title: A combined exercise model for improving muscle strength, balance, walking distance, and motor agility in multiple sclerosis patients: A randomized clinical trial.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a neurological disease with a variety of signs and symptoms. Exercise therapy has been shown to improve physical functions in MS. However, questions about an optimal exercise therapy remain. In this regard, we suggest a combined exercise therapy including aerobic and resistance exercises for MS patients. The study is designed to observe, test and compare the effects of proposed combined exercises on strength, balance, agility, fatigue, speed, and walking distance in people with mild to moderate MS [0 < expanded disability status scale (EDSS) < 5].
  
  
  METHODS
  A total of 40 people with relapse-remitting MS (16 male, 0 < EDSS < 5) were randomized into one of the four groups (3 intervention and one control). The intervention consisted of various combinations of aerobic and resistance exercises with different repetition rates. Pre- and post-intervention scores of fatigue severity scale (FSS), timed up and go (TUG) test, 6-minute walk test (6MWT), 10- and 20-MWT, Berg balance scale (BBS), and one repetition maximum (1RM) test were recorded and analyzed.
  
  
  RESULTS
  For most tests, post-intervention values of the group 1, with 3-aerobic and 1-resistance exercises, were significantly higher compared to control group (P < 0.050). However, no significant progression was observed in the other two intervention groups.
  
  
  CONCLUSIONS
  A combination of three aerobic exercises with one resistance exercise may result in improved balance, locomotion, and endurance in MS patients.
authors.affiliation: Department of Physiotherapy, School of Physiotherapy, Otago University, Dunedin, New Zealand AND Iranian Multiple Sclerosis Society Rehabilitation Centre, Tehran, Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Sangelaji
authors.affiliation: Department of Exercise Physiology, School of Physical ‎Education and Sport Sciences, University of Tehran, Tehran, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Kordi
authors.affiliation: Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Banihashemi
authors.affiliation: Department of Neurology, School of Medicine, Mostafa Khomeini Hospital, Shahed University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Massood
authors.initials: SM
authors.lastname: Nabavi
authors.affiliation: Department of Exercise Physiology, School of Physical ‎Education and Sport Sciences, University of Tehran, Tehran, Iran.
authors.forename: Sara
authors.initials: S
authors.lastname: Khodadadeh
authors.affiliation: Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Dastoorpoor
keywords: Aerobic Exercise; Exercise Therapy; Multiple Sclerosis; Resistance Training