BC
* Panjwani A
* et al.
Randomized trial of functional electrical stimulation therapy for walking in
incomplete spinal cord injury: effects on quality of life and community
participation.
Top Spinal Cord Inj Rehabil. 2013; 19: 245-258
* Crossref
* PubMed
* Scopus (23)
* Google Scholar
Kapadia, 2014
86
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* et al.
A randomized trial of functional electrical stimulation for walking in
incomplete spinal cord injury: effects on walking competency.
J Spinal Cord Med. 2014; 37: 511-524
* Crossref
* PubMed
* Google Scholar
Craven, 2017
87
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* Alavinia SM
* et al.
Evaluating the efficacy of functional electrical stimulation therapy assisted
walking after chronic motor incomplete spinal cord injury: effects on bone
biomarkers and bone strength.
J Spinal Cord Med. 2017; 40: 748-758
* Crossref
* PubMed
* Scopus (4)
* Google Scholar
Aerobic exercise
RCT
FairA. BWS treadmill walking with FES, 48 sessions over 16 weeks (n=17)
B. Aerobic and resistance training, 48 sessions over 16 weeks (n=17)
A vs. B
Age: 56.6 vs. 54.1
Female: 18% vs. 29%
Tetraplegia: 82% vs. 71%
UEMS: 38.3 vs. 37.5
LEMS: 30.4 vs. 27.9
C2-T12: 100%
AIS C or D: 100%
A vs. B, mean (SD), pre, post and 8 months after intervention:
10MWT: 42.8 (46.2) to 35.2 (40.8) to 42.2 (67.7) vs. 49.1 (41.7) to 28.7 (8.3)
to 35.1 (18.8), p=0.829
6MWT: 187.9 (123.4) to 217.1 (134.4) to 232.5 (138.9) vs. 79.4 (83.9) to 130
(46.0) to 126.4 (63.8), p=0.096
TUG: 43.6 (25.5) to 33.0 (15.7) to 32.2 (19.1) vs. 61.6 (36.2) to 49.5 (21.9) to
51.3 (19.6), p=0.138
FIM: 4.7 (1.82) to 5.19 (1.80) to 5.19 (1.83) vs. 4.18 (2.14) to 4.82 (1.66) to
5.09 (2.98), p=0.115
CHART Mobility subscale: 79.81 (21.00) to 85.28 (13.81) to 86.36 (14.44) vs.
82.09 (19.31) to 84.27 (11.89) to 88.45 (15.25), p=0.840
CHART Social subscale: 89.94 (13.12) to 90.31 (18.02) to 88.69 (17.10) vs. 72.73
(24.00) to 89.64 (12.63) to 73.73 (31.15), p=0.065
CHART Physical subscale: 92.35 (11.75) to 93.72 (8.02) to 93.81 (6.16) vs. 97.94
(2.49) to 94.99 (7.30) to 93.85 (5.01), p=0.214Yang, 2014
82
* Yang JF
* Musselman KE
* Livingstone D
* et al.
Repetitive mass practice or focused precise practice for retraining walking
after incomplete spinal cord injury? A pilot randomized clinical trial.
Neurorehabil Neural Repair. 2014; 28: 314-324
* Crossref
* PubMed
* Scopus (48)
* Google Scholar
Aerobic Exercise
RCT (Crossover)
Fair
A. BWS (if needed) treadmill walking, 40 sessions over 8 weeks (n=10)
B. Precision track walking training, 40 sessions over 8 weeks (n=10)A vs. B
Age: 48 vs. 44
Female: 30% vs. 30%
Able to walk > 5 meters with walking aid or braces: 100%
Cervical: 50%
A vs. B, mean change, p=between groups:
6MWT: 29 vs. 10, p=0.045
10MWT (self-selected): 0.070 vs. 0.025, p>0.05
10MWT (fast): 0.075 vs. 0.12, p>0.05
SCIFAP: –75 vs. –42, p>0.05
WISCI (self-selected): 0.08 vs. 0.85, p>0.05
WISCI (max): 0.04 vs. 0.08, p>0.05
Abbreviations: 2MWT = 2-Minute Walk Test; 6MWT = 6-Minute Walk Test; 10MWT=
10-Meter Walk Test; 25FWT = 25-Foot Walk Test; AIS = Asia Impairment Scale; BMI
= body mass index; BBS = Berg Balance Scale; BWS = body weight supported; CHART
= Craig Handicap and Assessment Reporting Technique; CI = confidence interval;
CP = cerebral palsy; CPQoL = Cerebral Palsy Quality of Life scale; DGI = Dynamic
Gait Index; EDSS = Expanded Disability Status Scale; FAC = functional ambulation
category; FAP = Functional Ambulation Profile; FES = functional electrical
stimulation; FIM = Functional Independence Measure; GMFCS = Gross Motor Function
Classification System; GMFM = Gross Motor Function Measure; GMFM-66 = Gross
Motor Function Measure 66;GMFM-66-D = Gross Motor Function Measure 66
(standing); GMFM-66-E = Gross Motor Function Measure 66 (walking, running,
jumping); GMFM-88 = Gross Motor Function Measure 88; GMFM-88-D = Gross Motor
Function Measure 88 (standing); GMFM-88-E = Gross Motor Function Measure 88
(walking, running, jumping); GNDS = Guy's Neurological Disability Scale; HAQUAMS
= Hamburg Quality of Life Questionnaire in Multiple Sclerosis questionnaire;
HiMAT = High-level Mobility Assessment Tool; ICF = International Classification
of Functioning; IPA = Impact on Participation and Autonomy; ISI = Insomnia
Severity Index; LEMS = Lower Extremity Motor Score; LMN = lower motor neuron; MD
= mean difference; MQLIM = Multicultural Quality of Life Index; MS = multiple
sclerosis; MSFC = multiple sclerosis functional composite; MSIS-29 = Multiple
Sclerosis Impact Scale-29; MSIS= Multiple Sclerosis Impact Scale; MSWS-12 =
Multiple Sclerosis Walking Scale-12; MusiQoL = Multiple Sclerosis International
Quality of Life questionnaire; NR = not reported; NS = not significant; PBS =
Pediatric Balance Scale; PEDI = Pediatric Evaluation Disability Inventory; PODCI
= Pediatric Outcomes Data Collection Instrument; PPMS = primary progressive
multiple sclerosis; PSQI = Pittsburg Sleep Quality Index; PT = physical therapy;
QOL = quality of life; RAGT = Robot assisted gait training; RCT = randomized
controlled trial; RRMS = relapsing-remitting multiple sclerosis; rTMS =
transcranial magnetic stimulation; SAWS = Satisfaction with Abilities and
Well-Being Scale; SCI = spinal cord injury; SCIM = Spinal Cord Independence
Measure; SD = standard deviation; SE = standard error; SF-12 = Short Form (12)
Health Survey; SF- 36 = Short Form (36) Health Survey; SPMS = secondary
progressive multiple sclerosis; TBS = Tinetti Balance Scale; TUG = Timed Up and
Go Test; UEMS = Upper Extremity Motor Score; UMN = upper motor neuron; WeeFIM =
Wee-Functional Independence Measure for children; WHOQOL = World Health
Organization Quality of Life; WISCI = Walking Index for Spinal Cord Injury.
* Open table in a new tab
Supplemental Table 2Studies of the Benefits and Harms of Physical
Activity—Postural Control Interventions
Author, Year
Intervention
Study Design
Study QualityIntervention and ComparisonPopulationResultsBalance
Exercise—Multiple SclerosisAfrasiabifar, 2018
89
* Afrasiabifar A
* Karami F
* Najafi Doulatabad S
Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in
patients with multiple sclerosis: a randomized controlled trial.
Clin Rehabil. 2018; 32: 57-65
* Crossref
* PubMed
* Scopus (11)
* Google Scholar
Postural control
RCT
GoodA. Cawthorne-Cooksey exercise: 36 sessions over 12 weeks (n=24)
B. Frenkel exercises, number of sessions NR, over 12 weeks (n=23)
C. Usual care (n=25)A vs. B vs. C
Age: 32.4 vs. 32 vs. 33.6
Female: 83% vs. 74% vs. 76%
RRMS: 96% vs. 96% vs. 92%
PPMS+SPMS: 4% vs. 4% vs. 8%
A vs. B vs. C, mean change from baseline (SD):
BBS: 8.9 (SD 1.8) vs. 2.3 (SD 0.9) vs. –1.2 (SD 1.05)
BBS: mean difference between-groups:
A vs. B: 5.9, 95% CI 1.9 to 9.9, p=0.001
A vs. C: 10.7, 95% CI 6.8 to 14.6, p=0.001
B vs. C: 4.8, 95% CI 0.9 to 8.8, p=0.01
Amiri, 2019
96
* Amiri B
* Sahebozamani M
* Sedighi B
The effects of 10-week core stability training on balance in women with multiple
sclerosis according to Expanded Disability Status Scale: a single-blinded
randomized controlled trial.
Eur J Phys Rehabil Med. 2019; 55: 199-208
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. Core Stability Training, 30 sessions over 10 weeks (n=35)
B. Conventional treatment (n=34)A vs. B
Age: 32 vs. 31
Female: 100%
EDSS: 3.58 vs. 3.74
RRMS: 100%Significant interaction between time and group according to baseline
EDSS score for core muscle function (i.e., core endurance and core strength
tests) and static and dynamic stability (p<0.05)Arntzen, 2019
94
* Arntzen EC
* Straume BK
* Odeh F
* et al.
Group-based individualized comprehensive core stability intervention improves
balance in persons with multiple sclerosis: a randomized controlled trial.
Phys Ther. 2019; 99: 1027-1038
* Crossref
* PubMed
* Google Scholar
Arntzen, 2020
99
* Arntzen EC
* Straume B
* Odeh F
* et al.
Group-based, individualized, comprehensive core stability and balance
intervention provides immediate and long-term improvements in walking in
individuals with multiple sclerosis: a randomized controlled trial.
Physiother Res Int. 2020; 25: e1798
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
GoodA. GroupCoreDIST, 18 sessions over 6 weeks + home exercises (n=39)
B. Usual care (n=40)A vs. B
Age: 52 vs. 48
Female: 69% vs. 73%
EDSS: 2.45 vs. 2.28
RRMS: 82% vs. 90%
PPMS: 13% vs. 5%
SPMS: 5% vs. 5%A vs. B, mean difference between groups:MiniBEST: MD 1.91, 95% CI
1.07 to 2.76, p<0.001
2MWT at 7 weeks: MD 16.7, 95% CI 8.15 to 25.25
2MWT at 30 weeks: MD 16.38, 95% CI 7.65 to 25.12
10MWT at 7 weeks: MD 0.48, 95% CI 0.11 to 0.85
10MWT at 30 weeks: MD 0.33, 95% CI –0.04 to 0.71
MSWS-12 at 7 weeks: MD 9.77, 95% CI 3.19 to 16.35
MSWS-12 at 30 weeks: MD 3.87, 95% CI –2.80 to 10.54Brichetto, 2015
90
* Brichetto G
* Piccardo E
* Pedulla L
* et al.
Tailored balance exercises on people with multiple sclerosis: a pilot
randomized, controlled study.
Mult Scler. 2015; 21: 1055-1063
* Crossref
* PubMed
* Scopus (20)
* Google Scholar
Postural control
RCT
GoodA. Personalized rehab (tailored to sensory impairment), 12 sessions over 4
weeks (n=16)
B. Traditional rehab (visual rehab for balance disorders), 12 sessions over 4
weeks (n=16)A vs. B
Age: 50.1 vs. 51.0
Female: 69% vs. 75%
RRMS: 56% vs. 63% SPMS: 31% vs. 25% PPMS: 13% vs. 13%
EDSS: 3.7 vs. 3.7A vs. B, mean (SD), p=between groups:
BBS: 46.5 (3.6) to 52.8 (2.8) vs. 45.8 (6.6) to 47.8 (6.1), p<0.001Callesen,
2019
93
* Callesen J
* Cattaneo D
* Brincks J
* et al.
How do resistance training and balance and motor control training affect gait
performance and fatigue impact in people with multiple sclerosis? A randomized
controlled multi-center study.
Mult Scler. 2020; 26: 1420-1432
* Crossref
* PubMed
* Scopus (8)
* Google Scholar
Postural control
RCT
FairA. Balance and Motor Control Training, 20 sessions over 10 weeks (n=28)
B. Waitlist Control (n=18)A vs. B
Age: 51 vs. 56
Female: 82% vs. 80%
EDSS: 4 vs. 3.5
RRMS: 75% vs. 65%
SPMS: 14% vs. 15%
PPMS: 11% vs. 20%A vs. B, mean difference, p=between groups
6MWT: MD 17.5, 95% CI –4.1 to 39.2, p=0.11
25FWT (m/s): MD 0.10, 95% CI 0.00 to 0.20, p=0.04
MSWS-12: MD –7.3, 95% CI –12.7 to –2.0, p=0.01
MiniBEST: MD 3.3, 95% CI 1.6 to 5.0, p<0.01Carling, 2017
92
* Carling A
* Forsberg A
* Gunnarsson M
* et al.
CoDuSe group exercise programme improves balance and reduces falls in people
with multiple sclerosis: a multi-centre, randomized, controlled pilot study.
Mult Scler. 2017; 23: 1394-1404
* Crossref
* PubMed
* Scopus (23)
* Google Scholar
Postural control
RCT
FairA. Group balance training (CoDuSe), 14 sessions over 7 weeks (n=23)
B. Waitlist (Late start) controls (n=25)A vs. B
Age: 62 vs. 55
Female: 76% vs. 62%
EDSS: 6.16 vs. 6.06
RRMS: 0% vs. 23%
SPMS: 68% vs. 58%
PPMS: 32% vs. 19%A vs. B, mean change (SE):
BBS: 3.65 (1.44), p=0.015
TUG: 4.41 (3.17), p=0.17
2MWT: –3.24 (3.37), p=0.34
Sit-to-Stand: 0.24 92.12), p=0.17
10MWT: 1.49 (3.84), p=0.70
Falls Efficiency Scale: –1.66 (2.39), p=0.49
MSWS-12: –7.21 (3.60), p=0.051
Falls: –1.24 (1.66), p<0.001
Near Falls: –8.24 (14.78), p=0.002Forsberg, 2016
5
* Young HJ
* Mehta TS
* Herman C
* et al.
The effects of M2M and adapted yoga on physical and psychosocial outcomes in
people wth multiple sclerosis.
Arch Phys Med Rehabil. 2019; 100: 391-400
* Abstract
* Full Text
* Full Text PDF
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Postural control
RCT
FairA. Group Core Stability Dual Tasking Sensory Strategies (CoDuSe), 14
sessions over 7 weeks (n=35)
B. No intervention (n=38)A vs. B
Age: 52 vs. 56
Female: 80% vs. 82%
EDSS 6.0 or less: 100%
RRMS: 57% vs. 34%
PPMS: 11% vs. 13%
SPMS: 31% vs. 53%A vs. B, least squares mean, 95% CI p=between groups
TUG: 1.4, 95% CI –1.7 to 4.5, p=0.37
MSWS-12: –3.7, 95% CI –6.0 to –1.3, p=0.0026
FGA: 2.1, 95% CI 0.6 to 3.6, p=0.0079
BBS: –2.1, 95% CI –3.8 to –0.5, p=0.011Gandolfi, 2015
91
* Gandolfi M
* Munari D
* Geroin C
* et al.
Sensory integration balance training in patients with multiple sclerosis: a
randomized, controlled trial.
Mult Scler. 2015; 21: 1453-1462
* Crossref
* PubMed
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Postural control
RCT
FairA. Balance training (sensory integration), 15 sessions over 5 weeks (n=39)
B. Conventional rehabilitation, 15 sessions over 5 weeks (n=41)A vs. B
Age: 47.21 vs. 49.56
Female: 72% vs. 76%
EDSS (median): 3.00 vs. 3.66
RRMS: 100%A vs. B, mean (SD), p=between groups:
MSQOL-54 PHC: 63.09 (11.09) to 65.56 (10.31) vs. 58.77 (11.05) to 59.64 (9.80),
p>0.05 (postintervention); 63.09 (11.09) to 63.56 (10.27) vs. 58.77 (11.05) to
58.54 (11.64), p>0.05 (1 month posttreatment)
MSQOL-54 MHC: 61.05 (20.15) to 65.32 (18.29) vs. 60.50 (16.6) to 63.09 (12.19),
p>0.05 (postintervention); 61.05 (20.15) to 63.19 (17.94) vs. 60.50 (16.6) to
63.25 (13.18), p>0.05 (1 month posttreatment)
BBS: 47.97 (4.89) to 52.77 (3.15) vs. 46.49 (5.21) to 47.79 (6.05), p<0.001
(postintervention); 47.97 (4.89) to 52.92 (2.97) vs. 46.49 (5.21) to 48.33
(5.88), p<0.001 (1 month posttreatment)
Number of Falls: 0.59 (0.99) to 0.03 (0.16) vs. 0.37 (0.54) to 0.29 (0.34),
p=0.005 (postintervention); 0.59 (0.99) to 0.08 (0.27) vs. 0.37 (0.54) to 0.27
(0.55), p=0.053 (1 month posttreatment)Ozkul, 2020
97
* Ozkul C
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* Yazici G
* et al.
Effect of immersive virtual reality on balance, mobility, and fatigue in
patients with multiple sclerosis: a single-blinded randomized controlled trial.
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Postural control
RCT
FairA. Balance training, 16 sessions over 8 weeks (n=13)
B. Relaxation exercises at home, 16 sessions over 8 weeks (n=13)A vs. B
Age: 34 vs. 34
Female: 85% vs. 77%
EDSS median: 1 vs. 2
Number of relapses: 2 vs. 2Pre-post median (IQR):
BBS: 47 (44, 56) to 52 (46, 56) vs. 55 (53, 56) to 56 (53.5, 56), p>0.05
TUG: 7.3 (6.7, 8.5) to 7.3 (6, 7.9) vs. 6.9 (6.5, 7.5) to 7.4 (6.4, 7.7),
p<0.017Sadeghi Bahmani, 2019
8
* Sadeghi Bahmani D
* Razazian N
* Farnia V
* et al.
Compared to an active control condition, in persons with multiple sclerosis two
different types of exercise training improved sleep and depression, but not
fatigue, paresthesia, and intolerance of uncertainty.
Mult Scler Relat Disord. 2019; 36101356
* Abstract
* Full Text
* Full Text PDF
* PubMed
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Postural control
RCT
FairA. Balance and coordination exercises, 24 sessions over 8 weeks (n=24)
B. Attention control, 24 sessions over 8 weeks (n=21)A vs. B
Age: 39 vs. 38
Female: 100%
EDSS: 3.38 vs. 2.02A vs. B, mean (SD), p=between groups:
EDSS: 3.38 (1.87) to 3.10 (1.86) vs. 2.02 (1.84) to 1.98 (1.70), p>0.05
ISI: 13.46 (5.81) to 10.13 (4.92) vs. 1.71 (5.43) to 11.14 (5.39), p>0.05Salci,
2017
98
* Salci Y
* Fil A
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* et al.
