Table 1.
Characteristics of the studies included in this review.
| First Author, Year (Design) | Participants | Interventions | Outcomes (Test) | Results |
|---|---|---|---|---|
| McAuley, 2015 [18] (RCT) |
n = 48 (75% women) Score EDSS: <6.5 IG: n = 24 (75% women) Score EDSS: NR Age: 59.62 ± 1.43 years Disease duration: 18.10 ± 9.42 years MS type: RR: n = 16 (66.7%) SP: n = 3 (12.5%) PP: n = 1 (4.2%) NR: n = 4 (16.6%) CG: n = 24 (75% women) Score EDSS: NR Age: 59.78 ± 1.50 years Disease duration: 19.85 ± 9.42 years MS type: RR: n = 16 (66.7%) SP: n = 2 (8.3%) PP: n = 0 NR: n = 6 (25%) |
Combined Exercises Program: “FlexToBa DVDs” (balance, strength and flexibility) Duration: 6 months Development: - The first two weeks of each month: Volume: 1 to 2 sets of 8 to 10 reps Intensity: Borg 6–20 RPE scale of 10–12 - The last two weeks of the month: Volume: 2 sets of 10 to 12 reps Intensity: Borg 6–20 RPE scale of 13–15 Volume: 6 progressive exercise sessions/Each session containing two sets of 11 to 12 different exercises Frequency: 3 times/week (non-consecutive days) Intensity: All exercises began with the lower resistance band and advanced to the thicker band |
Flexibility - Upper body (Back Scratch test) - Lower body (Sit and Reach test) |
- Sit and Reach test: Intragroup: IG: Pre: −0.45 cm ± 0.84/Post: 0.62 cm ± 0.95 Post-adjusted: 0.61 cm ± 0.57 CG: Pre: −0.48 cm ± 0.84/Post: 0.44 cm ±0.95 Post-adjusted: 0.27 cm ± 0.57 Intergroup: Not-significant values p-value pre: 0.80/p-value post: 0.68 p-value post- adjusted: 0.68 - Back Scratch test: Intragroup: IG: pre: −4.52 cm ± 1.30/Post: −4.19 cm ± 1.06 Post-adjusted: −4.50 cm ± 0.54 CG: Pre: −5.28 cm ± 1.30/Post: −6.29 cm ± 1.06 Post-adjusted: −6.02 cm ± 0.54 Intergroup: p-value pre: 0.38/p-value post: 0.16 p-value post-adjusted: 0.05 * |
| Duff, 2018 [19] (RCT) |
n = 30 (77% women) Score EDSS: NR IG: n = 15 (80% women) Score EDSS: NR Age: 45.7 ± 9.4 years Disease duration: NR MS type: RR: n = 14 (93%) SP: n = 0 PP: n = 1 (7%) CG: n = 15 (73% women) Score EDSS: NR Age: 45.1 ± 7.4 years Disease duration: NR MS type: RR: n = 11 (73%) SP: n = 2 (13%) PP: n = 2 (13%) |
“Pilates exercise program and physiotherapy massage” Duration: 12 weeks Development: - Exercises in the standing position on the CoreAlign apparatus and floor mat work - Each session started with a warm-up and ended with a cool-down IG: Pilates + massage Volume: 50 min—Pilates 60 min—massage Frequency: 2 times/week 1 time/week Intensity: Existing exercises progressed in difficulty, and new exercises were introduced over the study period based on each participant’s individual performance. CG: Massage Volume: 60 min—massage Frequency: 1 time/week |
Flexibility - Lower body, posterior kinetic chain (Sit and Reach test) |
- Sit and Reach test: Intragroup: IG: Pre: 23.4 cm (11.4)/Post: 25.4 cm (11.0) CG: Pre: 28.4 cm (10.8)/Post: 30.3 cm (9.5) Intergroup: IG: 2.0 cm (−1.8 to 5.7) CG:1.9 cm (−2.0 to 5.8) p-value = 0.98 |
