Balance exercises bring about many improvements in patients with MS

In patients with multiple sclerosis (MS), balance, dizziness, fatigue, and quality of life may all be improved by training with a rehabilitation program known as Balance and Eye-Movement Exercises for Persons with Multiple Sclerosis (BEEMS), according to results from a study recently published in Neurology.

Multiple sclerosis is unpredictable and disabling and affects 2.3 million people worldwide. Typically presenting between the ages of 20 and 50, it is two to three times more common in women.

Approximately 1 million Americans have MS, according to preliminary results from the National Prevalence Initiative presented at the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2017, the world’s largest MS conference. This estimate is based on the work of leading experts and is nearly twice as large as estimates based on previous research—specifically an updated study from 1975.

Patients with MS typically experience balance problems and fatigue, which are in turn associated with falling and limited mobility. These can have profound effects on their ability to work or complete activities of daily living. Vision problems are also common and may cause patients with MS to inappropriately compensate for their movements, which can lead to further balance issues.

“Most rehabilitation programs to improve balance have focused mainly on strength exercises and balance exercises that are not designed for the specific problems of people with MS,” said study author Jeffrey R. Hebert, PT, PhD, associate professor, Physical Medicine & Rehabilitation-Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO. “We wanted to see if performing balance and eye movement exercises while processing multiple different sensory information could help people improve their balance and fatigue issues.” 

Dr. Hebert and colleagues, therefore, conducted this randomized, controlled, two-arm, examiner-blinded stratified study to assess the effects on balance of the multifaceted, vestibular-related rehabilitation program BEEMS. They also sought to determine whether differences in outcomes were based on brainstem/cerebellar lesion involvement.

They included 88 patients with MS who were assigned to either BEEMS or no treatment. To measure balance control, researchers used Computerized Dynamic Posturography-Sensory Organization Testing (CDP-SOT). They also used the Dizziness Handicap Inventory (DHI), Modified Fatigue Impact Scale (MFIS), and the Short Form-36 Health Status Questionnaire (SF-36).

Exercises included balancing and walking on various surfaces, with and without head movements, with eyes both opened and shut. Eye movement exercises were included to help improve visual stability.

At 6 weeks, subjects participating in BEEMS had greater improvements compared with controls in the following measures:

• CDP-SOT composite (model-estimated difference in change: 4.9; 95% CI: 1.39 to 8.38; P=0.006),
• DHI total (model-estimated difference in change: −13.5; 95% CI: −17.7 to −7.25; P < 0.0001),
• MFIS total (model-estimated difference in change: −11.4; 95% CI: −15.7 to −7.0; P < 0.0001),
• SF-36 Mental (model-estimated difference in change: 5.6; 95% CI: 2.43 to 8.71; P=0.0006), and
• SF-36 Physical (model-estimated difference in change: 3.5; 95% CI: 1.12 to 5.81; P=0.004) scores.

From baseline to 14 weeks, BEEMS participants showed greater improvements in:

• CDP-SOT composite (model-estimated difference in change: 8.3; 95% CI: 4.73 to 11.9, P < 0.0001)
• DHI total (model-estimated difference in change: −13.9; 95% CI: −19.3 to −8.62, P < 0.0001)
• MFIS total (model-estimated difference in change: −12.3; 95% CI: −16.7 to −7.79, P < 0.0001)
• SF-36 Mental (model-estimated difference in change: 3.9; 95% CI: 0.70 to 7.16, P=0.02), and
• SF-36 Physical (model-estimated difference in change: 3.2; 95% CI: 0.79 to 5.62, P=0.01) scores.

Finally, Dr. Hebert and colleagues found that from baseline to 6 weeks, BEEMS participants who had brainstem/cerebellar lesion involvement demonstrated greater improvements compared with those without such involvement in both CDP-SOT composite (model-estimated difference in change: 5.26; 95% CI: 0.34 to 10.2, P=0.04) and MFIS total (model-estimated difference in change: −7.6; 95% CI: −14.0 to −1.33, P=0.02) scores.

The differences in the CDP-SOT assessments translated to an improvement in the average baseline score of 63 to an average of 73 at 6 weeks in patients who participated in BEEMS, compared with a baseline score of 62 in the control group that improved only to 66 at 6 weeks.

Dr. Hebert said further studies are needed to determine whether these improvements can be sustained, as well as to compare BEEMS to other balance training programs.

This study was supported by National Multiple Sclerosis Society.