Effects of different exercise modalities on ataxia in multiple sclerosis
patients: a randomized controlled study.
Disabil Rehabil. 2017; 39: 2626-2632
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Postural control
RCT
FairA. Balance training, 18 sessions over 6 weeks (n=14)
B. Lumbar stabilization plus balance training, 18 sessions over 6 weeks (n=14)
C. Task-oriented training (individualized exercises) plus balance training, 18
sessions over 6 weeks (n=14)A vs. B vs. C
Age: 35.36 vs. 37.29 vs. 34.36
Female: 43% vs. 62% vs. 71%
Ambulatory: 100%
EDSS (median): 3.5 vs. 3.5 vs. 3.5
RRMS: 79% vs. 79% vs. 86%
PPMS: 7% vs. 7% vs. 0%
SPMS: 14% vs. 14% vs. 14%A vs. B vs. C, mean change (SD), p=between groups:
2MWT: 10.75 (SD 9.97) vs. 25.55 (SD 16.90) vs. 18.69 (SD 14.24)
A vs. B: p=0.08; A vs. C: p=0.085; B vs. C: p=0.265
BBS: 3.57 (SD 2.20) vs. 5.78 (SD 3.40) vs. 5.57 (SD 3.73); p=>0.05 for all
comparisons
Tollar, 2020
28
* Tollar J
* Nagy F
* Toth BE
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Exercise effects on multiple sclerosis quality of life and clinical-motor
symptoms.
Med Sci Sports Exerc. 2020; 52: 1007-1014
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Postural control
RCT
FairA. Balance training, 25 sessions over 5 weeks (n=14)
B. Usual PT, 25 sessions over 5 weeks (n=12)A vs. B
Age: 46.9 vs. 44.4
Female: 86% vs. 92%
EDSS median: 5.0 vs. 5.0
RRMS: 64% vs. 67%A vs. B, mean difference between groups:
MSIS-29: –6.3 (4.36) vs. 1.0 (3.46), p=0.008
6MWT: 19.2 (35.40) vs. 6.3 (49.27), p=0.174
BBS: 3.9 (2.25) vs. –0.2 (2.62), p=0.015
EQ-5 Sum score:–0.6 (1.15) vs. 0.0 (1.13), p=0.023Balance Exercise—Cerebral
PalsyBleyenheuft, 2017
101
* Bleyenheuft Y
* Ebner-Karestinos D
* Surana B
* et al.
Intensive upper- and lower-extremity training for children with bilateral
cerebral palsy: a quasi-randomized trial.
Dev Med Child Neurol. 2017; 59: 625-633
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Postural control
Quasiexperimental
PoorA. Hand-arm bimanual intensive therapy including lower extremity, MSFC
6.4-hour sessions over 13 days (n=10)
B. Usual PT, 2 weeks (n=10)A vs. B
Age: 10.5 vs. 11.4
Female: 40% vs. 50%
GMFCS II: 20% vs. 20%
GMFCS III: 70% vs. 70%
GMFCS IV: 10% vs. 10%A vs. B, mean (SD); p=interaction of 2 interventions X 3
time points (baseline, postintervention and 3 months postintervention):
LE GMFM-66: 55 (5.9) to 58 (6.2) to 62 (6.4) vs. 55 (8.7) to 56 (7.6) to 57
(6.6), p<0.001
6MWT: 190 (108.5) to 226 (100.8) to 236 (105.1) vs. 194 (101.1) to 180 (111.1)
to 182 (101.1), p=0.026
PEDI: 52 (12.4) to 57 (11.5) to 60 (10.7) vs. 51 (14.6) to 51 (15.3) to 51
(15.8), p=0.001
PBS: 33 (17.5) to 43 (20.1) to 42 (21.3) vs. 30 (23.9) to 27 (22.2) to 26
(23.2), p=0.002Curtis, 2018
100
* Curtis DJ
* Woollacott M
* Bencke J
* et al.
The functional effect of segmental trunk and head control training in
moderate-to-severe cerebral palsy: a randomized controlled trial.
Dev Neurorehabil. 2018; 21: 91-100
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* PubMed
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Postural control
RCT
FairA. Trunk control training: 120 sessions over 24 weeks (n=14)
B. Usual care (n=14)A vs. B
Age: 8 vs. 8
Female: 21% vs. 50%
Spastic: 50% vs. 64% Dyskinetic: 50% vs. 36%
GMFCS III: 14% vs. 21%
GMFCS IV: 29% vs. 14% GMFCS V: 57% vs. 64%A vs. B, mean difference, p=between
groups:
GMFM–66: 1.1, 95% CI –2.2 to 4.4, p>0.05 (postintervention); 0.1, 95% CI –3.6 to
3.3, p>0.05 (12-month followup)
SATCo: mean between group difference at end of treatment and at posttreatment
followup: p>0.05
PEDI Self Care, PEDI Mobility, PEDI Mobility Caregiver Assistance: mean between
group difference at end of treatment and at posttreatment followup: p>0.05Kim,
2017
103
* Kim BJ
* Kim SM
* Kwon HY
The effect of group exercise program on the self-efficacy and activities of
daily living in adults with cerebral palsy.
J Phys Ther Sci. 2017; 29: 2184-2189
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Postural control
Social activity/exercise (Boccia)
Cohort study
PoorA. Group boccia, 12 sessions over 6 weeks (n=11)
B. Usual care (n=12)A vs. B
Age: 22.36 vs. 21.83
Female: 45% vs. 42%
A vs. B, mean (SD), p=between groups:
Modified Barthel Index, mean change from baseline: 2.82 (SD 1.25) vs. 1.58 (SD
1.38), p<0.05; MD 1.24, 95% CI 0.09 to 2.34, p=0.04
Lorentzen, 2015
102
* Lorentzen J
* Greve LZ
* Kliim-Due M
* et al.
Twenty weeks of home-based interactive training of children with cerebral palsy
improves functional abilities.
BMC Neurol. 2015; 15: 75
* Crossref
* PubMed
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* Google Scholar
Postural control
Quasiexperimental
PoorA. Interactive, home-based computer training, 140 sessions over 20 weeks
(n=34)
B. Usual care (n=12)
A vs. B
Age: 10.9 vs. 11.3
Female: 32% vs. 42%
GMFCS I: 97% vs. 92%
GMFCS II: 3% vs. 8%A. vs. B, mean (SD), p=between groups:
Sit-to-stand, number of cycles performed: 20.0 (0.9) vs, 15.1 (0.9), p=0.04
Left leg lateral step up, number of steps: 23.5 (1.4) vs. 17.8 (2.2), p=0.004
Right leg lateral step up, number of steps: 22.1 (1.4) vs. 18.0 (2.0), p<0.001
Romberg Balance Test center of gravity maintenance area (mm2): 462.2 (62.5) vs.
314.6 (104.9), p=0.18Balance Exercise—Spinal Cord InjuryHota, 2020
104
* Hota D
* Das S
* Joseph NM
Effect of dual task exercise to develop body balance, movement co-ordination and
walking speed among post cervical injury clients.
Int J Res Pharm Sci. 2020; 11: 1117-1122
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Postural control
RCT
FairA. Dual task exercises for upper and lower limbs, 24 sessions over 4 weeks
(n=20)
B. Control group – details NR, (n=20)A vs. B
Age 11-25: 40% vs. 30%
Age 26-40: 25% vs. 45%
Age 41-55: 25% vs. 25%
Age 56-70: 10% vs. 0%
Female: 10% vs. 10%A vs. B, mean (SD):
BBS: MD 4.55, 95% CI 2.16 to 6.94
Motor Assessment Scale: MD 3.82, 95% CI 1.09 to 6.55, p=0.006Norouzi, 2019
105
* Norouzi E
* Vaezmousavi M
Neurofeedback training and physical training differentially impacted on reaction
time and balance skills among Iranian veterans with spinal cord injury.
J Mil Veterans Health. 2019; 27: 11-18
* Google Scholar
Postural control
RCT
FairA. Cawthorne/ Cooksey exercises, 12 sessions over 4 weeks (n=10)
B. Usual care, 4 sessions over 4 weeks (n=10)A vs. B
Age: NR
Female: 0%
L3-L4: 100%A vs. B, mean (SD), p-value=between groups
BBS: 38.36 (6.01) to 48.39 (4.01) vs. 37.67 (6.07) to 43.20 (4.05), MD 4.5, 95%
CI –0.17 to 9.17, p=0.059Hippotherapy—Multiple SclerosisMoraes, 2020
108
* Moraes AG
* Neri SGR
* Motl RW
* et al.
Effect of hippotherapy on walking performance and gait parameters in people with
multiple sclerosis.
Mult Scler Relat Disord. 2020; 43102203
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. Hippotherapy, 16 sessions over 8 weeks (n=17)
B. Waitlist control (n=16)A vs. B
Age: 45.5 vs. 48.4
Female: 94% vs. 94%
EDSS, median: 2.0 vs. 1.75
RRMS: 100%A vs. B, mean (SD):
6MWT: 459.06 (118.34) to 503.59 (126.38) vs. 513.00 (101.97) to 497.13 (88.88),
p<0.001
25FWT: 6.37 (1.70) to 5.36 (1.43) vs. 5.82 (1.29) to 5.84 (1.08),
p<0.001Vermohlen, 2018
106
* Vermohlen V
* Schiller P
* Schickendantz S
* et al.
Hippotherapy for patients with multiple sclerosis: a multicenter randomized
controlled trial (MS-HIPPO).
Mult Scler. 2018; 24: 1375-1382
* Crossref
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* Google Scholar
Postural control
RCT
FairA. Hippotherapy plus standard care, 12 sessions over 12 weeks (n=32)
B. Control group (standard care), 12 weeks (n=38)
A vs. B
Age (median): 50 vs. 51
Female: 90% vs. 73%
EDSS: 5.4 vs. 5.3
A vs. B, mean difference, p=between groups:
MSQoL-54 mental health subscale score: 14.4, 95% CI 7.5 to 21.3, p<0.001
MSQoL-54 physical health subscale score: 12.0, 95% CI: 6.2 to 17.7, p<0.001
BBS: 2.33, 95% CI: 0.03 to 4.63, p=0.047Hippotherapy—Cerebral PalsyDeutz, 2018
111
* Deutz U
* Heussen N
* Weigt-Usinger K
* et al.
Impact of hippotherapy on gross motor function and quality of life in children
with bilateral cerebral palsy: a randomized open-label crossover study.
Neuropediatrics. 2018; 49: 185-192
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Postural control
RCT
Poor
A. Hippotherapy, 16 to 32 sessions over 16 to 20 weeks plus usual physiotherapy
(n=35)
B. Usual physiotherapy over 16 to 20 weeks (n=38)
Crossover studyA vs. B
Age: 9.29 vs. 8.87
Female: 34% vs. 45%
GMFCS II: 29% vs. 45%
GMFCS III: 20% vs. 26%
GMFCS IV: 51% vs. 29%
A vs. B, mean difference, p=between groups:
GMFM-66 total: 0.52, 95% CI –0.52 to 1.55, p>0.05
GMFM-66-D: 0.016, 95% CI –1.09 to 1.12, p>0.05
GMFM-66-E: 2.30, 95% CI 0.28 to 4.33, p<0.05
CHQ-28 social: 0.21, 95% CI –3.89 to 3.47, p>0.05
CHQ-28 physical: 4.77, 95% CI –1.12 to 10.66, p>0.05
KIDSCREEN-27: mean difference 1.07, 95% CI –2.53 to 4.68, p>0.05Herrero, 2012
112
* Herrero P
* Gomez-Trullen EM
* Asensio A
* et al.
Study of the therapeutic effects of a hippotherapy simulator in children with
cerebral palsy: a stratified single-blind randomized controlled trial.
Clin Rehabil. 2012; 26: 1105-1113
* Crossref
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* Google Scholar
Postural control
RCT
Fair
A. Hippotherapy
simulator ON, 10 sessions over 10 weeks (n=19)
B. Hippotherapy
simulator OFF, 10 sessions over 10 week (n=19)A vs. B
Age: 9.95 vs. 9.05
Female: 26% vs. 32%
GMFCS I: 11% vs. 11%
GMFCS II: 11% vs. 5%
GMFCS III: 16% vs. 11%
GMFCS IV: 16% vs. 21%
GMFCS V: 47% vs. 53%A vs. B, mean difference, p=between groups
GMFM total: 0.27, 95% CI –0.07 to 0.62, p>0.05
GMFM total, 22 weeks: 0.25, 95% CI –0.10 to 0.60, p>0.05
GMFM total: Proportion with improvement from baseline, 10 weeks: (11/19) vs.
(8/19); OR 1.89 (95% CI 0.5 to 6.9), p>0.05
GMFM total: Proportion with improvement from baseline, 22 weeks: (10/19) vs.
(12/19); OR 0.65 (95% CI 0.18 to 2.37), p>0.05
Sitting Assessment Scale: 0.26 (0.65) vs. –0.21 (0.92), p>0.05Kwon, 2011
117
* Kwon JY
* Chang HJ
* Lee JY
* et al.
Effects of hippotherapy on gait parameters in children with bilateral spastic
cerebral palsy.
Arch Phys Med Rehabil. 2011; 92: 774-779
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (83)
* Google Scholar
Postural control
Quasiexperimental
FairA. Hippotherapy, 16 sessions over 8 weeks plus usual PT, 16 sessions over 8
weeks (n=16)
B. Usual PT, 16 sessions over 8 weeks (n=16)A vs. B
Age: 6.4 vs. 6.1
Female: 31% vs. 38%
Ambulatory: 100%
GMFCS I: 25% vs. 25%
GMFCS II: 75% vs. 75%A vs. B, mean (SD), p=between groups:
GMFM-66: 70.4 (7.4) to 73.7 (8.3) vs. 69.8 (8.7) to 70.1 (8.1), p=0.003
GMFM-88: 89.4 (7.3) to 91.1 (6.7) vs. 88.0 (8.3) to 88.3 (8.4), p=0.054
GMFM-88-D: 83.2 (15.5) to 83.3 (10.9) vs. 79.6 (15.5) to 79.3 (16.6), p=0.826
GMFM-88-E: 67.2 (17.5) to 74.6 (19.3) vs. 65.3 (20.0) vs. 66.9 (20.1), p=0.042
PBS: 41.7 (8.8) to 45.8 (8.6) vs. 41.0 (10.4) to 41.5 (10.6), p=0.004Kwon, 2015
109
* Kwon JY
* Chang HJ
* Yi SH
* et al.
Effect of hippotherapy on gross motor function in children with cerebral palsy:
a randomized controlled trial.
J Altern Complement Med. 2015; 21: 15-21
* Crossref
* PubMed
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* Google Scholar
Balance
RCT
Good
A. Hippotherapy, 16 sessions over 8 weeks plus usual PT (n=46)
B. Home-based aerobic exercise, 16 sessions over 8 weeks plus usual PT (n=46)A
vs. B
Age: 5.7 vs. 5.9
Female: 56% vs. 37%
GMFCS I: 27% vs. 26%
GMFCS II: 27% vs. 26%
GMFCS III: 24% vs. 26%
GMFCS IV: 22% vs. 22%
Spastic: 91% vs. 93%
Unilateral: 9% vs. 13%
A vs. B, mean (SD), p=between groups:
GMFM-66: 60.8 (14.9) to 63.5 (15.8) vs. 61.4 (14.8) to 61.8 (15.0), p<0.01
GMFM-88: 72.7 (19.2) to 75.7 (18.3) vs. 73.9 (17.9) to 74.3 (18.1), p<0.01
GMFM-88-D: 54.1 (34.2) to 59.7 (32.5) vs. 55.5 (32.2) to 54.9 (33.2), p<0.01
GMFM-88-E: 41.0 (34.1) to 45.1 (35.4) vs. 42.0 (33.2) to 43.0 (33.0), p<0.01
PBS: 25.1 (18.9) to 28.9 (18.8) vs. 26.9 (18.3) to 27.1 (18.3), p<0.01Lee, 2014
110
* Lee CW
* Kim SG
* Na SS
The effects of hippotherapy and a horse riding simulator on the balance of
children with cerebral palsy.
J Phys Ther Sci. 2014; 26: 423-425
* Crossref
* PubMed
* Scopus (13)
* Google Scholar
Postural control
RCT
PoorA. Hippotherapy, 36 sessions over 12 weeks (n=13)
B. Horseback
riding simulator, 36 sessions over 12 weeks (n=13)A vs. B
Age: 10.8 vs. 10.0
Female: 38% vs. 31%
Walk > 10 meters independently: 100%A vs. B, mean (SD), p=between groups
PBS: 35.6 (3.8) to 41.2 (4.7) vs. 35.8 (4.7) to 38.5 (5.3),
p>0.05Matusiak-Wieczorek, 2016
118
* Matusiak-Wieczorek E
* Malachowska-Sobieska M
* Synder M
Influence of hippotherapy on body balance in the sitting position among children
with cerebral palsy.
Ortop Traumatol Rehabil. 2016; 18: 165-175
* Crossref
* PubMed
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* Google Scholar
Postural control
Quasiexperimental
PoorA. Hippotherapy, 12 sessions over 12 weeks (n=19)
B. Maintain current activities (n=20)A vs. B
Age: 8.42 vs. 8.3
Female: 47% vs. 45%
Ambulatory: 100%
Hemiplegia: 68% vs. 75%
GMFCS I: 63% vs. 55%
GMFCS II: 37% vs. 45%A vs. B, mean (SD)
Sitting Assessment Scale: 14.42 (4.39) to 15.63 (3.65) vs.15.50 (3.14) to 15.75
(3.19), p=0.010Matusiak-Wieczorek, 2020
115
* Matusiak-Wieczorek E
* Dziankowska-Zaborszczyk E
* Synder M
* et al.
The influence of hippotherapy on the body posture in a sitting position among
children with cerebral palsy.
Int J Environ Res Public Health. 2020; 17: 19
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* Google Scholar
Postural control
RCT
FairA. Hippotherapy, 24 sessions over 12 weeks (n=15)
B. Hippotherapy, 12 sessions over 12 weeks (n=15)
C. No hippotherapy (n=15)A vs. B vs. C
Age: 7.93 vs. 7.60 vs. 8.13
Female: 40% vs. 47% vs. 47%
GMFCS I: 67% vs. 80% vs. 47%
GMFCS II: 33% vs. 20% vs. 53%A vs. B vs. C, mean (SD), p=between groups
Sitting Assessment Scale: 10.93 (3.97) to 13.13 (3.46) vs. 15.93 (4.17) to 17.27
(2.76) vs. 14.87 (3.27) to 15.13 (3.36)
A vs. C: MD 1.93, 95% CI 0.94 to 2.92, p<0.001
B vs. C: MD 1.06, 95% CI 0.61 to 1.51, p<0.001
A vs. B: MD 0.87, 95% CI 0.06 to 1.69, p=0.036Mutoh, 2019
114
* Mutoh T
* Mutoh T
* Tsubone H
* et al.