| Pau, 2017 [20] (RCT) |
n = 22 (45% women) Score EDSS: NR IG: n = 11 (45% women) Score EDSS: 3.6 ± 0.9 Age: 47.4 ± 10.8 years Disease duration: NR MS type: RR: n = 11 (100%) CG: n = 11 (45% women) Score EDSS: 3.4 ± 1.1 Age: 44.5 ± 13.5 years Disease duration: NR MS type: RR: n = 11 (100%) |
“Combined exercises program” (aerobic and strength training) Duration: 24 weeks Development: Total volume: 60 min Frequency: 1 time/week Warm-up: Cycle-ergometer and stretching exercises for upper and lower limbs and trunk muscles Volume: 10 min Intensity: 30% of the maximum workload previously calculated by means of a cardiopulmonary test (CPT) Main Part: (Aerobic training) Volume: 20 min Intensity: 50% of the maximum value calculated for each participant on the basis of his/her CPT and progressively increased every week up to 80% of maximum work rate (Strength training) Volume: 20 min/1 set of 8 reps to progress until 3 sets of 12 reps Intensity: 15% (1RM) to progress until a 30% (1RM). Rest: 2–3 min/sets Cool-down: relaxation, postural control, spine mobility exercises and post-stretching Volume: 10 min |
Flexibility - Dynamic ROM of the hip, knee and ankle (goniometer) |
- Dynamic ROM during the gait cycle: Hip flexion–extension: Intragroup: IG: Pre: 42.70º ± 9.61/Post: 47.04° ± 10.13 p-value = 0.029 * CG: Pre: 42.71° ± 6.00/Post: 43.54° ± 3.88 Knee flexion–extension: Intragroup: IG: Pre: 52.88° ± 9.60/Post: 57.71° ± 10.06 p-value: 0.047 * CG: Pre: 50.75° ± 14.46/Post: 51.91° ± 12.98 Ankle dorsi–plantar–flexion: Intragroup: IG: Pre: 23.60° ± 5.81/Post: 26.08° ± 6.53 p-value = 0.043 * CG: Pre: 25.06° ± 10.14/Post: 25.17° ± 8.17 |
| Ponzano, 2017 [21] (RCT) |
n = 22 (NR %women) Score EDSS: ≤6.5 IG1: n = 8 (NR %women) Score EDSS: 4 ± 2 Age: 50 ± 18 years Disease duration: NR MS type: RR: n = 8 (100%) IG2: n = 7 (NR %women) Score EDSS: 3 ± 2 Age: 52 ± 10 years Disease duration: NR MS type: RR: n = 7 (100%) IG3: n = 7 (NR %women) Score EDSS: 2 ± 2 Age: 45 ± 6 years Disease duration: NR MS type: RR: n = 7 (100%) |
Three groups of training: 1. Flexibility training 2. Strength training 3. Pilates program Duration: 16 weeks Development: Each training session began with a warm-up including joint mobility and muscle flexibility exercises IG1: static stretching protocols Volume: 11 exercises/3 sets of 30 s Rest: 30 seg/sets Frequency: 2 times/week IG2: elastic bands Volume: 11 exercises/3 sets of 10 reps Rest: 30 seg/sets Frequency: 2 times/week IG3: Pilates protocol Volume: 12 exercises/2 sets of 8 reps Rest: 30 seg/sets Frequency: 2 times/week |
The three groups were tested three times: - T0: after a month - T1: two months after T0 - T2: two months after T1 Flexibility: - Posterior kinetic chain (Sit and Reach test and Spinal Mouse test). |
