Progressive Resistance Training for Middle-Aged MS Patients: A Practical Guide to Improving Strength and Function

As clinicians, we're constantly seeking effective, evidence-based strategies to help our patients with Multiple Sclerosis (MS) combat the debilitating effects of muscle weakness and functional decline. A recent systematic review and meta-analysis published in the *Journal of Clinical Medicine* in 2024 provides a comprehensive look at the role of progressive resistance training (PRT) for middle-aged individuals with MS, a demographic where frailty and functional loss become increasingly prominent. This brief will break down the key findings of this research and offer practical guidance on how to translate this evidence into your clinical practice. The review, which analyzed 12 randomized controlled trials involving 459 participants, confirms what many of us have seen in practice: PRT is a powerful tool for improving muscle strength in people with MS. The meta-analysis revealed a large and statistically significant effect size (g = 0.786) in favor of PRT for enhancing muscle strength. This is a crucial finding, as muscle weakness is a primary contributor to disability in MS, affecting up to 70% of patients and leading to a cascade of functional limitations. So, what does an effective PRT program look like for this population? The review provides some valuable parameters. The most effective protocols involved training 2-3 times per week, focusing on major muscle groups with 1-2 multi-joint exercises per group. The intensity sweet spot appears to be between 70% and 85% of a patient's 1-repetition maximum (1RM). This intensity is high enough to stimulate muscle hypertrophy and strength gains, but it's also crucial to individualize the program and progress gradually to avoid overexertion and potential adverse effects. The review also highlights the inclusion of concentric exercises performed at higher speeds with moderate intensities (40-60% of 1RM) to improve muscle power. While the impact of PRT on muscle strength is clear, its effect on gait is more nuanced. The meta-analysis found that PRT alone resulted in only modest and non-significant improvements in walking performance. However, the story changes when PRT is combined with motor control exercises. The review's subgroup analysis showed a medium and statistically significant effect size (g = 0.677) for combined interventions on gait. This suggests that a holistic approach that addresses both strength and motor control is likely to be more effective for improving walking ability in people with MS. This makes intuitive sense, as gait is a complex task that requires not only strength but also coordination, balance, and proprioception. The evidence regarding the impact of PRT on fatigue and quality of life was more mixed. While some studies in the review reported improvements in these domains, the overall effect was not statistically significant. This variability may be due to the multifaceted nature of fatigue in MS, which can be influenced by a wide range of physiological and psychological factors. However, it's worth noting that even in the absence of significant improvements in fatigue, the strength and functional gains from PRT can still have a positive impact on a patient's overall well-being and ability to participate in daily activities. Safety is always a primary concern when prescribing exercise for people with MS. The review found that PRT is generally safe and well-tolerated. Of the five studies that reported on adverse events, four found none. The most common adverse event was fatigue, which is not unexpected given the nature of the intervention. This underscores the importance of careful monitoring, gradual progression, and open communication with patients to ensure that the program is challenging but not overwhelming.