Impact of long-term hippotherapy on the walking ability of children with
cerebral palsy and quality of life of their caregivers.
Front Neurol. 2019; 10: 834
* Crossref
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* Google Scholar
Postural control
RCT
Fair
A. Hippotherapy, 48 sessions over 48 weeks (n=12)
B. Outdoor recreation 48 sessions over 48 weeks (n=12)A vs. B
Age: 8 vs. 9
Female: 58% vs. 50%
GMFCS II: 42% vs. 42%
GMFCS III: 58% vs. 58%A vs. B, mean (SD), p=between groups
GMFM-66: 56.6 (9.2) to 62.8 (10.8) vs. 57.4 (7.9) to 57.9 (9.2), p<0.05
GMFM-66-E: 45.4 (7.0) to 49.7 (7.6) vs. 46.0 (6.3) to 46.5 (6.6), p<0.05
5MWT (m/min): 31.9 (10.7) to 38.8 (13.5) vs. 31.1 (11.3) to 32.3 (11.6), p<0.05
WHOQOL (positive feelings): 3.1 (1) to 4.1 (1) vs. 3.1 (0.9) to 3.4 (1), p<0.05
WHOQOL (self-esteem): 2.9 (1.2) to 4.0 (0.7) vs. 3.3 (1.1) to 3.7 (0.7), p<0.05
WHOQOL (negative feelings): 2.9 (0.8) to 2.8 (0.7) vs. 2.8 (0.8) to 2.8 (0.8),
p>0.05Park, 2014
119
* Park ES
* Rha DW
* Shin JS
* et al.
Effects of hippotherapy on gross motor function and functional performance of
children with cerebral palsy.
Yonsei Med J. 2014; 55: 1736-1742
* Crossref
* PubMed
* Scopus (48)
* Google Scholar
Postural control
Cohort
PoorA. Hippotherapy, 16 sessions over 8 weeks (n=34)
B. Waitlist control (n=21)A vs. B
Age: 6.68 vs. 7.76
Female: 56% vs. 52%
Bilateral CP: 94% vs. 90%
GMFCS I: 24% vs. 29%
GMFCS II: 32% vs. 19%
GMFCS III: 15% vs. 29%
GMFCS IV: 29% vs. 24%A vs. B, mean (SD) change from baseline, p=between groups:
GMFM-66: 2.93 (3.95) vs. 1.25 (1.99), p<0.05
PEDI: 10.89 (11.94) vs. 2.00 (4.93), p<0.05Silva e Borges, 2011
113
* Silva e Borges MB
* Werneck MJ
* da Silva Mde L
* et al.
Therapeutic effects of a horse riding simulator in children with cerebral palsy.
Arq Neuropsiquiatr. 2011; 69: 799-804
* Crossref
* PubMed
* Scopus (23)
* Google Scholar
Postural control
RCT
FairA. Riding simulator, 12 sessions over 6 weeks (n=20)
B. Usual PT, 12 sessions over 6 weeks (n=20)A vs. B
Age: 5.65 vs. 5.77
Female: 60% vs. 55%
GMFCS II: 20%
GMFCS III: 40%
GMFCS IV: 35%
GMFCS V: 5%A vs. B, p=between groups:
GMFCS reclassification indicating improved function: 25% (5/20) vs. 10% (2/20),
p=0.24Hippotherapy—Spinal Cord InjuryNo studies identified———Tai Chi—Multiple
SclerosisAzimzadeh, 2015
120
* Azimzadeh E
* Hosseini MA
* Nourozi K
* et al.
Effect of tai chi chuan on balance in women with multiple sclerosis.
Complement Ther Clin Pract. 2015; 21: 57-60
* Crossref
* PubMed
* Google Scholar
Postural control
RCT
PoorA. Tai Chi plus usual care, 24 sessions over 12 weeks (n=16)
B. Usual care (n=18)A vs. B
Age: 37.5 vs. 33
Female: 100%
Ambulatory: 100%A vs. B, mean (SD)
BBS: 52.25 (3.39) to 53.94 (2.23) vs. 53.22 (2.23) to 53.61 (2.14); MD 1.39, 95%
CI –0.39 to 3.17, p=0.13
Burschka, 2014
121
* Burschka JM
* Keune PM
* Oy UH
* et al.
Mindfulness-based interventions in multiple sclerosis: beneficial effects of tai
chi on balance, coordination, fatigue and depression.
BMC Neurol. 2014; 14: 165
* Crossref
* PubMed
* Scopus (65)
* Google Scholar
Postural control
Quasiexperimental
PoorA. Tai Chi, 48 sessions 6 months (n=15)
B. Usual care (n=17)A vs. B
Age: 42 vs. 43
Female: 66% vs. 71%
Ambulatory: 100%
RRMS: 93% vs. 76%
SPMS: 0% vs. 24%
CIS: 7% vs. 0%A vs. B, mean (SD), p=between groups:
CES-D: 12.21 (6.66) to 7.67 (5.12) vs. 13.87 (10.82) to 16.13 (11.99), p<0.05
QLS 7 item, 1–7 rating scale, maximum score 420 points): 215 (25.55) to 232.57
(25.62) vs. 204.46 to 193.81 (36.20), p<0.01
Balance (14 Balance tasks, measured 1=achieved task, 0=failed task): 8.00 (2.83)
to 9.33 (2.26) vs. 6.88 (4.09) to 6.53 (4.49), p<0.05Tai Chi—Cerebral PalsyNo
studies identified———Tai Chi—Spinal Cord InjuryQi, 2018b
122
* Qi Y
* Zhang X
* Zhao Y
* et al.
The effect of wheelchair tai chi on balance control and quality of life among
survivors of spinal cord injuries: a randomized controlled trial.
Complement Ther Clin Pract. 2018; 33: 7-11
* Crossref
* PubMed
* Scopus (6)
* Google Scholar
Postural control
RCT
Fair
A. Wheelchair Tai Chi, 60 sessions over 6 weeks (n=20)
B. Usual care control, (n=20)
A vs. B
Age: 38.3 vs. 43.05
Female: 25% vs. 20%
Wheelchair user: 100%
C6-T1: 15% vs. 20%
T2-T5: 25% vs. 30%
T6-T12: 40% vs. 35%
Below L1: 20% vs. 15%
A vs. B, mean (SD), p=between groups:
WHOQOL-BREF (physical): 11.40 (1.25) to 11.80 (1.33) vs. 10.94 (1.15) to 11.09
(1.29), p=0.08
WHOQOL-BREF (psychological): 10.95 (1.57) to 12.23 (1.65) vs. 10.87 (1.08) to
11.20 (1.33), p=0.01
WHOQOL-BREF (social): 10.93 (1.60) to 12.40 (1.79) vs. 10.53 (1.29) to 11.27
(1.47), p=0.07
WHOQOL-BREF (environmental): 10.00 (1.72) to 10.65 (1.58) vs. 9.67 (1.51) to
10.09 (1.77), p=0.28Motion Gaming—Multiple SclerosisKalron, 2016
123
* Kalron A
* Fonkatz I
* Frid L
* et al.
The effect of balance training on postural control in people with multiple
sclerosis using the CAREN virtual reality system: a pilot randomized controlled
trial.
J Neuroeng Rehabil. 2016; 13: 13
* Crossref
* PubMed
* Scopus (70)
* Google Scholar
Postural control
RCT
FairA. Balance training using Caren Integrated Virtual Reality System with 3D
visual, sound and proprioception, 12 sessions over 6 weeks (n=15)
B. Static postural control, weight shifting and perturbation exercises, 12
sessions over 6 weeks (n=15)A vs. B
Age: 47.3 vs. 43.9
Female: 67% vs. 60%
EDSS: 4.5 vs. 3.9A vs. B, mean (SD), p=between groups:
Berg Balance Scale: 46.8 (9.6) to 47.9 (6.4) vs. 43.3 (7.1) to 44.6 (4.9),
p=0.56
Four Square Step Test: 16.2 (7.0) to 12.7 (6.4) vs. 14.2 (7.1) to 11.7 (5.9),
p=0.361
Falls Efficacy Scale International: 36.4 (9/7) to 29.4 (7.8) vs. 32.9 (10.3) to
28.6 (5.8), p=0.021Khalil, 2018
126
* Khalil H
* Al-Sharman A
* El-Salem K
* et al.
The development and pilot evaluation of virtual reality balance scenarios in
people with multiple sclerosis (MS): a feasibility study.
NeuroRehabilitation. 2018; 43: 473-482
* Crossref
* PubMed
* Scopus (9)
* Google Scholar
Postural control
RCT
FairA. Nintendo Wii balance board and VR scenarios with tasks to complete, 12
sessions over 6 weeks (n=16)
B. Balance training at home, 18 sessions over 6 weeks (n=16)A vs. B
Age: 39.9 vs. 34.9
Female: 75% vs. 63%
EDSS: 2.9 vs. 3.1
RRMS: 100%A vs. B, mean difference between groups:
TUG: 0.04, 95% CI –2.24 to 2.32, p=0.97
10MWT: 8.48, 95% CI –5.16 to 22.12, p=0.21
3MWT: –7.11, 95% CI –34.18 to 19.95, p=0.59
SF-36 PCS: –11.62, 95% CI –22.27 to –0.99, p=0.03
SF-36 MCS: –13.60, 95% CI –23.66 to –3.55, p=0.01
FES-I: 3.86, 95% CI –0.062 to 8.34, p=0.08
BBS: –4.52, 95% CI –7.90 to –1.09, p=0.01Nilsagard, 2013
125
* Nilsagard YE
* Forsberg AS
* von Koch L
Balance exercise for persons with multiple sclerosis using Wii games: a
randomised, controlled multi-centre study.
Mult Scler. 2013; 19: 209-216
* Crossref
* PubMed
* Scopus (101)
* Google Scholar
Postural control
RCT
Fair
A. Play games using Nintendo Wii Fit Plus® Balance Board for balance, yoga,
strength and aerobics, 12 sessions over 6 weeks (n=42)
B. No balance exercise during routine PT (n=42)
A vs. B
Age: 50.0 vs. 49.4
Female: 76% vs. 76%
Able to walk 100 m: 100%
RRMS: 62% vs. 67%
SPMS: 31% vs. 31%
PPMS: 7% vs. 2%
No assist device indoors: 76% vs. 88%
No assist device outdoors: 52% vs. 50%A vs. B, mean (SD) change at followup,
p=between groups:
TUG: –0.8 (2.4) vs. 0.1 (2.1), p=0.10
25footWT: –0.3 (1.1) vs. –0.1 (1.4), p=0.51
DGI: 1.78 (2.3) vs. 1.0 (2.0), p=0.21
MS Walking Scale: –5.9 (11.5) vs. –3.95 (18.1), p=0.76
Four Square Step Test: –1.6(2.1) vs. –2.0 (6.6), p=0.64
Ozkul, 2020
97
* Ozkul C
* Guclu-Gunduz A
* Yazici G
* et al.
Effect of immersive virtual reality on balance, mobility, and fatigue in
patients with multiple sclerosis: a single-blinded randomized controlled trial.
Eur J Integr Med. 2020; 35101092
* Crossref
* Scopus (5)
* Google Scholar
Postural control
RCT
FairA. Immersive virtual reality, 16 sessions over 8 weeks (n=13)
B. Relaxation exercises at home, 16 sessions over 8 weeks (n=13)A vs. B
Age: 29 vs. 34
Female: 69% vs. 77%
EDSS median: 1 vs. 2
Number of relapses: 3 vs. 2Pre-post median (IQR):
BBS: 52 (42.5, 56) to 54 (44.5, 56) vs. 55 (53, 56) to 56 (53.5, 56), p>0.05
TUG: 7.6 (6.9, 8) to 6.3 (5.7, 7.2) vs. 6.9 (6.5, 7.5) to 7.4 (6.4, 7.7),
p<0.017Tollar, 2020
28
* Tollar J
* Nagy F
* Toth BE
* et al.
Exercise effects on multiple sclerosis quality of life and clinical-motor
symptoms.
Med Sci Sports Exerc. 2020; 52: 1007-1014
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. Xbox 360, Adventure video game, 25 sessions over 5 weeks (n=14)
B. Usual PT, 25 sessions over 5 weeks (n=12)A vs. B
Age: 48.2 vs. 44.4
Female: 86% vs. 92%
EDSS median: 5.0 vs. 5.0
RRMS: 50% vs. 67%A vs. B, mean difference between groups:
MSIS-29: –10.8 (6.09) vs. 1.0 (3.46), p<0.001
6MWT: 57.4 (52.09) vs. 6.3 (49.27), p=0.017
BBS: 6.1 (3.52) vs. –0.2 (2.62), p<0.001
EQ-5 Sum score:–2.3 (1.44) vs. 0.0 (1.13), p<0.001Yazgan, 2020
124
* Yazgan YZ
* Tarakci E
* Tarakci D
* et al.
Comparison of the effects of two different exergaming systems on balance,
functionality, fatigue, and quality of life in people with multiple sclerosis: a
randomized controlled trial.
Mult Scler Relat Disord. 2019; 39101902
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (10)
* Google Scholar
Postural control
RCT
Fair
A. Nintendo Wii Fit, 16 sessions over 8 weeks (n=15)
B. Balance Trainer motion gaming, 16 sessions over 8 weeks (n=12)
C. Waitlist control (n=15)A vs. B vs. C
Age: 47.5 vs. 43.1 vs. 40.7
Female: 86.7% vs. 100% vs. 86.7%
EDSS: 4.16 vs. 3.83 vs. 4.06
RRMS: 73.3% vs. 66.7% vs. 93.3%A vs. C, mean change scores:
BBS: 5.8 vs. 0.93, p<0.05
TUG: –1.54 vs; 0.05, p<0.05
6MWT: 42.71 vs. 7.59 p<0.05
MusiQoL: 12.61 vs. –0.19, p<0.05
B vs. C, mean change scores:
BBS: 2.66 vs. 0.93, p<0.05
TUG: –0.64 vs; 0.05, p<0.05
6MWT: 23.25 vs. 7.59 p>0.05
MusiQoL: 5.32 vs. –0.19, p<0.05
A vs. C, mean change scores: p<0.05 in favor of group A for BBS and
MusiQoLMotion Gaming—Cerebral PalsyAcar 2016
131
* Acar G
* Altun GP
* Yurdalan S
* et al.
Efficacy of neurodevelopmental treatment combined with the Nintendo Wii in
patients with cerebral palsy.
J Phys Ther Sci. 2016; 28: 774-780
* Crossref
* PubMed
* Scopus (13)
* Google Scholar
Postural control
RCT
Poor
A. Nintendo Wii gaming plus neuro-developmental treatment, 12 sessions over 6
weeks (n=15)
B. Neurodevelopmental treatment, 12 sessions over 6 weeks (n=15)
A vs. B
Age: 9.5 vs. 9.7
Female: 47% vs. 60%
GMFCS I: 40% vs. 40%
GMFCS II: 60% vs. 60%
Spastic hemiparesis: 100%A vs. B, mean (SD), p=between groups
WeeFIM: 46.0 (8.23) to 46.751 (7.51) vs. 48.3 (7.27) to 48.0 (7.14), p>0.05
QUEST (dissociated movement): 80.1 (7.73) to 85.6 (8.54) vs. 81.4 (10.70) to
86.4 (8.78), p>0.05
QUEST (grasp): 42.2 (18.76) to 47.1 (16.64) vs. 53.0 (16.45) to 55.7 (15.30),
p>0.05
QUEST (weight bearing): 60.2 to 72.7 (19.60) vs. 75.4 (19.97) to 77.3 (15.43),
p>0.05
QUEST (extension): 72.9 (14.78) to 77.0 (12.05) vs. 71.0 (23.53) to 74.0
(23.36), p>0.05El Shamy, 2018
133
* El-Shamy SM
Efficacy of Armeo robotic therapy versus conventional therapy on upper limb
function in children with hemiplegic cerebral palsy.
Am J Phys Med Rehabil. 2018; 97: 164-169
* Crossref
* PubMed
* Scopus (22)
* Google Scholar
Postural control
RCT
FairA. Arm exoskeletal + virtual reality 36 sessions over 12 weeks (n=15)
B. Conventional therapy, 36 sessions over 12 weeks (n=15)A vs. B
Age: 7 vs. 7
Female 40% vs. 27%
Mobile Ability Classification
I: 33% vs. 40%
II: 53% vs. 40%
III: 13% vs. 20%A vs. B, mean (SD), p=between groups
QUEST total: 61.9 (2) to 84.6 (2.7) vs. 62.3 (1.8) to 79.1 (2); MD 5.9, 95% CI
3.7 to 7.3, p<0.05Hsieh, 2018
127
* Hsieh HC
Effects of a gaming platform on balance training for children with cerebral
palsy.
Pediatr Phys Ther. 2018; 30: 303-308
* Crossref
* PubMed
* Scopus (8)
* Google Scholar
Postural control
RCT
FairA. PC gaming using arm and trunk, 60 sessions over 12 (n=20)
B. PC gaming using mouse, 60 sessions over 12 weeks (n=20)A vs. B
Age: 7.3 vs. 7.4
Female: 30% vs. 25%
Quadriplegia: 55% vs. 60%
Diplegia: 20% vs. 15%
Athetoid: 10% vs. 10%
Ataxic: 15% vs. 15%A vs. B, mean (SD), p=between groups:
TUG: 16.43 (2.12) to 17.51 (1.70) vs. 15.60 (1.10) to 15.91 (1.87), p<0.05
BBS: 44.74 (2.75) to 48.81 (4.74) vs. 44.39 (2.33) to 45.37 (2.68), p<0.05
Hsieh, 2020
128
* Hsieh HC
Preliminary study of the effect of training with a gaming balance board on
balance control in children with cerebral palsy: a randomized controlled trial.
Am J Phys Med Rehabil. 2020; 99: 142-148
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. PC gaming using balance board, 36 sessions over 12 weeks (n=28)
B. PC gaming using mouse, 36 sessions over 12 weeks (n=28)
A vs. B
Age: 7.9 vs. 8.1
Female: 32% vs. 31.5%
GMFCS I: 53.5% vs. 50%
GMFCS II: 28.6% vs. 32.1%
GMFCS III: 17.9% vs. 17.9%
Deplegic: 57.1% vs. 42.9%A vs. B, mean (SD)
2MWT: 103.4 (16.6) to 120.1 (20.2) vs. 101.4 (23.1) to 106.1 (22.8), p=0.002
PBS-total: 29.9 (5.3) to 35.8 (5.5) vs. 32.3 (7.5) to 34.4 (5.9),
p=0.002Pourazar, 2020
130
* Pourazar M
* Bagherzadeh F
* Mirakhori F
Virtual reality training improves dynamic balance in children with cerebral
palsy.