No significant variations concerning unlisted parameters emerged from this research. - Spinal Mouse test: IG1: T0 and T2 (p < 0.05, −55%, ES = 0.67) “Inclination line test between ThSp1 and S1” IG2 and IG3: NR - Sit and Reach test: IG1: T0 and T2 (p < 0.05, +15%, ES = 0.36) IG2: NR IG3: T0 and T2 (p < 0.05, +15%, ES = 0.4) |
| Pereira, 2012 [22] (Descriptive longitudinal quantitative) |
n = 4 (100% women) Score EDSS: NR Age: 45.5 years (between 33–53 years) Disease duration: 7 years MS type: RR: n = 4 (100%) |
“Combined exercises program” by physiotherapy (strength, flexibility and balance) Duration: 30 sets Development: Home session; exercises of strength, flexibility and balance Volume: 60 min Frequency: 1 time/week Type of exercise to improve ROM: - 10 joint mobilizations (shoulder, elbow, wrist, hip, knee and ankle) - 3 muscle stretching maintained for 30 s - The same pattern was followed on the contralateral side |
Flexibility in three different measurements: - ROM of the ankle, knee, hip, shoulder, elbow and wrist during active movements performed in dorsal decubitus, ventral, sitting and orthodontic, respectively (goniometer) |
- ROM (First, second, third measurement): Ankle dorsi-flexion: Right: 7.5°, 10°, 15° Left: 10°, 17.5°, 20° Ankle plantar-flexion: Right: 30°, 37.5°, 42.5° * Left: 40°, 42.5°, 45° Knee flexion: Right: 105°, 112.5°, 117.5° * Left: 92.5°, 112.5°, 122.5° * Hip flexion: Right: 25°, 40°, 57.5° * Left: 25°, 47.5°, 55° * Hip extension: Right: 17.5°, 20°, 25° Left: 20°, 17.5°, 20° Hip abduction: Right: 27.5°, 30°, 32.5° Left: 25°, 32.5°, 40° * Shoulder flexion: Right: 142.5°, 140°, 165° Left: 147.5°, 150°, 160° Shoulder extension: Right: 60°, 65°, 70° * Left: 52.5°, 62.5°, 70° * Shoulder abduction: Right: 142.5°, 150°, 170° * Left: 160°, 162.5°, 170° * Elbow flexion: Right: 127.5°, 132.5°, 135° * Left: 130°, 140°, 140° * Wrist flexion: Right: 80°, 82.5°, 87.5° Left: 70°, 75°, 82.5° Wrist extension: Right: 57.5°, 62.5°, 65° * Left: 67.5°, 67.5°, 70° |
| Rodgers, 1999 [23] (Non-randomized, non-controlled) |
n = 18 (77.7% women) Score EDSS: 3.6 ± 2.1 Age: 43.2 ± 10.8 years Disease duration: NR MS type: NR |
“Aerobic exercise program” Duration: 6 months Development: Cycle ergometry protocol (upright or recumbent ergometer depending on their ability level) Volume: 30 min Intensity: 65–70% age-predicted maximal heart rate Frequency: 3 times/week |
Measurements of flexibility: - Range of motion during walking (ROM gait) - Passive Range of motion (PROM) “Using goniometers (°) and standard techniques (ankle, knee, and hip)” |
