title: Uphill and Downhill Walking in Multiple Sclerosis: A Randomized Controlled Trial.
abstract: BACKGROUND
  Various exercise protocols have been recommended for patients with multiple sclerosis (MS). We investigated the effects of uphill and downhill walking exercise on mobility, functional activities, and muscle strength in MS patients.
  
  
  METHODS
  Thirty-four MS patients were randomly allocated to either the downhill or uphill treadmill walking group for 12 sessions (3 times/wk) of 30 minutes' walking on a 10% negative slope (n = 17) or a 10% positive slope (n = 17), respectively. Measurements were taken before and after the intervention and after 4-week follow-up and included fatigue by Modified Fatigue Impact Scale; mobility by Modified Rivermead Mobility Index; disability by Guy's Neurological Disability Scale; functional activities by 2-Minute Walk Test, Timed 25-Foot Walk test, and Timed Up and Go test; balance indices by Biodex Balance System; and quadriceps and hamstring isometric muscles by torque of left and right knee joints. Analysis of variance with repeated measures was used to investigate the intervention effects on the measurements.
  
  
  RESULTS
  After the intervention, significant improvement was found in the downhill group versus the uphill group in terms of fatigue, mobility, and disability indices; functional activities; balance indices; and quadriceps isometric torque (P < .05). The results were stable at 4-week follow-up.
  
  
  CONCLUSIONS
  Downhill walking on a treadmill may improve muscle performance, functional activity, and balance control in MS patients. These findings support the idea of using eccentric exercise training in MS rehabilitation protocols.
authors.affiliation: Internal Medicine Group (AS) and the Neuromuscular Rehabilitation Research Center, Rehabilitation Faculty (AHB, AH, EF, FM), Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Samaei
authors.affiliation: Internal Medicine Group (AS) and the Neuromuscular Rehabilitation Research Center, Rehabilitation Faculty (AHB, AH, EF, FM), Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Amir Hoshang
authors.initials: AH
authors.lastname: Bakhtiary
authors.affiliation: Internal Medicine Group (AS) and the Neuromuscular Rehabilitation Research Center, Rehabilitation Faculty (AHB, AH, EF, FM), Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Abdolhamid
authors.initials: A
authors.lastname: Hajihasani
authors.affiliation: Internal Medicine Group (AS) and the Neuromuscular Rehabilitation Research Center, Rehabilitation Faculty (AHB, AH, EF, FM), Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Fatemi
authors.affiliation: Internal Medicine Group (AS) and the Neuromuscular Rehabilitation Research Center, Rehabilitation Faculty (AHB, AH, EF, FM), Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Motaharinezhad