Int J Dev Disabil. 2019;
* Crossref
* Scopus (3)
* Google Scholar
Postural control
RCT
FairA. Virtual reality Microsoft Xbox 360 Kinect, 20 sessions over 6 weeks
(n=10)
B. Encouraged to do typical physical activity at home (n=10)
A vs. B
Age: 9.2 vs. 9.6
Female: 100%
GMFCS I: 50% vs. 60%
GMFCS II: 20% vs. 30%
GMFCS III: 30% vs. 10%Dynamic balance was improved in the anterior,
posterolateral, and posteromedial directions with virtual reality dance game
compare with the control group, p=0.001 all comparisonsTarakci, 2016
129
* Tarakci D
* Ersoz Huseyinsinoglu B
* Tarakci E
* et al.
Effects of Nintendo Wii-Fit® video games on balance in children with mild
cerebral palsy.
Pediatr Int. 2016; 58: 1042-1050
* Crossref
* PubMed
* Google Scholar
Postural control
RCT
Fair
A. Nintendo Wii-Fit balanced gaming, 24 sessions over 12 weeks (n=15)
B. Conventional balance training, 24 sessions over 12 weeks (n=15)A vs. B
Age: 10.5 vs. 10.5
Female: 33% vs. 40%
Hemiplegic: 47% vs. 47%
Diplegic: 47% vs. 33%
Dyskinetic: 7% vs. 20%
Assist devices: 0% vs. 20%A vs. B, mean difference between groups:
TUG: –1.24, 95% CI –4.13 to 1.65, p=0.40
10MWT: –1.4, 95% CI –4.36 to 1.56, p=0.35
Sit to Stand Test: 2.07, 95% CI 0.82 to 3.32, p=0.001, favors conventional
balance training
10 Step Climbing Test: –0.99, 95% CI –3.99 to 2.01, p=0.52
WeeFIM: 3.43, 95% CI –3.75 to 10.61, p=0.35
Wiibalance: 1.05, 95% CI 0.64 to 1.46, p<0.001
Tilt-table: 11.00, 95% CI 4.74 to 17.26, p=0.001
Tight-rope walking, heading in soccer, and ski slalom: p<0.001
Zoccolillo, 2015
132
* Zoccolillo L
* Morelli D
* Cincotti F
* et al.
Video-game based therapy performed by children with cerebral palsy: a cross-over
randomized controlled trial and a cross-sectional quantitative measure of
physical activity.
Eur J Phys Rehabil Med. 2015; 51: 669-676
* PubMed
* Google Scholar
Postural control
RCT
PoorA. Microsoft Xbox with Kinect (3D motion capture) gaming plus
neuro-developmental treatment, 16 sessions over 8 weeks (n=15)
B. Neurodevelopmental treatment, 16 sessions over 8 weeks (n=16)
No demographics by group
Age: 6.89
Female: NR
GMFM-88: 84.6A vs. B, mean (SD), p=between groups:
QUEST: 76 (21) to 81 (20) vs. 74 (20) to 78 (20), p>0.05Motion Gaming—Spinal
Cord InjuryTak, 2015
134
* Tak S
* Choi W
* Lee S
Game-based virtual reality training improves sitting balance after spinal cord
injury: a single-blinded, randomized controlled trial.
Med Sci Technol. 2015; 56: 53-59
* Crossref
* Scopus (7)
* Google Scholar
Postural control
RCT
FairA. Nintendo Wii, 18 sessions over 6 weeks + conventional rehabilitation
(n=13)
B. Conventional rehabilitation (n=13)A vs. B
Age: 50 vs. 43
Cervical: 31% vs. 38%
ASIA (A): 77% vs. 77%
ASIA (B): 23% vs. 23%A vs. B mean (SD), p=between groups
T-shirt test (s): 29.5 (10.95) to 22.60 (8.28) vs. 23.59 (11.35) to 22.15
(12.28), p<0.05Whole Body Vibration—Multiple SclerosisAbbasi, 2019
136
* Abbasi M
* Kordi Yoosefinejad A
* Poursadeghfard M
* et al.
Whole body vibration improves core muscle strength and endurance in ambulant
individuals with multiple sclerosis: a randomized clinical trial.
Mult Scler Relat Disord. 2019; 32: 88-93
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. WBV, 18 sessions over 6 weeks (n=22)
B. No intervention (n=24)A vs. B
Age: 37 vs. 39
Female: 5% vs. 17%
EDSS: 1.54 vs. 1.55A vs. B, median (IQR) followup-baseline scores, p=between
groups:
MSQOL-54 (PCS): 4.20 (1.73, 8.40) vs. –1.26 (–3.28, 0), p<0.001
MSQOL-54 (MCS): 5.96 (2.71, 11.89) vs. –0.17 (–2.20, 0.07), p<0.001Claerbout,
2012
135
* Claerbout M
* Gebara B
* Ilsbroukx S
* et al.
Effects of 3 weeks' whole body vibration training on muscle strength and
functional mobility in hospitalized persons with multiple sclerosis.
Mult Scler. 2012; 18: 498-505
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. WBV, 10 sessions over 3 weeks plus conventional therapy (n=16)
B. Whole body light vibration, 10 sessions over 3 weeks plus conventional
therapy (n=14)
C. Conventional therapy (n=17)A vs. B vs. C
Age: 39.1 vs. 43.8 vs. 47.6
Female: 28.6% vs. 22.2% vs. 64.7%
EDSS: 5.3 vs. 5.1 vs. 5.2A vs. B vs. C: mean (SD) change for each group,
p=between groups:
3MWT: 45.0 (42.6) vs. 37.4 (34.3) vs. 20.4 (27.95), p>0.05 for all comparisons
TUG: –0.8 (2.3) vs. –3.2 (4.7) vs. 0.8 (5.5), p>0.05 for all comparisons
BBS: 3.9 (4.4) vs. 4.2 (6.1) vs. 0.2 (7.5), p>0.05 for all comparisonsWhole Body
Vibration—Cerebral PalsyAhmadizadeh, 2020
138
* Ahmadizadeh Z
* Khalili MA
* Ghalam MS
* et al.
Effect of whole body vibration with stretching exercise on active and passive
range of motion in lower extremities in children with cerebral palsy: a
randomized clinical trial.
Iran J Pediatr. 2019; 29: e84436
* Crossref
* Scopus (2)
* Google Scholar
Postural control
RCT
FairA. WBV + stretching, 18 sessions over 6 weeks (n=10)
B. Stretching only, 16 sessions over 6 weeks (n=10)A vs. B
Age: 6.9 vs. 8.1
Hemiplegic: 30% vs. 60%
Diplegic: 60% vs. 40%
Quadrapletic: 10% vs. 0%A vs. B, mean (SD):
6MWT: 158.8 (100.24) to 189.45 (115.47) vs. 194 (78.82) to 271.5 (60.81),
p=0.04Lee, 2013
137
* Lee BK
* Chon SC
Effect of whole body vibration training on mobility in children with cerebral
palsy: a randomized controlled experimenter-blinded study.
Clin Rehabil. 2013; 27: 599-607
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
FairA. WBV + PT, 24 sessions of vibration over 8 weeks (n=15)
B. PT (n=15)A vs. B
Age: 10.00 vs. 9.66
Female: 60% vs. 40%
Ambulatory: 100%
GMFM: 78.4 vs. 79.53A vs. B, mean (SD), p=between groups:
Walking speed (meters/second): 0.37 (0.04) to 0.48 (0.06) vs. 0.39 (0.05) to
0.40 (0.05), p=0.001
In, 2018
139
* In T
* Jung K
* Lee MG
* et al.
Whole-body vibration improves ankle spasticity, balance, and walking ability in
individuals with incomplete cervical spinal cord injury.
NeuroRehabilitation. 2018; 42: 491-497
* Crossref
* PubMed
* Scopus (7)
* Google Scholar
Postural control
RCT
FairA. WBV plus PT, 80 sessions over 8 weeks (n=14)
B. Sham WBV plus PT, 80 sessions over 8 weeks (n=14)A vs. B
Age: 46.1 vs. 49.9
Female: 36% vs. 29%
Ambulatory: 100%
C6-C7: 100%A vs. B, mean (SD), p=between groups:
10MWT: 29.3 (9.0) to 25.8 (8.1) vs. 28.8 (7.2) to 27.5 (6.3), p=0.005
TUG: 13.7 (3.1) to 11.4 (2.8) vs. 14.7 (4.5) to 13.7 (4.1), p=0.016Yoga—Multiple
SclerosisAhmadi, 2013
66
* Ahmadi A
* Arastoo AA
* Nikbakht M
* et al.
Comparison of the effect of 8 weeks aerobic and yoga training on ambulatory
function, fatigue and mood status in MS patients.
Iran Red Crescent Med J. 2013; 15: 449-454
* Crossref
* PubMed
* Scopus (58)
* Google Scholar
Postural control
RCT
FairA. Yoga, 24 sessions over 8 weeks (n=11)
B. Waitlist control (n=10)A vs. B
Age: 32 vs. 37
Female: 100%
EDSS: 2.00 vs. 2.25A vs. B, mean (SD), p-value between groups:
10MWT (sec): 8.78 to 8.13 vs. 9.16 to 9.47, p<0.001
2MWT: 109 (17.44) to 120.36 (20.62) vs. 121.50 (27.73) to 119.05 (27.12), p=0.11
BBS: 47.72 (6.78) to 53.81 (3.40) vs. 44.50 (8.48) to 41.70 (8.48),
p=0.07Doulatabad, 2012
143
* Doulatabad SN
* Nooreyan K
* Doulatabad AN
* et al.
The effects of pranayama, hatha and raja yoga on physical pain and the quality
of life of women with multiple sclerosis.
Afr J Tradit Complement Altern Med. 2012; 10: 49-52
* Crossref
* PubMed
* Scopus (29)
* Google Scholar
Najafidoulatabad, 2014
144
* Najafidoulatabad S
* Mohebbi Z
* Nooryan K
Yoga effects on physical activity and sexual satisfaction among the Iranian
women with multiple sclerosis: a randomized controlled trial.
Afr J Tradit Complement Altern Med. 2014; 11: 78-82
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
PoorA. Yoga, 24 sessions over 12 weeks (n=30)
B. No intervention over 12 weeks (n=30)A vs. B
Age: 31.6 (18 to 45)
Female: 100%
A vs. B, mean difference between groups; mean (SD), p-value within groups
MSQoL-54: 2.6, 95% CI 1.64 to 3.56, p<0.001
Sexual satisfaction:
A: baseline 1.8 (2.0) to 1.4 (1.5), p=0.001
B: 2.1 (1.2) to 2.1 (1.2), p>0.05Garrett, 2013a
140
* Garrett M
* Hogan N
* Larkin A
* et al.
Exercise in the community for people with minimal gait impairment due to MS: an
assessor-blind randomized controlled trial.
Mult Scler. 2013; 19: 782-789
* Crossref
* PubMed
* Scopus (49)
* Google Scholar
Garrett, 2013b
141
* Garrett M
* Hogan N
* Larkin A
* et al.
Exercise in the community for people with multiple sclerosis–a follow-up of
people with minimal gait impairment.
Mult Scler. 2013; 19: 790-798
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
Poor
A. Physiotherapist–led exercise, 10 sessions over 10 weeks (n=80)
B. Yoga, 10 sessions over 10 weeks (n=77)
C. Fitness instructor-led exercise, 10 sessions over 10 weeks (n=86)
D. Usual care (n=71)A vs. B vs. C vs. D
Age: 51.7 vs. 49.6 vs. 50.3 vs. 48.8
Female: 79% vs. 70% vs. 68% vs. 87%
Wheelchair user: 0%
RRMS: 55% vs. 60% vs. 49% vs. 55%
SPMS: 14% vs. 11% vs. 19% vs. 20%
PPMS: 7% vs. 13% vs. 13% vs. 6%
Benign: 0% vs. 2% vs. 5% vs. 2%B vs. D, median (SIQR), p=between groups:
6MWT: 268 (222) to 285 (152) vs. 250 (206) to 315 (232), p=0.73
MSIS-29 (physical): 33.4 (20.0) to 29.4 (19.4) vs. 29.6 (23.0) to 29.9 (20.7),
p=0.12
MSIS-29 (psychological): 33.3 (33.3) to 25.9 (33.3) vs. 22.2 (24.1) to 18.5
(38.9), p=0.04Hasanpour-Dehkordi, 2014
147
* Hasanpour-Dehkordi A
* Jivad N
Comparison of regular aerobic and yoga on the quality of life in patients with
multiple sclerosis.
Med J Islam Repub Iran. 2014; 28: 141
* PubMed
* Google Scholar
Hasanpour-Dehkordi, 2016
146
* Hasanpour-Dehkordi A
* Jivad N
* Solati K
Effects of yoga on physiological indices, anxiety and social functioning in
multiple sclerosis patients: a randomized trial.
J Clin Diagn Res. 2016; 10 (VC01-5)
* Google Scholar
Hasanpour-Dehkordi, 2016 (2)
145
* Hasanpour-Dehkordi A
Influence of yoga and aerobics exercise on fatigue, pain and psychosocial status
in patients with multiple sclerosis: a randomized trial.
J Sports Med Phys Fitness. 2016; 56: 1417-1422
* PubMed
* Google Scholar
Postural control
RCT
PoorA. Yoga, 36 sessions over 12 weeks (n=20)
B. Aerobics, 36 sessions over 12 weeks (n=20)
C. Usual care control (n=21)A vs. B vs. C
Age: 31.9
Female: 98%
A vs. B vs. C mean difference, p=between groups on SF-36 QOL:
C vs. A: 1106.41, p<0.001
B vs. A: 229.32, p=0.07
C vs. B: 877.10, p<0.001
Hogan, 2014
142
* Hogan N
* Kehoe M
* Larkin A
* et al.
The effect of community exercise interventions for people with MS who use
bilateral support for gait.
Mult Scler Int. 2014; 2014109142
* PubMed
* Google Scholar
Postural control
RCT
PoorA. Group PT, 10 sessions over 10 weeks (n=48)
B. 1-on-1 PT, 10 sessions over 10 weeks (n=35)
C. Yoga (n=13)
D. Usual care (n=15)A vs. B vs. C vs. D
Age: 57 vs. 52 vs. 58 vs. 49
Female: 63% vs. 57% vs. 62% vs. 87%
RRMS: 27% vs. 20% vs. 31% vs. 33%
SPMS: 42% vs. 46% vs. 38% vs. 33%
PPMS: 17% vs. 31% vs. 15% vs. 33%
Unknown: 15% vs. 3% vs. 15% vs. 0%
A vs. B vs. C vs. D, mean (SD/SIQR), p=between groups:
6MWT: 101 (39.5) to 121.2 (47.4) vs. 70 (30) to 45 (54.5) vs. 83.9 (39.8) to 100
(55) vs. 83.5 (44) to 90 (35), p>0.05 for all group comparisons
MSIS-29 (physical): 50.5 (9.5) to 45.9 (10.5) vs. 48.3 (10.5) to 49.6 (11.6) vs.
54 (11.5) to 49.4 (12) vs. 55.3 (9.5) to 50.5 (11.3), p=NR
MSIS-29 (psychological): 18 (5.5) to 15 (5.7) vs. 14 (2.2) to 15 (4) vs. 18
(5.38) to 17 (4.8) vs. 17 (4) to 15 (4.5), p>0.05 for all group comparisons
BBS: 28.9 (9.5) to 34.5 (9.8) vs. 22.6 (12.6) to 27.9 (11.5) vs. 30.4 (11.6) to
34.2 (9.8) vs. 24.9 (11.6) to 21.8 (11.9), p<0.05 for all comparisons vs.
controlYoung, 2019
5
* Young HJ
* Mehta TS
* Herman C
* et al.
The effects of M2M and adapted yoga on physical and psychosocial outcomes in
people wth multiple sclerosis.
Arch Phys Med Rehabil. 2019; 100: 391-400
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (0)
* Google Scholar
Postural control
RCT
Fair
A. Movement to Music, 36 sessions over 12 weeks (n=27)
B. Adapted Yoga, 36 sessions over 12 weeks (n=26)
C. Waitlist control (n=28)A vs. B vs. C
Age: 50 vs. 48 vs. 47
Female: 81% vs. 77% vs. 86%
White: 44 vs. 58% vs. 61%
A vs. B vs. C, mean difference, p=between groups:
TUG:
A vs. C: –1.89, 95% CI –3.30 to –0.48,p=0.01
B vs. C: –1.20, 95% CI –2.58 to 0.18, p=0.09
B vs. A: 0.69, 95% CI –0.71 to 2.08, p=0.33
6MWT:
A vs. C: 40.98, 95% CI 2.21 to 80, p=0.04
B vs. C: 22.83, 95%CI –16.67 to 6.2,p=0.25
B vs. A: –18.15, 95% CI –56.4 to 20.1, p=0.34
5xSit-to-Stand:
A vs. C: –1.00, 95% CI –2.58 to 0.55, p=0.20
B vs. C: –0.70, 95% CI –2.17 to 0.77, p=0.34
B vs. A: 0.30, 95% –1.21 to 1.82, p=0.69Yoga—Cerebral PalsyNo studies
identified———Yoga—Spinal Cord InjuryNo studies identified———
Abbreviations: 2MWT = 2-Minute Walk Test; 6MWT = 6-Minute Walk Test; 10MWT=
10-Meter Walk Test; 25FWT = 25-Foot Walk Test; ASIA = American Spinal Injury
Association Impairment Scale; BBS = Berg Balance Scale; CI = confidence
interval; CIS = Clinically Isolated Syndrome; CoDuSe = core stability, dual
tasking, sensory strategies; CP = cerebral palsy; DGI = Dynamic Gait Index;
EDSS = Expanded Disability Status Scale; EQ-5D = EuroQOL-5 Dimension
Questionnaire; FES = functional electrical stimulation; FIM = Functional
Independence Measure; GMFCS = Gross Motor Function Classification System;
GMFM = Gross Motor Function Measure; GMFM-66 = Gross Motor Function Measure
66;GMFM-66-D = Gross Motor Function Measure 66 (standing); GMFM-66-E = Gross
Motor Function Measure 66 (walking, running, jumping); GMFM-88 = Gross Motor
Function Measure 88; GMFM-88-D = Gross Motor Function Measure 88 (standing);
GMFM-88-E = Gross Motor Function Measure 88 (walking, running, jumping);
IPA = Impact on Participation and Autonomy; IQR = interquartile range;
ISI = Insomnia Severity Index; MD = mean difference; MiniBEST = Mini Balance
Evaluation System Test; MS = multiple sclerosis; MSFC = multiple sclerosis
functional composite; MSIS-29 = Multiple Sclerosis Impact Scale-29; MSIS=
Multiple Sclerosis Impact Scale; MSQOL= Multiple Sclerosis Quality of Life;
MSWS-12 = Multiple Sclerosis Walking Scale-12; MusiQoL = Multiple Sclerosis
International Quality of Life questionnaire; NR = not reported; PBS = Pediatric
Balance Scale; PEDI = Pediatric Evaluation Disability Inventory; PPMS = primary
progressive multiple sclerosis; PT = physical therapy; QLS = Questionnaire of
Life Satisfaction; QOL = quality of life; RCT = randomized controlled trial;
RRMS = relapsing-remitting multiple sclerosis; SD = standard deviation;
SE = standard error; SF- 36 = Short Form (36) Health Survey; SPMS = secondary
progressive multiple sclerosis; TUG = Timed Up and Go Test; VR = virtual
reality; WBV = whole body vibration; WeeFIM = Wee-Functional Independence
Measure for children; WHOQOL = World Health Organization Quality of Life.
