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The Effect of Cycling Using Active-Passive Trainers on Spasticity, Cardiovascular Fitness, Function and Quality of Life in People with Moderate to Severe Multiple Sclerosis (MS); a Feasibility Study

Barclay A, Paul L, MacFarlane N, McFadyen AK

Background: Exercise options for those with moderate to high levels of disability are limited. The aim of the study was to evaluate the feasibility of a progressive, four-week lower limb cycling program using active-passive trainers (APT’s) on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe MS.

Methods: Participants were in-patients in the Physical Disability Rehabilitation Unit, Queen Elizabeth University Hospital, Glasgow, UK and randomized to APT + usual care or usual care only. The APT group received 30 min of APT (2 min passive warm up, 26 min active cycling, 2 min passive cool down), five days per week for 4 weeks. Outcome measures: Oxygen Uptake Efficiency Slope, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale, Functional Independence Measure, timed 25 foot walk test and the MSQOL-54, were taken before and after the intervention period. Symmetry, distance cycled, and active participation were also recorded for each cycling session.

Results:  24 participants were recruited, 15 to the intervention and 9 to the control group. There was a 100% adherence to the intervention and a significant increase in average speed, power output and distance cycled (p < 0.001 for each) over the four weeks. There were no adverse events and both groups improved in average scores for all outcome measures.

Conclusions: APT cycling was well tolerated, while the cycling parameters improved it was difficult to separate the effects of the therapy program and APT cycling. A longer duration, fully powered trial in a community setting is merited.

Conclusion: With the isokinetic dynamometer, it was not possible to show an effect of passive cycling on spasticity reduction. However, six out of 10 of the subjects estimated their spasticity to be less after cycling. This positive effect might be attributed to a reduced spasticity in the trunk and/or to the attention the subjects perceived during the intervention.

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