Larger and longer studies are needed to determine how long the benefits last, and which people with MS would be most likely to respond to the training program. The study, by Jeffrey Hebert, PT, PhD (University of Colorado, Aurora) and colleagues, was reported in the journalPhysical Therapy in August, 2011 and was partially funded by a pilot research grant from the National MS Society.
Fatigue and impaired balance are two common and troublesome symptomsexperienced by people with MS. Current treatments vary greatly in effectiveness. This study is the first to examine the effects of an exercise program involving balance and eye movement training – or “vestibular rehabilitation” -- in people with MS to see if it improves both fatigue and balance.
For this controlled study, 38 people with MS were divided into three groups: one group did not participate in an exercise program and only received normal MS medical care; one group participated in a general exercise program involving endurance and stretching; and one group participated in the vestibular rehabilitation program specifically designed to improve balance. The endurance and stretching exercises included bicycle riding and exercise designed to stretch various muscles. The vestibular rehabilitation program included balance exercises on various surfaces (firm surface, foam cushion, trampoline, tiltboard), arm movements while kneeling, head movements on a trampoline and while fixating on different objects, ball catching while walking. The vestibular rehabilitation program also included 3 types of eye movement exercises. Both exercise programs were performed for 60 minutes twice a week in the clinic. A daily home exercise program, consisting of a subset of exercises performed in the clinic, was also assigned to each participant. The exercise training programs lasted for 6 weeks.
Effects on balance, fatigue, dizziness/equilibrium, depression, and walking ability were examined at the end of the 6 weeks and also 4 weeks after the exercise program had ended. At the end of the 6-week period, the group that underwent the vestibular rehabilitation program showed improved balance, reduced fatigue, and reduced disability due to dizziness or disequilibrium. Depression and walking ability were minimally improved. Neither of the control groups showed improvement in balance, fatigue, or dizziness/disequilibrium disability. Four weeks after the exercise program ended, those in the vestibular rehabilitation program group continued to show benefit.
It should be noted that in this study, the bicycle riding was not designed as an aerobic exercise, and thus these findings do not counter prior research studies that have shown benefits of aerobic exercise on MS fatigue. In their paper, the researchers suggest that the vestibular rehabilitation program reteaches the brain how to maintain balance when performing activities during standing or walking, after such abilities are impaired by MS, leading to improved balance, fatigue and dizziness.
Future studies should include more participants and a longer follow-up to determine how long the benefit lasts and which people with MS would most likely respond to this program. Proposals for these investigations are underway.
Based on these preliminary results, balance and eye movement training may help people with MS who are experiencing fatigue and balance problems. Those wishing to explore this option should consult with their neurologists, local rehabilitation facilities or hospitals to see whether this type of training is available.