* Open table in a new tab
Supplemental Table 3Studies of the Benefits and Harms of Physical
Activity—Strength Exercise Interventions
Author, Year
Intervention
Study Design
Study QualityIntervention and ComparisonPopulationResultsMuscle Strength
Exercise—Multiple SclerosisBulguroglu, 2017
149
* Bulguroglu I
* Guclu-Gunduz A
* Yazici G
* et al.
The effects of mat Pilates and reformer Pilates in patients with multiple
sclerosis: a randomized controlled study.
NeuroRehabilitation. 2017; 41: 413-422
* Crossref
* PubMed
* Scopus (12)
* Google Scholar
Strength
RCT
PoorA. Mat Pilates, 16 sessions over 8 weeks (n=12)
B. Reformer Pilates, 16 sessions over 8 weeks (n=13)
C. Attention control, 16 sessions over 8 weeks (n=13)A vs. B vs. C
Age: 45 vs. 37 vs. 40
Ambulatory: 100%
EDSS: 1.8 vs. 2.0 vs. 1.0Median (IQR)
A vs. C
TUG: 6.5 (5.2 to 7.0) vs. 5.2 (4.6 to 6.1) (baseline); 5.7 (5.0 to 6.5) vs. 4.9
(4.5 to 5.3) (postintervention)
MSQoL-54-MCS: 74.54 (65.43 to 83.41) vs. 75.65 (68.08 to 86.38) (baseline);
77.23 (70.72 to 84.54) vs. 78.52 (64.77 to 89.21) (postintervention)
MSQoL-54-PCS: 74.54 (65.43 to 83.41) vs. 77.35 (68.17 to 88.31) (baseline);75.8
(70.83 to 86.42) vs. 82.64 (66.77 to 91.27) (postintervention)
ABCS: 76.6 (62.7 to 92.7) vs. 90.6 (74.4 to 97.4) (baseline); 80.5 (71.7 to
97.3) vs. 91.9 (75.6 to 99.1) (postintervention)
B vs. C
TUG: 6.4 (5.0 to 8.9) vs. 5.2 (4.6 to 6.1) (baseline); 5.4 (4.9 to 7.1) vs. 4.9
(4.5 to 5.3) (postintervention)
MSQoL-54-MCS: 74.58 (70.39 to 80.58) vs. 75.65 (68.08 to 86.38) (baseline); 69.2
(65.86 to 71.41) vs. 78.52 (64.77 to 89.21) (postintervention)
MSQoL-54-PCS: 71.14 (67.26 to 74.35) vs. 77.35 (68.17 to 88.31) (baseline); 76.3
(74.39 to 83.37) vs. 82.64 (66.77 to 91.27) (postintervention)
ABCS: 69.4 (52.8 to 87.8) vs. 90.6 (74.4 to 97.4) (baseline); 69.4 (52.8 to
87.8) vs. 91.9 (75.6 to 99.1) (postintervention)Callesen, 2019
93
* Callesen J
* Cattaneo D
* Brincks J
* et al.
How do resistance training and balance and motor control training affect gait
performance and fatigue impact in people with multiple sclerosis? A randomized
controlled multi-center study.
Mult Scler. 2020; 26: 1420-1432
* Crossref
* PubMed
* Scopus (8)
* Google Scholar
Strength
RCT
FairA. Progressive resistance training (n=17): 20 sessions over 10 weeks
-median number of sessions completed (range): 17 (8 to 19)
B. Balance training (n=24): 20 sessions over 10 weeks
-median number of sessions completed (range): 16 (6 to 20)
C. Waitlist control (n=18)A vs. B vs. C
Median age: 52 vs. 51 vs. 56 years
Female: 70% vs. 82% vs. 80%
Race: NR
Ambulatory: 100% vs. 100% vs. 100%
Gait assistive devices: 17% vs. 11% vs. 10%
Median duration of illness: 15 vs. 10 vs. 11 years
MS type
- RRMS: 70% vs. 75% vs. 65%
- SPMS: 22% vs. 14% vs. 15%
- PPMS: 70% vs. 9% vs. 20%
Median EDSS: 4 vs. 4 vs. 3.5Mean change scores (95% CI); mean difference between
groups (95% CI)
A vs. C
6MWT (meters):
22.8 (4.6 to 41.0) vs. 11.3 (−6.0 to 28.5), MD 12.6 (−11.3 to 36.5), p=0.30
MSWS-12:
−6.5 (3.0 to 10.1) vs. −1.3 (−2.2 to 4.7), MD −4.2 (−10.0 to 1.6), p=0.16
MiniBEST:
2.1 (0.8 to 3.4) vs. 0.9 (−0.4 to 2.2), MD 1.1 (−0.7 to 2.9), p=0.24
25FWT (meters/second):
0.06 (−0.01 to 0.13) vs. 0.04 (−0.03 to 0.11), MD 0.02 (−0.08 to 0.13), p=0.66
SSST (seconds):
−0.9 (−2.0 to 0.2) vs. −0.4 (−1.5 to 0.7), MD −0.5 (−2.1 to 1.0), p=0.52
B vs. A
6MWT (meters):
28.5 (13.6 to 43.4) vs. 2.8 (4.6 to 41.0), MD 4.9 (−17.5 to 27.3), p=0.67
MSWS-12:
−9.3 (6.3 to 12.3) vs. −6.5 (3.0 to 10.1), MD −3.1 (−8.2 to 2.0), p=0.23
MiniBEST:
4.1 (3.0 to 5.2) vs. 2.1 (0.8 to 3.4), MD 2.2 (0.5 to 3.9), p=0.01
25FWT (meters/second):
0.14 (0.08 to 0.20) vs. 0.06 (−0.01 to 0.13), MD 0.08 (−0.02 to 0.18), p=0.11
SSST (seconds):
−2.6 (−3.6 to –1.7) vs. −0.9 (−2.0 to 0.2), MD −1.7 (−3.1 to –0.2),
p=0.02Dalgas, 2009
152
* Dalgas U
* Stenager E
* Jakobsen J
* et al.
Resistance training improves muscle strength and functional capacity in multiple
sclerosis.
Neurology. 2009; 73: 1478-1484
* Crossref
* PubMed
* Scopus (185)
* Google Scholar
Dalgas, 2010
153
* Dalgas U
* Stenager E
* Jakobsen J
* et al.
Fatigue, mood and quality of life improve in MS patients after progressive
resistance training.
Mult Scler. 2010; 16: 480-490
* Crossref
* PubMed
* Scopus (165)
* Google Scholar
Strength
RCT
Fair
A. Progressive resistance, 24 sessions over 12 weeks (n=15)
B. Waitlist control (n=16)A vs. B
Age: 45 vs. 48
Female: 63% vs. 67%
Ambulatory to 100m: 100%
RRMS: 100%A vs. B, mean (95% CI), p=between groups:
6MWT: 15.3% (9.8% to 20.9%) vs. 3.9% (−1.2% to 8.9%), p<0.05
10MWT: −12.3% (−16.8% to −7.9%) vs. 6.7% (−0.7% to 14.1%), p<0.05
SF-36 MCS: 54.3 (50.4 to 58.2) vs. 55.0 (50.5 to 59.5) (baseline); 56.8 (52.4 to
61.2) vs. 53.1 (49.3 to 56.8) (postintervention), p>0.05
SF-36 PCS: 41.4 (37.5 to 45.3) vs. 42.6 (38.5 to 46.6) (baseline); 44.9 (40.9 to
48.9) vs. 41.6 (37.8 to 45.4) (postintervention), p<0.05
EDSS: 3.9% (−3.4% to 11.2%) vs. −0.7% (−9.3% to 7.9%), p>0.05Dodd, 2011
155
* Dodd KJ
* Taylor NF
* Shields N
* et al.
Progressive resistance training did not improve walking but can improve muscle
performance, quality of life and fatigue in adults with multiple sclerosis: a
randomized controlled trial.
Mult Scler. 2011; 17: 1362-1374
* Crossref
* PubMed
* Scopus (99)
* Google Scholar
Strength
RCT
GoodA. Progressive resistance, 20 sessions over 10 weeks (n=36)
B. Attention control (social program), 10 sessions over 10 weeks (n=35)A vs. B
Age: 47.7 vs. 50.4
Female: 72% vs. 74%
Ambulation index:
2 (mild): 47% vs. 54%
3 (moderate): 39% vs. 26%
4 (severe): 14% vs. 20%
Gait aid use (yes): 33% vs. 37%A vs. B, mean difference
2MWT: MD 2.6, 95% CI −4.0 to 9.1, p>0.05 (post-pre change); MD −3.4 (95% CI −9.5
to 2.7), p>0.05 (week 22 followup)
WHO-QOL: MD 0.3, 95% CI −0.1 to 0.6, p>0.05 (post-pre change); MD −0.2, 95% CI
−0.6 to 0.3, p>0.05 (week 22 followup)
Duff, 2018
150
* Duff WRD
* Andrushko JW
* Renshaw DW
* et al.
Impact of Pilates exercise in multiple sclerosis: a randomized controlled trial.
Int J MS Care. 2018; 20: 92-100
* Crossref
* PubMed
* Scopus (18)
* Google Scholar
Strength
RCT
FairA. Pilates plus massage, 24 sessions of Pilates and 12 massages over 12
weeks (n=15)
B. Attention control (massage), 12 massages over 12 weeks (n=15)A vs. B
Age: 45.7 vs. 45.1
Female: 80% vs. 73%
Ambulatory: 100%
Wheelchair user: 0%
RRMS: 93% vs. 73%
SPMS: 0% vs. 13%
PPMS: 7% vs. 13%
A vs. B, mean difference (95% CI), p=between groups
TUG left turn: −1.5 (–2.7 to –0.4) vs. 0.3 (95% CI –0.9 to 1.4), p=0.03
TUG right turn: –1.1 (95% CI –2.1 to –0.1) vs. 0.3 (–0.7 to 1.4), p=0.6
6MWT: 52.4 (32.7 to 72.1) vs. 15.0 (–4.7 to 34.7), p=0.01
MSQoL-54-PCS: 4.6 (–1.3 to 10.5) vs. 2.4 (–3.5 to 8.3), p=0.60
MSQoL-54-MCS: 5.9 (–0.5 to 12.2) vs. 4.2 (–2.1 to 10.6), p=0.71
FABS: 2.3 (0.3 to 4.3) vs. 2.2 (0.2 to 4.2), p=0.96Fox, 2016
151
* Fox EE
* Hough AD
* Creanor S
* et al.
Effects of Pilates-based core stability training in ambulant people with
multiple sclerosis: multicenter, assessor-blinded, randomized controlled trial.
Phys Ther. 2016; 96: 1170-1178
* Crossref
* PubMed
* Scopus (37)
* Google Scholar
Freeman, 2012
156
* Freeman J
* Fox E
* Gear M
* et al.
Pilates based core stability training in ambulant individuals with multiple
sclerosis: protocol for a multi-centre randomised controlled trial.
BMC Neurol. 2012; 12: 19
* Crossref
* PubMed
* Scopus (25)
* Google Scholar
Strength
RCT
FairA. Pilates, 12 sessions over 12 weeks (n=33)
B. Usual PT, 12 sessions over 12 weeks (n=35)
C. Relaxation, 3 sessions over 12 weeks (n=32)A vs. B vs. C
Age: 53.97 vs. 54.60 vs. 53.78
Female: 85% vs. 71% vs. 66%
Ambulatory to 20 m: 100%
RRMS: 39% vs. 37% vs. 38%
SPMS: 24% vs. 31% vs. 34%
PPMS: 36% vs. 31% vs. 25%
Benign: 0% vs. 0% vs. 3%Mean difference (95% CI), p=between groups:
A vs. B
10MWT: −3.71 (−7.79 to 0.37), p>0.05 (postintervention); −1.96 (−6.04 to 2.13),
p>0.05 (4-week followup)
MSWS-12: −15.65 (−29.50 to −1.79), p<0.05 (postintervention); −15.97 (−29.83 to
−2.12), p<0.05 (4-week followup)
ABCS: 0.98 (−0.24 to 2.21), p>0.05 (postintervention); 0.95 (−0.28 to 2.17),
p>0.05 (4-week followup)
A vs. C
10MWT: −0.50 (−4.68 to 3.69), p>0.05 (postintervention); −0.50 (−4.68 to 3.69),
p>0.05 (4-week followup)
MSWS-12: −4.90 (−19.11 to 9.32), p>0.05 (postintervention); −3.71 (−17.93 to
10.50), p>0.05 (4-week followup)
ABCS: 0.49 (−0.76 to 1.74), p>0.05 (postintervention); 0.31 (−0.94 to 1.56),
p>0.05 (4-week followup)Kalron, 2017
148
* Kalron A
* Rosenblum U
* Frid L
* et al.
Pilates exercise training vs. physical therapy for improving walking and balance
in people with multiple sclerosis: a randomized controlled trial.
Clin Rehabil. 2017; 31: 319-328
* Crossref
* PubMed
* Scopus (43)
* Google Scholar
Strength
RCT
FairA. Pilates, 12 sessions over 12 weeks (n=22)
B. Usual physical therapy, 12 sessions over 12 weeks (n=23)A vs. B
Age: 42.9 vs. 44.3
Female: 60.9% vs. 68.2%
Ambulatory to 100m: 100%
EDSS: 4.1 vs. 4.6
RRMS: 100%A vs. B, mean change (SD), p=between group
TUG: −1.8 (2.1) vs. −1.7 (2.1), p=0.422
6MWT: 39.1 (78.3) vs. 25.3 (67.2), p=0.341
2MWT: 14.5 (25.8) vs. 12.7 (23.0), p=0.872
MSWS-12: 2.8 (6.3) vs. 2.4 (5.9), p=0.924
BBS: 1.1 (4.2) vs. 1.3 (5.2), MD –0.20, 95% CI –2.888 to 2.488, p=0.561Kara,
2017
9
* Kara B
* Kucuk F
* Poyraz EC
* et al.
Different types of exercise in multiple sclerosis: aerobic exercise or Pilates,
a single-blind clinical study.
J Back Musculoskeletal Rehabil. 2017; 30: 565-573
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Strength
Quasiexperimental
PoorA. Pilates, 16 sessions over 8 weeks (n=27)
B. Multimodal exercise (focus on aerobic), 16 sessions over 8 weeks (n=28)A vs.
B
Age: 50 vs. 43
Female: 67% vs. 65%
EDSS: 2.85 vs. 3.2A vs. B, mean difference (95% CI), p=between groups:
TUG right:
–0.47 (–2.98 to 2.04), p=0.71
TUG left:
–3.07 (–6.34 to 0.20), p=0.07
BBS:
–0.67 (–10.56 to 9.22), p=0.89Kjolhede, 2016
154
* Kjolhede T
* Dalgas U
* Gade AB
* et al.
Acute and chronic cytokine responses to resistance exercise and training in
people with multiple sclerosis.
Scand J Med Sci Sports. 2016; 26: 824-834
* Crossref
* PubMed
* Scopus (4)
* Google Scholar
Strength
RCT
FairA. Progressive resistance, 48 sessions over 24 weeks (n=17)
B. Usual care (habitual lifestyle) (n=18)A vs. B
Age: 44.6 vs. 42.2
Female: 75% vs. 75%
EDSS: 2.9 vs. 2.9
RRMS: 100%A vs. B, mean (95% CI), p=between group:
2MWT (m/s): 1.61 (1.4 to 1.8) vs. 1.66 (1.5 to 1.8) (baseline); 1.77 (1.6 to
2.0) vs. 1.69 (1.5 to 1.9) (postintervention), p=0.011
2MWT (meters): 193.2 (168 to 216) vs. 199.2 (180 to 216) (baseline); 212.2 (192
to 240) vs. 202.8 (180 to 228) (postintervention)
25FWT (m/s): 1.66 (1.5 to 1.8) vs. 1.79 (1.6 to 2.0) (baseline); 1.82 (1.7 to
2.0) vs. 1.80 (1.6 to 2.0) (postintervention), p=<0.001Marandi, 2013
16
* Marandi SM
* Nejad VS
* Shanazari Z
* et al.
A comparison of 12 weeks of Pilates and aquatic training on the dynamic balance
of women with mulitple sclerosis.
Int J Prev Med. 2013; 4: S110-S117
* PubMed
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,
17
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* Minacian V
* et al.
A comparison between Pilates exercise and aquatic training effects on mascular
strength in women with mulitple sclerosis.
Pak J Med Sci. 2013; 29: 285-289
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Strength
RCT
PoorA. Pilates, 36 sessions over 12 weeks (n=15)
B. Aquatics, 36 sessions over 12 weeks (n=15)
C. Usual care (n=15)A vs. B vs. C
Age: NR
Female: 100%
Ambulatory: 100%
Wheelchair user: 0%Mean difference (SE), p=between groups:
A vs. C
Right leg Six Spot Step Test: −5.96 (1.4), p=0.000
Left leg Six Spot Step Test: −6.23 (1.2), p=0.000
A vs. B
Right leg Six Spot Step Test: −0.08 (1.4), p=0.955
Left leg Six Spot Step Test: 0.00 (1.2), p=0.997Ortiz-Rubio, 2016
157
* Ortiz-Rubio A
* Cabrera-Martos I
* Rodriguez-Torres J
* et al.
Effects of a home-based upper limb training program in patients with multiple
sclerosis: a randomized controlled trial.
Arch Phys Med Rehabil. 2016; 97: 2027-2033
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Google Scholar
Strength
RCT
GoodA. Upper extremity strength plus coordination, 16 sessions over 8 weeks
(n=19)
B. Booklet with exercise info (n=18)A vs. B
Age: 42.21 vs. 44.89
Female: 26% vs. 33%
MS type:
RRMS: 21% vs. 22%
PPMS: 16% vs. 11%
SPMS: 63f% vs. 67%
EDSS: 5.71 vs. 6.04A vs. B, mean difference (95% CI), p=between groups:
ARAT most affected upper limb: 2.21 (−2.95 to −1.46) vs. 0.16 (−0.29 to 0.62),
p=<0.001
ARAT least affected upper limb: 0.68 (−1.28 to −0.08) vs. 0.16 (−0.08 to 0.42),
p<0.001
Tollar, 2020
28
* Tollar J
* Nagy F
* Toth BE
* et al.
Exercise effects on multiple sclerosis quality of life and clinical-motor
symptoms.