- ROM during the gait cycle, mean (SD): Ankle dorsi-flexion: Pre: 7.1 (5.3)/Post: 77.0 (8.1)/p-value = 0.0007 * Ankle plantar-flexion: Pre: 101.0 (8.7)/Post: 108.9 (8.3)/p-value = 0.0001 * Ankle dorsi-plantar-flexion: Pre: 29.8 (7.1)/Post: 31.9 (8.8)/p-value = 0.204 Ankle angle at contact: Pre: 89.2 (5.3)/Post: 97.0 (7.3)/p-value = 0.0001 * Ankle angle at toe-off: Pre: 92.9 (9.1)/Post: 99.5 (10.7)/p-value = 0.003 * Knee flexion: Pre: 122.5 (9.3)/Post: 124.3 (11.0)/p-value = 0.178 Knee extension: Pre: 172.0 (6.4)/Post: 171.0 (6.1)/p-value = 0.339 Knee (flexo-extension): Pre: 49.5 (10.2)/Post: 46.6 (11.3)/p-value = 0.023 * Knee angle at contact: Pre: 165.1 (8.0)/Post: 165.6 (8.0)/p-value = 0.736 Knee angle at toe off: Pre: 142.4 (7.9)/Post: 143.4 (11.8)/p-value = 0.644 Hip extension: Pre: 176.0 (6.8)/Post: 172.0 (6.5)/p-value = 0.020 * Hip flexion: Pre: 151.1 (8.6)/Post: 151.0 (8.7)/p-value = 0.949 Hip flexo-extension: Pre: 24.9 (6.0)/Post: 21.0 (4.5)/p-value = 0.0029 * Hip angle at contact, flexo-extension: Pre: 156.6 (8.3)/Post: 157.8 (9.3)/p-value = 0.431 Hip angle at toe off, flexo-extension: Pre: 169.6 (6.9)/Post: 166.4 (7.3)/p-value = 0.052 Hip adduction: Pre: 189.3 (6.8)/Post: 196.7 (4.7)/p-value = 0.000 * Hip abduction: Pre: 172.2 (6.7)/182.2 (4.5)/p-value = 0.000 * Hip adduction-abduction: Pre: 16.5 (6.8)/Post: 13.0 (6.1)/p-value = 0.0712 Hip angle at contact, adduction-abduction: Pre: 180.5 (6.0)/Post: 189.9 (7.7)/p-value = 0.000 * Hip angle at toe off, adduction-abduction: Pre: 182.1 (8.0)/Post: 187.3 (10.7)/p-value = 0.071 - Passive ROM, mean (SD): Hip flexion (knee extended): Pre: 93.8 (11.4)/Post: 100.3 (7.0)/p-value = 0.034 * Hip flexion (knee flexed): Pre: 128.8 (9.1)/Post: 126.0 (10.6)/p-value = 0.154 Hip extension: Pre: 16.1 (3.8)/Post: 14.0 (2.5)/p-value = 0.092 Hip abduction: Pre: 32.6 (9.2)/Post: 40.0 (10.8)/p-value = 0.0006 * Hip adduction: Pre: 24.6 (9.7)/Post: 37.0 (13.0)/p-value = 0.001 * Hip external rotation: Pre: 31.0 (5.6)/Post: 40.6 (6.9)/p-value = 0.000 * Hip internal rotation: Pre: 34.3 (7.9)/Post: 37.8 (7.2)/p-value = 0.109 Knee flexion: Pre: 139.4 (6.4)/Post: 140.6 (4.7)/p-value = 0.125 Ankle plantar-flexion: Pre: 48.8 (6.0)/Post: 47.6 (3.6)/p-value = 0.503 Ankle dorsi-flexion: Pre: 10.2 (3.3)/Post: 11.5 (3.8)/p-value = 0.155 Subtalar inversion: Pre: 11.0 (2.3)/Post: 11.7 (2.6)/p-value = 0.263 Subtalar eversion: Pre: 8.2 (3.2)/Post: 9.3 (1.9)/p-value = 0.227 |
| Husted, 1999 [24] (Non-randomized, non-controlled) |
n = 19 (84.2% women) Score EDSS: NR Age: NR Disease duration: NR MS type: RR: n = 11 (58%) PP: n = 5 (26%) NR: n = 4 (16%) |
“Tai Chi program” Duration: 8 weeks Development: Volume: 1 h Frequency: 2 times/week |
Flexibility: - Posterior kinetic chain (Hamstring flexibility test) |
- Hamstring flexibility test: Pre: −5.3 cm/Post: −3.8 cm Change: 28% |
IG: Intervention group; CG: Control group; EDSS: Expanded Disability Status Scale; NR: Not reported; MS: Multiple Sclerosis; RR: Relapsing-Remitting; SP: Secondary Progressive; PP: Primary Progressive; RPE: Rating of Perceived Exertion; Post-adjusted: Adjusted for sex, age, baseline value; ROM: Range of motion; ThSp1: First thoracic vertebrae; S1: First sacral vertebrae. *: Significant values p-value ≤ 0.05.