Med Sci Sports Exerc. 2020; 52: 1007-1014
* Crossref
* PubMed
* Scopus (0)
* Google Scholar
Strength:
proprioceptive neuromuscular facilitation
RCT
FairA. Proprioceptive neuromuscular facilitation, 25 sessions over 5 weeks
(n=14)
B. Usual care, 25 sessions over 5 weeks (n=12)
Age: 47 vs. 44
Female: 93% vs. 92%
Ambulatory: 100% RRMS: 64% vs. 66%
PPMS: 36% vs. 34%
Median EDSS score: 5.0 vs. 5.0A vs. B, mean (SD)
MSIS-29:
109.8 (10.67) vs. 109.8 (10.67) (baseline)
–1.9 (2.8) vs. 1.0 (3.46), MD –2.9 (95% CI –5.4 to –0.4) (pre-post change)
EQ-5D sum score:
13.9 (1.44) vs. 13.3 (0.89) (baseline)
–0.5 (1.16) vs. 0.0 (1.3), MD –0.5 (95% CI –1.5 to 0.5) (pre-post change)
BDI:
12.3 (2.55) vs. 14.3 (3.22) (baseline)
–0.6 (1.87) vs. –0.4 (2.94), MD –0.2 (95% CI –2.2 to 1.8) (pre-post change)
BBS:
21.1 (1.51) vs. 22.5 (4.38) (baseline)
1.6 (3.52) vs. –0.2 (2.62), MD 1.8 (95% CI –0.7 to 4.3) (pre-post change)
6MWT:
244.3 (52.98) vs. 243.3 (39.56) (baseline)
5.5 (34.64) vs. 6.3 (49.27), MD –0.8 (95% CI –34.9 to 33.3) (pre-post change)
Muscle Strength Exercise—Cerebral PalsyCho, 2020
167
* Cho HJ
* Lee BH
Effect of functional progressive resistance exercise on lower extremity
structure, muscle tone, dynamic balance and functional ability in children with
spastic cerebral palsy.
Children (Basel). 2020; 7: 31
* Google Scholar
Strength
RCT
PoorA. Functional progressive resistance exercise (FPRE), 12 sessions over 6
weeks (n=13)
B. Conventional therapy, 18 sessions over 6 weeks (n=12)
A vs. B
Age (mean years): 5.54 vs. 7.17
Female: 9 (69%) vs. 4 (33%)
Ambulatory: 100%
GMFCS: 2.08 vs. 2.33
A vs. B, mean (SD)
GMFM-88 score
69.98 (21.55) vs. 68.15 (27.15) (baseline)
71.78 (21.05) vs. 63.48 (27.48) (postintervention), p=0.019 for group A and
0.375 for group B for change from baseline
Increase pre-post for FPRE group p=0.019; control group showed no significant
difference, p=0.375.Elnaggar 2019
163
* Elnaggar RK
* Elbanna MF
* Mahmoud WS
* et al.
Plyometric exercises: subsequent changes of weight-bearing symmetry, muscle
strength and walking performance in children with unilateral cerebral palsy.
J Musculoskelet Neuronal Interact. 2019; 19: 507-515
* PubMed
* Google Scholar
Strength
RCT
FairA. Plyometric training, 16 sessions over 8 weeks (n=19)
B. Usual care (n=20)Age: 9.5 vs. 10.3
Female: 32% vs. 45%
Ambulatory: 100% All patients were considered to have mild spastic CPA vs. B,
mean (SD)
10MWT (m/s):
1.18 (0.08) vs. 1.21 (0.09) (baseline)
1.29 (0.06) vs. 1.25 (0.05) (postintervention)
0.11 (0.05) vs. 0.04 (0.06), MD 0.07 (95% CI 0.04 to 0.10) (pre-post change
score)Kara, 2020
164
* Kara OK
* Yardimci BN
* Sahin S
* et al.
Combined effects of mirror therapy and exercises on the upper extremities in
children with unilateral cerebral palsy: a randomized controlled trial.
Dev Neurorehabil. 2020; 23: 253-264
* Crossref
* PubMed
* Scopus (3)
* Google Scholar
Strength
RCT
Fair
A. Strength and power training, 36 sessions over 12 weeks (n=15)
B. Usual care occupational therapy, 36 sessions over 12 weeks (n=15)
A vs. B
Age: 12.3 vs. 11.8
Female: 53% vs. 53%
MACS Level
I: 47% vs. 40%
II: 27% vs. 33%
III: 27% vs. 27%
GMFCS Level
I: 87% vs. 87%
II: 13% vs. 13%A vs. B, mean (SD), p-value for between group difference
QUEST total:
8.88 (6.51) vs. 2.22 (4.74), MD 6.65 (95% CI 2.4 to 10.9), p=0.001 (pre-post
change)
COPM total:
6.12 (2.33) vs. 0.41 (1.56), MD 5.71 (95% CI 4.2 to 7.2), p<0.001 (pre-post
change)Scholtes, 2010
159
* Scholtes VA
* Becher JG
* Comuth A
* et al.
Effectiveness of functional progressive resistance exercise strength training on
muscle strength and mobility in children with cerebral palsy: a randomized
controlled trial.
Dev Med Child Neurol. 2010; 52: e107-e113
* Crossref
* PubMed
* Scopus (102)
* Google Scholar
Scholtes, 2012
160
* Scholtes VA
* Becher JG
* Janssen-Potten YJ
* et al.
Effectiveness of functional progressive resistance exercise training on walking
ability in children with cerebral palsy: a randomized controlled trial.
Res Dev Disabil. 2012; 33: 181-188
* Crossref
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* Google Scholar
Scholtes, 2008
158
* Scholtes VA
* Dallmeijer AJ
* Rameckers EA
* et al.
Lower limb strength training in children with cerebral palsy–a randomized
controlled trial protocol for functional strength training based on progressive
resistance exercise principles.
BMC Pediatr. 2008; 8: 41
* Crossref
* PubMed
* Scopus (49)
* Google Scholar
Strength
RCT
FairA. Progressive resistance, 36 sessions over 12 weeks (n=24)
B. Usual care (n=25)A vs. B
Age: 10.33 vs. 10.25
Female: 33% vs. 50%
Ambulatory: 100%
Bilateral: 71% vs. 60%
GMFM I: 54% vs. 48%
GMFM II: 33% vs. 36%
GMFM III: 13% vs. 16%A vs. B, Regression effect size (95% CI), p=between groups:
GMFM-66: −0.56 (−2.11 to 0.99), p=0.48 (postintervention); 0.26 (−1.23 to 1.76),
p=0.73 (6 weeks postintervention)
10MWT: −0.04 (−0.18 to 0.10), p=0.56 (postintervention); −0.06 (−0.17 to 0.04),
p=0.25 (6 weeks postintervention)
Sit-to-Stand (reps): −0.47 (−2.28 to 1.33), p=0.61 (postintervention); −0.75
(−2.21 to 0.72), p=0.32 (6-weeks postintervention)
Lateral step-up test (reps): 0.48 (−1.45 to 2.40), p=0.63 (postintervention);
0.13 (−1.84 to 2.10), p=0.9 (6 weeks postintervention)
1-minute fast walking test (m/s): 0.04 (−0.04 to 0.12), p=0.30
(postintervention); −0.01 (−0.08 to 0.06), p=0.78 (6 weeks postintervention)
Timed Stair Test (s): 0.83 (−2.64 to 4.30), p=0.64 (postintervention); 2.87
(−2.41 to 8.16), p=0.29 (6 weeks postintervention)Taylor, 2013
161
* Taylor NF
* Dodd KJ
* Baker RJ
* et al.
Progressive resistance training and mobility-related function in young people
with cerebral palsy: a randomized controlled trial.
Dev Med Child Neurol. 2013; 55: 806-812
* Crossref
* PubMed
* Scopus (63)
* Google Scholar
Bania, 2016
162
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* Dodd KJ
* Baker RJ
* et al.
The effects of progressive resistance training on daily physical activity in
young people with cerebral palsy: a randomised controlled trial.
Disabil Rehabil. 2016; 38: 620-626
* Crossref
* PubMed
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* Google Scholar
Strength
RCT
GoodA. Progressive resistance, 24 sessions over 12 weeks (n=23)
B. Usual care (n=25)A vs. B
Age: 18.17 vs. 18.58
Female: 44% vs. 48%
No gait aid 57% vs. 60%
GMFM II: 57% vs. 64%
GMFM III: 43% vs. 36%
A vs. B, mean difference (95% CI) between groups:
GMFM-66-D: –1.3 (–4.9 to 2.4), p>0.05 (postintervention); 2.5 (–1.8 to 6.9),
p>0.05 (12 weeks postintervention)
GMFM-66-E: 0.9 (–3.0 to 4.7), p>0.05 (postintervention); 1.0 (–2.6 to 4.5),
p>0.05 (12 weeks postintervention)
6MWT: 0.1 (–20.6 to 20.9), p>0.05 (postintervention); –12.3 (–34.8 to 10.2),
p>0.05 (12 weeks postintervention)
Timed Stair Test (s): –0.9 (–4.7 to 2.9) (postintervention); –0.6 (–4.2 to 3.0)
(12 weeks postintervention)
Gait Profile Score (°): 0.2 (–0.6 to 0.9), p>0.05 (postintervention); 0.2 (–0.8
to 1.2), p>0.05 (12 weeks postintervention)Kirk, 2016
168
* Kirk H
* Geertsen SS
* Lorentzen J
* et al.
Explosive resistance training increases rate of force development in ankle
dorsiflexors and gait function in adults with cerebral palsy.
J Strength Cond Res. 2016; 30: 2749-2760
* Crossref
* PubMed
* Scopus (13)
* Google Scholar
Strength
Quasiexperimental
PoorA. Progressive resistance, 36 sessions over 12 weeks (n=12)
B. Usual care (n=23)A+B
Age: 36.5
Female: 43%
Wheelchair user: 17%A vs. B, mean (SD), p=between groups:
10MWT: 7.76 (1.23) to 7.49 (1.10) vs. 8.83 (0.78) to 8.47 (0.86), p>0.05
6MWT: 481 (30) to 510 (33) vs. 400 (32) to 416 (33) p>0.05
Timed Stair Test (s): 30.69 (4.92) to 29.15 (4.62) vs. 49.82 (7.27) to 45.01
(6.57), p>0.05Qi, 2018a
165
* Qi YC
* Niu XL
* Gao YR
* et al.
Therapeutic effect evaluation of neuromuscular electrical stimulation with or
without strengthening exercise on spastic cerebral palsy.
Clin Pediatr (Phila). 2018; 57: 580-583
* Crossref
* PubMed
* Scopus (6)
* Google Scholar
Strength
RCT
FairA. Strength exercises + neuromuscular electrical stimulation, 30 sessions
over 6 weeks (n=50)
B. Neuromuscular electrical stimulation, 30 sessions over 6 weeks (n=50)A vs. B
Age: 5.8 vs. 6.0
Female: 48% vs. 46%
Spastic CP: 100%
A vs. B, mean (SD)
GMFM-D/E:
44.5 (13.2) vs. 44 (12.6), p>0.05 (baseline)
70.6 (15.2) vs. 56.7 (14.3), p<0.05 (postintervention)
MD 13.4, 95% CI 7.94 to 18.86, p<0.001
71.0 (16.4) vs. 58.0 (15.6), p<0.05 (6 weeks postintervention)
MD 12.5, 95% CI 6.74 to 18.26, p<0.001Tedla, 2014
166
* Tedla JS
Strength training effects on balance in spastic diplegia subjects: a randomized
controlled trial.
J Pediatr Neurol. 2014; 12: 15-28
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Strength
RCT
PoorA. Strength training 18 sessions over 6 weeks + conventional PT (n=31)
B. Conventional PT 3-5 sessionsweek for 6 weeks (n=31)A vs. B (data are for
completers only; n=30 vs. 30)
Age: 9.1 vs. 8.9 years
Female: 33% vs. 33%
Gross motor function classification system:
I: 7% vs. 3%
II: 20% vs. 27%
III: 37% vs. 27%
IV: 37% vs. 43%A vs. B, mean change from baseline (SD):
PBS total score
7.23 (3.350) vs. 1.87 (1.074), p<0.001
GMFM-total score
9.9 (NR) vs. 2.2 (NR), p=NRMuscle Strength Exercise—Spinal Cord InjuryChen, 2016
169
* Chen X
* Wei K
* Miao F
* et al.
Improvement of pulmonary function and life quality on high paraplegia patients
through pulmonary rehabilitation.
Int J Clin Exp Med. 2016; 9: 22275-22281
* Google Scholar
Strength
RCT
FairA. Pulmonary rehabilitation, 365 sessions over 52 weeks (n=49)
B. Usual care (n=49)A vs. B
Age: 62.3 vs. 63.1
Female: 0%
T1–2: 35% vs. 35%
T3–4: 33% vs. 33%
T5–6: 33% vs. 33%A vs. B, mean (SD):
SF-36 Subscale - physical function:
54.2 (7.8) vs. 54.2 (7.8), p>0.05 (baseline)
81.1 (3.1) vs. 54.4 (7.7), p<0.05 (postintervention)
54.4 (8.0) vs. 54.6 (7.9), p>0.05 (4-week followup)
SF-36 Subscale - social function:
50.6 (11.8) vs. 50.6 (11.8), p>0.05 (baseline)
80.1 (9.4) vs. 51.2 (11.0), p<0.05 (postintervention)
51.2 (11.0) vs. 50.6 (11.8), p>0.05 (4-week followup)
SF-36 Subscale - role emotional:
54.3 (7.85 vs. 5.3 (6.9), p>0.05 (baseline)
76.3 (7.3) vs. 54.3 (7.8), p<0.05 (postintervention)
54.2 (7.8) vs. 54.4 (7.7), p>0.05 (4-week followup)
SF-36 Subscale - mental health:
54.1 (7.7) vs. 54.2 (7.8), p>0.05 (baseline)
75.1 (6.8) vs. 54.2 (7.8), p<0.05 (postintervention)
54.2 (7.8) vs. 54.2 (7.8), p>0.05 (4-week followup)
Abbreviations: 2MWT = 2-Minute Walk Test; 6MWT = 6-Minute Walk Test; 10MWT=
10-Meter Walk Test; 25FWT = 25-Foot Walk Test; ABCS = Activities-specific
Balance Confidence Scale, ASIA = American Spinal Injury Association Impairment
Scale; BBS = Berg Balance Scale; BDI = Beck Depression Inventory; CI =
confidence interval; CP = cerebral palsy; EDSS = Expanded Disability Status
Scale; EQ-5D = EuroQOL-5 Dimension Questionnaire; FABS = Fullerton Advanced
Balance Scale; FPRE = functional progressive resistance exercise; GMFCS = Gross
Motor Function Classification System; GMFM = Gross Motor Function Measure;
GMFM-66 = Gross Motor Function Measure 66;GMFM-66-D = Gross Motor Function
Measure 66 (standing);GMFM-66-E = Gross Motor Function Measure 66 (walking,
running, jumping); GMFM-88 = Gross Motor Function Measure 88; GMFM-88-D = Gross
Motor Function Measure 88 (standing); GMFM-88-E = Gross Motor Function Measure
88 (walking, running, jumping); MACS = manual ability classification system; MD
= mean difference; MiniBEST = Mini Balance Evaluation System Test; MS = multiple
sclerosis; MSIS-29 = Multiple Sclerosis Impact Scale-29; MSQOL= Multiple
Sclerosis Quality of Life; MSWS-12 = Multiple Sclerosis Walking Scale-12; NR =
not reported; NS = not significant; PBS = Pediatric Balance Scale; PPMS =
primary progressive multiple sclerosis; PRE = progressive resistance exercise;
PT = physical therapy; QOL = quality of life; RCT = randomized controlled trial;
RRMS = relapsing-remitting multiple sclerosis; SCIM = Spinal Cord Independence
Measure; SD = standard deviation; SE = standard error; SF-12 = Short Form (12)
Health Survey; SF-36 MCS = Short-Form 36 Mental Component Score; SF-36 PCS =
Short-Form 36 Physical Component Score; SPMS = secondary progressive multiple
sclerosis; SSST; Six Spot Step Test; TUG = Timed Up and Go Test.
* Open table in a new tab
Supplemental Table 4Studies of the Benefits and Harms of Physical
Activity—Multimodal Interventions (Progressive Resistance or Strengthening
Combination Exercises) Muscle Strength Exercise—Multiple Sclerosis
Author, Year
Intervention
Study Design
Study QualityIntervention and ComparisonPopulationResultsMultimodal
Exercises—Multiple SclerosisCakit, 2010
176
* Cakit BD
* Nacir B
* Genc H
* et al.
Cycling progressive resistance training for people with multiple sclerosis: a
randomized controlled study.
Am J Phys Med Rehabil. 2010; 89: 446-457
* Crossref
* PubMed
* Scopus (116)
* Google Scholar
Multimodal exercise
RCT
PoorA. Progressive resistance cycling plus balance exercises (lower extremity
strengthening), 16 sessions over 8 weeks (n=14)
B. Usual care (n=9)A vs. B
Age: 36.4 vs. 35.5
Female: 64% vs. 67%
RRMS or SPMS: 100%
Assistive device: 28.5% vs. 37.5%
A vs. B, mean (SD) change, p=between groups:
TUG : –1.3 (1.2) vs. –0.2 (0.8), p<0.05
10MWT: –1.9 (1.2) vs. 0.1 (0.8), p<0.05
DGI: 2.7 (0.5) vs. 0.4 (0.4), p<0.01
Falls Efficiency Scale: –11.3 (7.8) vs. –2.6 (3.1), p<0.01
SF-36 Physical Function: 21.2 (14.4) vs. 7.7 (7.4), p>0.05
SF-36 Role-Physical Function: 34.0 (30.1) vs. 5.0 (44.7), p>0.05
SF-36 General Health: 4.3 (8.4) vs. 3.2 (11.7), p>0.05
SF-36 Vitality: 9.0 (19.3) vs. 11.0 (20.4), p>0.05
SF-36 Social Functioning: 3.4 (23.1) vs. 5.0 (16.7), p>0.05
SF-36 Role-Emotional Function: 24.2 (49.6) vs. 19.9 (50.5), p>0.05
SF-36 Mental Health: 7.2 (13.4) vs. 7.0 (6.7), p>0.05Ebrahimi, 2015
173
* Ebrahimi A
* Eftekhari E
* Etemadifar M
Effects of whole body vibration on hormonal & functional indices in patients
with multiple sclerosis.
Indian J Med Res. 2015; 142: 450-458
* Crossref
* PubMed
* Scopus (16)
* Google Scholar
Multimodal exercise
RCT
PoorA. Whole body vibration + low-intensity exercise, 30 sessions over 10 weeks
(n=17)
B. Usual care (n=17)A vs. B
Age: 37.06 vs. 40.75
Female: 69% vs. 86%
Ambulatory: 100%
EDSS: 3.12 vs. 3.10
A vs. B, mean (SD), p=between groups:
TUG: 11.32 (5.21) to 11.16 (8.82) vs. 14.43 (3.20) to 14.57 (4.02), p=0.05
10MWT: 17.67 (8.92) to 13.37 (4.59) vs. 21.16 (6.36) to 19.39 (6.52), p=0.56
6MWT: 184.01 (101.04) to 272.32 (105.60) vs. 150.37 (65.18) to 162.80 (60.57),
p=0.01
MSQoL-54 PCS: 45.80 (9.70) to 53.36 (11.9) vs. 43.38 (15.43) to 45.53 (7.30),
p=0.40
MSQoL-54 MCS: 50.87 (15.46) to 58.34 (14.89) vs. 41.66 (17.07) to 50.10 (14.72),
p=0.42
EDSS: 3.12 (1.19) to 2.65 (1.20) vs. 3.10 (0.76) to 3.03 (0.69), p=0.01
BBS: 40.37 (9.97) to 46.43 (8.34) vs. 34.00 (9.13) to 35.85 (7.22),
p=0.01Faramarzi, 2020
177
* Faramarzi M
* Banitalebi E
* Raisi Z
* et al.
Effect of combined exercise training on pentraxins and pro-inflammatory
cytokines in people with multiple sclerosis as a function of disability status.
Cytokine. 2020; 134155196
* Crossref
* PubMed
* Scopus (4)
* Google Scholar
Has companion: Banitalebi, 2020
178
* Banitalebi E
* Ghahfarrokhi MM
* Negaresh R
* et al.
Exercise improves neurotrophins in multiple sclerosis independent of disability
status.
Mult Scler Relat Disord. 2020; 43102143
* Abstract
* Full Text
* Full Text PDF
* PubMed
* Scopus (4)
* Google Scholar
Multimodal Exercise
Immediately Postintervention, 12 weeks
RCT
FairA. Resistance + endurance + Pilates + balance + stretch),
36 sessions over 12 weeks (n=23)
B. Combined exercise - Moderate disability group (4.5 ≤ EDSS ≤ 6)
36 sessions (3 per week) over 12 weeks (n=13)
C. Combined exercise - High disability group (EDSS ≥ 6.5)
36 sessions (3 per week) over 12 weeks (n=11)
D. Waitlist control Low (n=23)
E. Waitlist control Moderate (n=13)
F. Waitlist control High (n=11)A vs. B vs. C vs. D
Age: NR (between 18 and
50 years)
Female: 100%
Ambulatory: 100%
EDSS score:
EDSS < 4.5:
A. 23 (24%) vs. D. 23 (24%)
EDSS ≤ 4.5 to ≤ 6:
B.13 (14%) vs. D. 13 (14%)
EDSS ≥ 6.5:
C.11 (12%) vs. D. 11 (12%)
A vs. B vs. C vs. D vs. E vs. F, Mean change from baseline (95% CI)
[change value calculated by EPC from figures]
6MWT:
A vs. D
63.1 (95% CI -15.6 to 139.5) vs. -11.1 (95% CI -44.6 to 21.7)
B vs. E
49.7 (95% CI 1.5 to 97.83) vs. -1.9 (95% CI -35.0 to 32.4)
C vs. F
64.1 (95% CI 39.2 to 88.6) vs. -13.1 (95% CI -42.8 to 17.4)
TUG:
A vs. D
-1.5 (95% CI -4.1 to 1.2) vs. 0.72 (95% CI -0.34 to 1.8)
B vs. E
-1.6 (95% CI -3.6 to 0.37) vs. -0.3 (95% CI -4.9 to 4.5)
C vs. F
-1.9 (95% CI -3.9 to 0.03) vs. 1.4 (95% CI 0.05 to 2.6)
Author tests for interactions between disability levels were not statistically
significant.
VO2-peak change (mL/kg/min):
Significant positive correlation between
changes Vo2 peak) with exercise, p=0.041
There was a significant condition main effect on change in Vo2 peak,
p=0.004Kerling, 2015
180
* Kerling A
* Keweloh K
* Tegtbur U
* et al.
Effects of a short physical excercise intervention on patients with multiple
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Multimodal exercise
RCT
FairA. Full body progressive resistance + aerobic training, 36 sessions over 12
weeks (n=30)
B. Aerobic training, 36 sessions over 12 weeks (n=30)A vs. B
Age: 42.3 vs. 45.6
Female: 80% vs. 67%
EDSS: 2.6 vs. 3.1A vs. B, mean (SD), p=between groups:
SF-36 PCS: 44.9 (9.1) to 46.2 (9.1) vs. 39.0 (10.8) to 39.6 (11.3), p=0.56
SF=36 MCS: 44.9 (13.6) to 45.4 (13.4) vs. 46.7 (11.7) to 51.4 (8.6), p=0.01
Ozkul, 2020b
183
* Ozkul C
* Guclu-Gunduz A
* Eldemir K
* et al.
Combined exercise training improves cognitive functions in multiple sclerosis
patients with cognitive impairment: a single-blinded randomized controlled
trial.
Mult Scler Relat Disord. 2020; 45102419
* Abstract
* Full Text
* Full Text PDF
* PubMed
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* Google Scholar
Multimodal Exercise
RCT
FairA. Aerobics + Pilates, 24 sessions over 8 weeks (n=17)
B. Control group, relaxation exercise at home, 24 sessions over 8 weeks (n=17)
A vs. B
Age: 35.8 vs. 36.7
Female: 76% vs. 76%
Ambulatory: 100%
EDSS: 1.5 vs. 1.71
A vs. B, Mean (SD), change mean (SD), p=within groups
6MWT (meters):
539.94 (50.21) vs. 513.82 (50.96) (baseline)
587.92 (51.44) vs. 502.75 (53.54) (postintervention);
change mean (SD) 47.98 (23.34) vs. −11.07 (36.40), p<0.001
MSQOL-54-MCS:
62.74 (19.37) vs. 56.29 (16.47) (baseline)
74.24 (14.83) vs. 50.91 (20.42) (postintervention)
change mean (SD) 11.50 (15.94) vs. −5.38 (17.37), p=0.006
MSQOL-54-PCS:
120.54 (29.32) vs. 109.67(27.89) (baseline)
140.08 (18.42) vs. 97.83 (35.58) (postintervention)
change mean (SD) 19.54 (14.42) vs. −11.84 (28.36), p<0.001
BDI:
11.06 (8.05) vs. 15.18 (8.68) (baseline)
9.18 (5.48) vs. 18.41 (7.77) (postintervention)
change mean (SD) 1.88 (5.35) vs. −3.24 (8.86), p=0.152Roppolo, 2013
184
* Roppolo M
* Mulasso A
* Gollin M
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The role of fatigue in the associations between exercise and psychological
health in multiple sclerosis: direct and indirect effects.
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Multimodal exercise
Quasiexperimental
FairA. Combination therapy (aerobic + strength training), 24 sessons over 12
weeks (n=17)
B. Usual care (n=18)A vs. B
Age: 40 vs. 40 years
Female: 100% vs. 100%
EDSS: 1.5 vs. 2.0A vs. B, mean (SD)
MSQOL-54
202.7 (7.9) vs. 139.3 (32.4), MD 63.4 (7.86) (95% CI 47.43 to 79.4), p<0.001
(postintervention);
29.5 (36.17) vs. −22.5 (55.57), MD 52.0, 95% CI 20.8 to 83.2, p=NR (pre-post
change)
BDI:
8.8 (5.80) vs. 9.2 (3.70) (baseline)
3.4 (2.90) vs. 17 (7.00) (postintervention)Sandroff, 2017
175
* Sandroff BM
* Bollaert RE
* Pilutti LA
* et al.
Multimodal exercise training in multiple sclerosis: a randomized controlled
trial in persons with substantial mobility disability.
Contemp Clin Trials. 2017; 61: 39-47
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* Full Text
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Multimodal exercise
RCT
FairA. Resistance + aerobics + balance, 72 sessions over 24 weeks. (n=43)
B. Usual care-stretching and toning, 72 sessions over 24 weeks (n=40)A vs. B
Age: 49.8 vs. 51.2
Female: 83.7% vs. 87.5%
EDSS 4-6: 100%
Walking difficulties: 100%A vs. B mean (SD), p=between groups:
6MWT: 1073.1 (529.0) vs. 1097.5 (493.3) (baseline); 1185.5 (600.5) vs. 1115.1
(512.7) (postintervention), p=0.05
25-foot WT: 3.7 (1.8) vs. 4.0 (1.4) (baseline); 4.0 (1.9) vs. 4.0 (1.5)
(postintervention), p>0.11
MSWS-12: 64.8 (24.7) vs. 51.8 (24.7) (baseline);
59.0 (23.4) vs. 49.3 (27.1) (postintervention), p=0.98
Sangelaji, 2014
171
* Sangelaji B
* Nabavi SM
* Estebsari F
* et al.
Effect of combination exercise therapy on walking distance, postural balance,
fatigue and quality of life in multiple sclerosis patients: a clinical trial
study.
Iran Red Crescent Med J. 2014; 16: e17173
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Multimodal exercise
RCT
PoorA. Strength + aerobics + balance, 30 sessions over 10 weeks (n=29)
B. Usual care (previous activity level) (n=22)A vs. B
Age: 33.05 vs. 7.68
Female: 61.5% vs. 68.2%
EDSS 0-4: 100%A vs. B, mean difference (SD), p=between groups:
6MWT: 137.2 (24.54), p<0.0001; 184.3 (51.1), p=0.001 (1-year followup)
MSQoL-PCS: 12.17 (3.62), p=0.001; 10.90 (4.55), p=0.02 (1-year followup)
MSQoL-MCS: MD 16.36 (4.46), p=0.001; 13.54 (5.37), p=0.02 (1-year followup)
EDSS: –0.13 (0.23), p=0.60; –0.28 (0.29), p=0.35 (1 year followup)
BBS: 3.34 (0.87), p<0.0001; 3.21 (1.44), p=0.03 (1-year followup)Sangelaji, 2016
172
* Sangelaji B
* Kordi M
* Banihashemi F
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A combined exercise model for improving muscle strength, balance, walking
distance, and motor agility in multiple sclerosis patients: a randomized
clinical trial.
Iran J Neurol. 2016; 15: 111-120
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Multimodal exercise
RCT
FairA. 1 aerobic + 3 resistance training, 32 sessions over 8 weeks (n=10)
B. 2 aerobic + 2 resistance training, 32 sessions over 8 weeks (n=10)
C. 3 aerobic + 1 resistance training, 32 sessions over 8 weeks (n=10)
D. No intervention control (n=10)A vs. B vs. C vs. D
Age: 36 vs. 31 vs. 34 vs. 34
Female: 60% vs. 60% vs. 60 vs. 60%
Baseline EDSS: 1.33 vs. 2.06 vs. 1.95 vs. 1.81Mean difference (SE), p=vs.
control group:
A vs. D
10MWT: 2.31 (1.04), p=0.030
6MWT: −75.22 (28.21), p=0.010
BBS: –5.88 (1.80), p<0.001
B vs. D
10MWT: 1.45 (1.07), p=0.190
6MWT: −63.00 (29.03), p=0.040
BBS: –1.25 (1.85), p=0.500
C vs. D
10MWT: 1.83 (1.01), p=0.080
6MWT: −27.50 (27.54), p=0.330
BBS: –3.10 (1.75), p=0.090Tarakci, 2013
174
* Tarakci E
* Yeldan I
* Huseyinsinoglu BE
* et al.
Group exercise training for balance, functional status, spasticity, fatigue and
quality of life in multiple sclerosis: a randomized controlled trial.
Clin Rehabil. 2013; 27: 813-822
* Crossref
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* Google Scholar
Multimodal exercise
RCT
FairA. Exercise (e.g., ROM, strength, flexibility, balance, core stability), 36
sessions over 12 weeks (n=51)
B. Waitlist control (n=48)A vs. B
Age: 41.5 vs. 39.7
Female: 67% vs. 63%
EDSS: 9.0 vs. 8.4
RRMS: 63% vs. 69%
PPMS: 20% vs. 17%
SPMS: 18% vs. 15%A vs. B, mean (SD), p=between groups:
10MWT: 17.97 (2.89) vs. 17.17 (3.89) (baseline)
15.24 (2.51) vs. 18.62 (4.21), MD 0.98 (postintervention), p<0.001
MusiQoL: 74.41 (9.20) vs. 73.42 (9.73) (baseline)
76.39 (9.53) vs. 73.02 (10.30), MD 0.34 (postintervention), p=0.02
BBS: 37.68 (9.91) vs. 36.94 (12.55) (baseline)
42.01 (9.32) vs. 34.81 (12.85), MD 0.64 (postintervention), p=0.003
Stair Climbing Test: 12.00 (3.57) vs. 13.92 (4.54) 9.53 (3.49) vs. 18.46
(16.34), MD 0.290 (postintervention), p<0.001Wens, 2015b
179
* Wens I
* Dalgas U
* Vandenabeele F
* et al.
High intensity excercise in multiple sclerosis: effects on muscle contractile
characteristics and excercise capacity, a randomised controlled trial.
PLoS One. 2015; 10e0133697
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Multimodal exercise
RCT
FairA. Resistance training + high-intensity interval training, 30 sessions over
12 weeks (n=12)
B. Resistance training + high-intensity continuous cardiovascular training, 30
sessions over 12 weeks (n=11)
C. No intervention - "sedentary control" (n=11)A vs. B vs. C
Age: 43 vs. 47 vs. 47
Female: 42% vs. 45% vs. 82%
EDSS: WBV
2.3 vs. 2.7 vs. 2.5A vs. B, mean (SD):
VO2 max (ml/kg/min):
16.5 (6.5) vs. 15.4 (6.2), p=NR (baseline)
17.1 (5.9) vs. 15.9 (5.5), p=NR (postintervention)
Time X Group interaction p>0.20
Mean (SD) of % change
A vs. C
VO2 max (ml/min): 17.8% (4.6%) vs. 2.5% (4.1%), p<0.01
VO2 max (ml/min/kg):17.8% (4.6%) vs. 2.5%
B vs. C
VO2 max (ml/min): 7.5% (5.8%) vs. 2.5% (4.1%), p>0.05
VO2 max (ml/min/kg): 7.5% (5.8%) vs. 2.5% (4.1%), p>0.05Williams, 2020
182
* Williams KL
* Low Choy NL
* Brauer SG
Center-based group and home-based individual exercise programs have similar
impacts on gait and balance in people with multiple sclerosis: a randomized
trial.
PM R. 2021; 13: 9-18
* Crossref
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* Google Scholar
Multimodal exercise
RCT
FairA. Center-based group strength + endurance + balance, 16 sessions over 8
weeks (n=26)
B. Home-based exercise strength + endurance + balance exercises, 16 sessions
over 8 weeks (n=24)
Age: 53 vs. 51
Female: 65% vs. 88%
Ambulatory: 100%
Aid use
None: 27% vs. 58%
Unilateral: 42% vs. 29%
Bilateral: 31% vs. 13%
Type of MS
RRMS: 58% vs. 67%
PPMS: 19% vs. 8%
SPMS: 15% vs. 8%
Benign: 4% vs. 8%
Unknown/NR: 4% vs. 8%
A vs. B, mean (SD)
All patients
0.83 (0.5) vs. 1.1 (0.4) (baseline)
0.95 (0.5) vs. 1.25 (0.5) (postintervention)
MD 0.01 (95% CI −0.36 to 0.37) (pre-post change)
0.86 (0.4) vs. 1.2 (0.4) (8 weeks postintervention)
MD –0.07 (95% CI –0.22 to 0.08) (pre-8 week postintervention change)
Low disability patients (Disease Step Rating Scale 0-2)
1.37 (0.38) vs. 1.37 (0.32) (baseline)
1.28 (0.33) vs. 1.52 (0.46) (postintervention)
MD 0.24 (95% CI −0.61 to 1.08) (pre-post change)1.22 (0.06) vs. 1.41 (0.37) (8
weeks postintervention)
MD –0.19 (95% CI –0.41 to 0.03) (pre-8 week postintervention change)
High disability patients (Disease Step Rating Scale 3-5)0.71 (0.39) vs. 0.81
(0.28) (baseline)
0.86 (0.46) vs. 0.89 (0.36) (postintervention)
0.16 (0.59) vs. 0.07 (0.85) MD 0.8 (95% CI −0.47 to 0.64) (pre-post change)0.76
(0.41) vs. 0.92 (0.33) (8 weeks postintervention)
MD –0.06 (95% CI –0.24 to 0.12) (pre-8 week postintervention change)
6MWT (meters):
216.4 (128.4) vs. 301.3 (108.4) (baseline)
248.7 (125.3) vs. 312.3 (121.9) (immediately postintervention)
MD 18.67 (95% CI −78.22 to 115.56) (pre-post change)
236.3 (115.2) vs. 300.7 (119.4) (8 weeks postintervention)
MD -20.5 (95% CI –60.21 to 19.21) (pre-8 week postintervention change)
Low disability patients
372.5 (61.5) vs. 359.36 (85.6) (baseline)
378 (63.3) vs. 382.4 (103) (postintervention)
5.5 (248.8) vs. 23.1 (151.5), MD 17.6 (95% CI −184.2 to 219.26) (pre-post
change)
352 (67.2) vs. 367 (97.4) (8 weeks postintervention)
MD 28.14 (95% CI –8.26 to 64.54) (pre-8 week postintervention change)
High disability patients
178.6 (102.1) vs. 216.5 (84.6) (baseline)
214.5 (111.5) vs. 221.2 (93.7) (postintervention)
35.9 (151.7) vs. 4.7 (211.80), MD 31.17 (95% CI −108.37 to 170.72) (pre-post
change score)
204.1 (105.2) vs. 212.2 (85.1) (8 weeks postintervention)
MD –29.8 (95% CI –77.21 to 17.61) (pre-8-week postintervention change)
42 (16.7) vs. 50.9 (6) (baseline)
43.5 (14.9) vs. 50.7 (7.9) (postintervention)
1.5 (17.02) vs. −0.18 (17.37), MD 1.70 (95% CI −8.4 to 11.80) (pre-post change)
44 (15.4) vs. 51 (6.9) (8 weeks postintervention)
MD –1.9 (–6.44 to 2.64) (pre-8-week postintervention change)
Low disability patients
53.8 (0.8) vs. 53.3 (3.6) (baseline)
54.2 (1.9) vs. 53.8 (3.5) (immediately postintervention)
MD 0.2 (95% CI −7.69 to 8.01) (pre-post change)
54 (1.9) vs. 53.5 (3.9) (8 weeks postintervention)
0.20 (1.35) vs. 0.20 (2.39), MD 0.0 (–1.37 to 1.37) (pre-8-week postintervention
change)
High disability patients
39.1 (17.5) vs. 47.6 (7.3) (baseline)
40.7 (15.5) vs. 46.7 (10.2) (immediately postintervention)
MD 2.54 (95% CI −18.01 to 23.08) (pre-post change)
41.2 (16.4) vs. 47.7 (8.7) (8 weeks postintervention)
MD –2.0 (95% CI –9.31 to 5.31) (pre-8-week postintervention change)Multimodal
Exercises—Cerebral PalsyFosdahl, 2019b
193
* Fosdahl MA
* Jahnsen R
* Kvalheim K
* et al.
Effect of a combined stretching and strength training program on gait function
in children with cerebral palsy, GMFCS level I & II: a randomized controlled
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Multimodal exercise
RCT
FairA. Strength training (progressive resistance exercise) + stretching, 48
sessions over 16 weeks (n=17)
B. Usual care (n=20)A vs. B
Age: 10.4 vs. 10.0
Female: 59% vs. 30%
Ambulatory: 100%
GMFM:
I: 59% vs. 60%
II: 41% vs. 35%
III: 0% vs. 5%A vs. B, mean change score (SD)
6MWT (meters):
−45.7 (55.4) vs. −55.4 (55.5), adj. MD 10.6 (95% CI −29.3 to 50.6), p=0.590
(pre-post change)
−51.1 (72.8) vs. −56.6 (59.6), adj. MD 7.2 (95% CI −43.3 to 57.7), p=0.772
(16-week change)
GDI:
−0.4 (4.4) vs. −0.8 (7.14), adj. MD −1.0 (95% CI −5.3 to 3.3), p=0.650 (pre-post
change)
−0.7 (6.0) vs. 1.01 (5.9), adj. MD −1.4 (95% CI −5.6 to 2.8), p=0.504 (16-week
change)Kaya Kara, 2019
192
* Kaya Kara O
* Livanelioglu A
* Yardimci BN
* et al.
The effects of functional progressive strength and power training in children
with unilateral cerebral palsy.
Pediatr Phys Ther. 2019; 31: 286-295
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Multimodal exercise
RCT
FairA. Strength training (progressive resistance exercise) + balance, 36
sessions over 12 weeks (n=17)
B. Usual care,
36 sessions over 12 weeks (n=16)A vs. B
Age: 11.8 vs. 11.3
Female: 53% vs. 60%
Ambulatory: 100%
Manual ability classification
system level:
I: 47% vs. 47%
II: 33% vs. 27%
III: 20% vs. 27%A vs. B, mean change from baseline (SD)
(data are for completers only; n=15 vs. 15)
GMFM-88D:
0.17 (0.67) vs. 0.32 (1.42), MD −0.15 (95% CI −0.93 to 0.63), p=0.632; effect
size 0.13
GMFM-88E:
2.31 (2.20) vs. −0.37 (2.59), MD 2.68 (95% CI 0.98 to 4.38), p=0.004; effect
size 1.11
1MWT:
7.76 (7.03) vs. 0.53 (3.37), MD 7.23 (95% CI NR), p=0.001; effect size 1.31
TUG:
−1.02 (0.45) vs. 0.08 (0.45), MD −1.10 (95% CI −1.42 to −0.78), p<0.001; effect
size 2.42Slaman, 2015
188
* Slaman J
* van den Berg-Emons HJ
* van Meeteren J
* et al.
A lifestyle intervention improves fatigue, mental health and social support
among adolescents and young adults with cerebral palsy: focus on mediating
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Clin Rehabil. 2015; 29: 717-727
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* Slaman J
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* et al.
Can a lifestyle intervention programme improve physical behaviour among
adolescents and young adults with spastic cerebral palsy? A randomized
controlled trial.
Dev Med Child Neurol. 2015; 57: 159-166
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Can a lifestyle intervention improve physical fitness in adolescents and young
adults with spastic cerebral palsy? A randomized controlled trial.
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Learn 2 Move 16-24: effectiveness of an intervention to stimulate physical
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Multimodal exercise
RCT
FairA. Strength training + aerobic fitness, 48 sessions over 3 months plus 8-10
counseling sessions on physical activity and sports participation over 3 months:
(n=28)
B. Usual care (n=29)
A vs. B
Age: 20 vs. 20
Female: 48.3% vs. 57.1%
Ambulatory: 97% vs. 89%
Wheelchair user: 3.3% vs. 10.7%
Unilateral CP: 52% vs. 50%
GMFM I: 61% vs. 55%
GMFM II: 32% vs. 31%
GMFM III: 7% vs. 10%
GMFM IV: 0% vs. 3%
A vs. B, mean difference (95% CI), p=between groups:
GMFM-66: –1.94 (–4.69 to 0.82), p>0.05 (postintervention); –0.08 (–1.99 to
1.83), p>0.05 (1-year followup)
SF-36 Physical functioning: 3.11 (95% CI –8.31 to 14.53), p>0.05
(postintervention); 5.45 (–5.13 to 16.04), p>0.05 (1 year followup)
SF-36 Role physical: 4.15 (–15.10 to 23.40), p>0.05 (postintervention); 16.27
(–8.65 to 41.20), p>0.05 (1-year followup)
SF-36 General health: 7.41 (–3.81 to 18.62), p>0.05 (postintervention); 10.28
(–1.42 to 21.98), p>0.05 (1 year followup)
SF-36 Vitality: 1.64 (–4.96 to 8.23), p>0.05 (postintervention); −0.40 (–6.92 to
7.71), p>0.05 (1-year followup)
SF-36 Social functioning: 1.76 (–5.88 to 9.41), p>0.05 (postintervention); −3.08
(–12.64 to 6.49), p>0.05 (1-year followup)
SF-36 Role emotional: 5.94 (–5.01 to 16.90), p>0.05 (postintervention); 11.09
(–1.22 to 23.39), p>0.05 (1 year followup)
SF-36 Mental health: 8.00 (0.96 to 15.05), p<0.05 (postintervention); 8.80 (0.99
to 16.61), p<0.05 (1-year followup)Van Wely, 2014a
189
* Van Wely L
* Balemans AC
* Becher JG
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Physical activity stimulation program for children with cerebral palsy did not
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* Balemans AC
* Becher JG
* et al.
The effectiveness of a physical activity stimulation programme for children with
cerebral palsy on social participation, self-perception and quality of life: a
randomized controlled trial.
Clin Rehabil. 2014; 28: 972-982
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* Google Scholar
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* et al.
Learn 2 Move 7-12 years: a randomized controlled trial on the effects of a
physical activity stimulation program in children with cerebral palsy.
BMC Pediatr. 2010; 10: 77
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Multimodal exercise
RCT
Fair
A. Strength plus aerobics 24 sessions over 4 months plus PT and counseling over
6 months plus usual PT from months 4-12 (n=25)
B. Usual PT months 0-12 (n=25)A vs. B
Age: 9.5 vs. 10.0
Female: 52% vs. 33%
Ambulatory: 100%
Wheelchair user for long distances: 20%) vs. (21%
GMFCS I: 60% vs. 54%
GMFCS II: 24% vs. 25%
GMFCS III: 16% vs. 21%
Bilateral: 52%) vs. 54%
A vs. B, mean difference (95% CI), p=between groups:
GMFM-66: 2.8 (0.2 to 5.4), p=0.03 (month 6); −0.9 (−3.3 to 1.4), p>0.05 (month
12)
1MWT: 5.0 (0.0 to 9.0), p=0.06 (month 4); 2.0 (−4.0 to 9.0), p>0.05 (month 6);
3.0 (−43.0 to 10.0), p>0.05 (month 12)
CPQoL Social well-being & acceptance:
–3.1 (–7.9 to 1.7), p=0.19 (month 12)
CPQoL Functioning: –2.5 (–7.3 to 2.3), p=0.30 (month 12)
CPQoL Participation & Physical Health:
–0.8 (–5.7 to 4.1), p=0.75 (month 12)
CPQoL Emotional well-being and self-esteem:
–0.3 (–5.3 to 4.7), p=0.90 (month 12)
CPQoL pain and impact on disability: 5.0 (–5.2 to 15.2), p=0.33 (month
12)Multimodal Exercises—Spinal Cord InjuryGalea, 2018
197
* Galea MP
* Dunlop SA
* Geraghty T
* et al.
SCIPA Full-On: a randomized controlled trial comparing intensive whole-body
exercise and upper body exercise after spinal cord injury.
Neurorehabil Neural Repair. 2018; 32: 557-567
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Multimodal exercise
RCT
FairA. Whole body strength + aerobics, 36 sessions over 12 weeks (n=60)
B. Upper body strength + aerobics, 36 sessions over 12 weeks (n=56)
A vs. B
Age: 40.1 vs. 42.8
Female: 15% vs.16%
ASIA A: 48% vs. 50%
ASIA B: 15% vs. 14%
ASIA C: 12% vs. 9%
ASIA D: 25% vs. 27%
C2-C8: 48% vs. 59%
T1-T6: 30% vs. 23%
T7-T12: 22% vs. 18%A vs. B, mean difference (95% CI) between groups:
6MWT: –18.36 (–68.57 to 31.84), p=0.45 (12 weeks); 27.12 (–12.69 to 66.94),
p=0.168 (6 months)
10MWT (m•sec-1): –0.01 (–0.1 to 0.08), p=0.818 (12 weeks); –0.72 (–2.41 to
0.98), p=0.382 (6 months)
ASIA-UEMS: –0.04 (–1.12 to 1.04), p=0.94
ASIA-LEMS: 0.90 (–0.48 to 2.27), p=0.20Harness, 2008
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Multimodal exercise
Cohort study
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Age: 37.8 vs. 34.5
Female: 13.6% vs. 0%
ASIA-UEMS: 31.0 vs. 38.0, p=0.37
ASIA-LEMS: 8 vs. 4
A vs. B, mean change (SE), p=between groups:
EQ-5D: 14.0 (5.0) vs. 3.0 (5.0), p=0.14
LEMS: 3.3 (0.9) vs. 0 (0.2), p=0.035
ASIA Total Motor: 4.8 (1.0) vs. –0.1 (0.5), p<0.001
CHART: 12.0 (15.0) vs. 0.1 (18.0), p=0.60Jones, 2014a
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Multimodal exercise
RCT
PoorA. Activity-based therapy, 72 sessions over 24 weeks (n=20)
B. Waitlist (n=21)A vs. B
Age: 42 vs. 34
Female: 5% vs. 48%
Tetraplegia: 75% vs. 76%
AIS C: 35% vs. 52%
AIS D: 65% vs. 48%
A vs. B, mean change (SD), p=between groups:
10MWT (m/s): 0.096 (0.140) vs. 0.027 (0.104), p=0.036
6MWT: 35.97 (48.15) vs. 3.0 (25.51), p=0.002
TUG: –37.2 (81.3) vs. –6.2 (18.1), p=0.267
Reintegration to normal living index: 4.6 (13.87) vs. –2.0 (10.01), p=0.087
SCI-FAI: 5.0 (8.03) vs. –0.21 (2.83), p=0.031
SCIM-III: 1.35 (5.2) vs. 0.0 (4.53), p=0.393Liu, 2019
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Multimodal exercise
RCT
FairA. Strength exercise + treadmill + core stability training on a stable
support surface, 60 sessions over 12 weeks (n=20)
B. Strength exercise + treadmill + core stability training on an unstable
support surface, 60 sessions over 12 weeks (n=20)A vs. B
(data are for completers only; n=14 vs. 15)
Age: 43 vs. 46
Female: 21% vs. 27%
Ambulatory: 100%
-paraplegia: 36% vs. 40%
-tetraplegia: 64% vs. 60%
A vs. B, mean (SD), data for completers only:
Stride length (units NR):
0.564 (0.189) vs. 0.454 (0.173), p=0.025 (postintervention)
0.09 (0.26) vs. 0.06 (0.24), MD 0.03 (95% CI –0.16 to 0.22), p=NR (pre-post
change)
Walking speed (units NR):
0.350 (0.226) vs. 0.209 (0.171), p=0.0196 (postintervention)
0.09 (0.30) vs. 0.03 (0.23), MD 0.06 (95% CI –0.14 to 0.26), p=NR (pre-post
change)
Abbreviations: 1MWT = 1-Minute Walk Test; 6MWT = 6-Minute Walk Test; 10MWT=
10-Meter Walk Test; AIS = Asia Impairment Scale; ASIA = American Spinal Injury
Association Impairment Scale; ASIA-LEMS = American Spinal Injuries Association
Impairment Scale - Lower Extremity Motor Score; ASIA-UEMS = American; Spinal
Injuries Association Impairment Scale - Upper Extremity Motor Score; BBS = Berg
Balance Scale; BDI = Beck Depression Inventory; CHART = Craig Handicap and
Assessment Reporting Technique; CI = confidence interval; CP = cerebral palsy;
CPQoL = Cerebral Palsy Quality of Life scale; DGI = Dynamic Gait Index; EDSS =
Expanded Disability Status Scale; EPC = Evidence-based Practice Center; EQ-5D =
EuroQOL-5 Dimension Questionnaire; FIM = Functional Independence Measure; GMFCS
= Gross Motor Function Classification System; GMFM = Gross Motor Function
Measure; GMFM-66 = Gross Motor Function Measure 66;GMFM-66-D = Gross Motor
Function Measure 66 (standing);GMFM-66-E = Gross Motor Function Measure 66
(walking, running, jumping); GMFM-88 = Gross Motor Function Measure 88;
GMFM-88-D = Gross Motor Function Measure 88 (standing); GMFM-88-E = Gross Motor
Function Measure 88 (walking, running, jumping); LEMS = Lower Extremity Motor
Score; MD = mean difference; MS = multiple sclerosis; MSFC = multiple sclerosis
functional composite; MSIS-29 = Multiple Sclerosis Impact Scale-29; MSIS-88 =
Multiple Sclerosis Impact Scale-88; MSQOL= Multiple Sclerosis Quality of Life;
MSWS-12 = Multiple Sclerosis Walking Scale-12; MusiQoL = Multiple Sclerosis
International Quality of Life questionnaire; NR = not reported; PPMS = primary
progressive multiple sclerosis; PT = physical therapy; QOL = quality of life;
RCT = randomized controlled trial; RRMS = relapsing-remitting multiple
sclerosis; SCI = spinal cord injury; SCIM = Spinal Cord Independence Measure; SD
= standard deviation; SE = standard error; SF-12 = Short Form (12) Health
Survey; SF-36 MCS = Short-Form 36 Mental Component Score; SF-36 PCS = Short-Form
36 Physical Component Score; SPMS = secondary progressive multiple sclerosis TUG
= Timed Up and Go Test; UEMS = Upper Extremity Motor Score; VO2 max = maximal
oxygen uptake; VO2 peak = highest value of VO2 attained upon an incremental or
other high-intensity
* Open table in a new tab
Supplemental Table 5Measures of Function
MeasureFunction CategorySpinal Cord Independence MeasureADLBerg Balance
ScaleBalance5-meter walk testMobility6-minute walk testMobility10-meter walk
testMobility25-foot walk testMobility30-Second Lateral Step UpMobility600-yard
walk-run testMobilityDynamic Gait IndexMobilityFour Square Step
TestMobilityFunctional Ambulation ProfileMobilityGross Motor Function
Classification SystemMobilityMultiple Sclerosis Walking
ScaleMobilitySelf-selected walking speedMobilitySit-to-StandMobilityTime Up and
GoMobilityWalking Index for Spinal Cord InjuryMobilityGross Motor Function
MeasureMotorQuality of Upper Extremity Skills TestMotorCanadian Occupational
Performance MeasureMultiple domainsMultiple Sclerosis Impact ScaleMultiple
domainsImpact of Participation and Autonomy QuestionnaireParticipation
* Open table in a new tab
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ARTICLE INFO
PUBLICATION HISTORY
Published online: October 12, 2021
Accepted: October 2, 2021
Received in revised form: September 10, 2021
Received: May 24, 2021
FOOTNOTES
Supported by the AHRQ (contract no. HHSA290201500009I).
Role of the funding source: This project was funded under contract no. HHSA
290-2015-00009-I from the AHRQ, US Department of Health and Human Services in a
National Institutes of Health (NIH) Office of Disease Prevention through an
interagency agreement. A representative from AHRQ served as a Contracting
Officer's Technical Representative and provided assistance during the conduct of
the full evidence report and comments on draft versions of the report. AHRQ did
not directly participate in the literature search, determination of study
eligibility criteria, data analysis, or interpretation. The draft report was
presented at a virtual NIH Office of Disease Prevention Pathways to Prevention
workshop (December 1-3, 2020). Experts in the field, AHRQ and NIH partners, and
the public reviewed earlier drafts of the full technical report. The
investigators are solely responsible for the contents of this article.
Disclaimer: The findings and conclusions in this document are those of the
authors, who are responsible for its contents; the findings and conclusions do
not necessarily represent the views of AHRQ or NIH. Therefore, no statement in
this report should be construed as an official position of NIH, AHRQ, or of the
US Department of Health and Human Services.
Disclosures: none.
IDENTIFICATION
DOI: https://doi.org/10.1016/j.apmr.2021.10.002
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SCIENCEDIRECT
Access this article on ScienceDirect
Physical Activity and the Health of Wheelchair Users: A Systematic Review in
Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury
*
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Hide CaptionDownloadSee figure in article
Toggle Thumbstrip
* Fig. 1
* Fig. 2
* Fig. S1
* Fig. S2
* Fig. S3
* Fig. S4
* View Large Image
* Download Hi-res image
* Download .PPT
FIGURES
* Fig 1Analytic framework diagram. The analytic framework for physical activity
and the health of wheelchair users with multiple sclerosis, cerebral palsy,
and spinal cord injury concepts are illustrated based on key questions and
clinical outcomes as well intermediate outcomes and are described in detail
in the full report. Evidence base descriptions are of studies that evaluate
prevention of obesity, diabetes, cardiovascular conditions, and harms.
Abbreviations: BMI, body mass index; Hb A1c, glycosylated hemoglobin; KQ, key
question; V̇o2max, maximum oxygen consumption.
* Fig 2Literature flow diagram. The diagram indicates the number of abstracts
and full-text articles reviewed for inclusion and subsequently included or
excluded and the final studies included for each population. *Interventions
with <10 sessions/<10 d, or only family/caregiver observed. †Case reports and
case series are not included because of methodological limitations. ‡Studies
before January 2008 and systematic reviews from 2014 or older are outside of
the search dates. §Studies with sample sizes <30 for multiple sclerosis and
cerebral palsy and <20 for spinal cord injury. ‖Systematic reviews not used
because they did not meet all inclusion criteria but checked for includable
studies.
* Supplemental Figure 1Overview of included studies by population and
intervention
* Supplemental Figure 26MWT meta-analysis of all randomized controlled trials
versus no treatment/usual care
* Supplemental Figure 3BBS meta-analysis of all randomized controlled trials
versus no intervention/usual care
* Supplemental Figure 4Effect of exercise versus usual care on depression
scores in multiple sclerosis
TABLES
* Table 1PICOTS—inclusion and exclusion criteria
* Table 2Overview of included studies by intervention category and population
*
Studies with multiple interventions appear more than once on the table.
Studies with only intermediate outcome(s) appear in full report tables.
* Table 3Summary of evidence
* Table 4Effects of physical activity interventions compared with usual care
* Supplemental Table 1Studies of the Benefits and Harms of Physical
Activity—Aerobic Exercise Interventions
* Supplemental Table 2Studies of the Benefits and Harms of Physical
Activity—Postural Control Interventions
* Supplemental Table 3Studies of the Benefits and Harms of Physical
Activity—Strength Exercise Interventions
* Supplemental Table 4Studies of the Benefits and Harms of Physical
Activity—Multimodal Interventions (Progressive Resistance or Strengthening
Combination Exercises) Muscle Strength Exercise—Multiple Sclerosis
* Supplemental Table 5Measures of Function
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