title: Quantitative assessment of the effects of 6 months of adapted physical activity on gait in people with multiple sclerosis: a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this study is to quantitatively assess the effect of 6 months of supervised adapted physical activity (APA i.e. physical activity designed for people with special needs) on spatio-temporal and kinematic parameters of gait in persons with Multiple Sclerosis (pwMS).
  
  
  METHODS
  Twenty-two pwMS with Expanded Disability Status Scale scores ranging from 1.5 to 5.5 were randomly assigned either to the intervention group (APA, n = 11) or the control group (CG, n = 11). The former underwent 6 months of APA consisting of 3 weekly 60-min sessions of aerobic and strength training, while CG participants were engaged in no structured PA program. Gait patterns were analyzed before and after the training using three-dimensional gait analysis by calculating spatio-temporal parameters and concise indexes of gait kinematics (Gait Profile Score - GPS and Gait Variable Score - GVS) as well as dynamic Range of Motion (ROM) of hip, knee, and ankle joints.
  
  
  RESULTS
  The training originated significant improvements in stride length, gait speed and cadence in the APA group, while GPS and GVS scores remained practically unchanged. A trend of improvement was also observed as regard the dynamic ROM of hip, knee, and ankle joints. No significant changes were observed in the CG for any of the parameters considered.
  
  
  CONCLUSIONS
  The quantitative analysis of gait supplied mixed evidence about the actual impact of 6 months of APA on pwMS. Although some improvements have been observed, the substantial constancy of kinematic patterns of gait suggests that the full transferability of the administered training on the ambulation function may require more specific exercises. Implications for rehabilitation Adapted Physical Activity (APA) is effective in improving spatio-temporal parameters of gait, but not kinematics, in people with multiple sclerosis. Dynamic range of motion during gait is increased after APA. The full transferability of APA on the ambulation function may require specific exercises rather than generic lower limbs strength/flexibility training.
authors.affiliation: a Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy.
authors.forename: Massimiliano
authors.identifier: http://orcid.org/0000-0001-9835-3629
authors.initials: M
authors.lastname: Pau
authors.affiliation: a Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy.
authors.forename: Federica
authors.identifier: http://orcid.org/0000-0002-4928-5129
authors.initials: F
authors.lastname: Corona
authors.affiliation: b Department of Medical Sciences and Public Health , Multiple Sclerosis Center, University of Cagliari , Cagliari , Italy.
authors.forename: Giancarlo
authors.identifier: http://orcid.org/0000-0002-3796-3279
authors.initials: G
authors.lastname: Coghe
authors.affiliation: c Department of Medical Sciences and Public Health , Sports Physiology Lab, University of Cagliari , Cagliari , Italy.
authors.forename: Elisabetta
authors.identifier: http://orcid.org/0000-0002-0954-2901
authors.initials: E
authors.lastname: Marongiu
authors.affiliation: c Department of Medical Sciences and Public Health , Sports Physiology Lab, University of Cagliari , Cagliari , Italy.
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0003-2037-2445
authors.initials: A
authors.lastname: Loi
authors.affiliation: c Department of Medical Sciences and Public Health , Sports Physiology Lab, University of Cagliari , Cagliari , Italy.
authors.forename: Antonio
authors.identifier: http://orcid.org/0000-0003-1933-2841
authors.initials: A
authors.lastname: Crisafulli
authors.affiliation: c Department of Medical Sciences and Public Health , Sports Physiology Lab, University of Cagliari , Cagliari , Italy.
authors.forename: Alberto
authors.identifier: http://orcid.org/0000-0002-1813-0845
authors.initials: A
authors.lastname: Concu
authors.affiliation: d Department of Electronics, Information and Bioengineering , Politecnico di Milano , Milan , Italy.|e IRCCS San Raffaele Pisana , Rome , Italy.
authors.forename: Manuela
authors.identifier: http://orcid.org/0000-0003-2772-4837
authors.initials: M
authors.lastname: Galli
authors.affiliation: b Department of Medical Sciences and Public Health , Multiple Sclerosis Center, University of Cagliari , Cagliari , Italy.
authors.forename: Maria Giovanna
authors.identifier: http://orcid.org/0000-0003-2334-2081
authors.initials: MG
authors.lastname: Marrosu
authors.affiliation: b Department of Medical Sciences and Public Health , Multiple Sclerosis Center, University of Cagliari , Cagliari , Italy.
authors.forename: Eleonora
authors.identifier: http://orcid.org/0000-0002-3878-8820
authors.initials: E
authors.lastname: Cocco
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D026241:Exercise Movement Techniques / Q000379:methods*; D005081:Exercise Therapy; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D009103:Multiple Sclerosis / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome; D016138:Walking
keywords: Gait Profile Score (GPS); Multiple sclerosis (MS); adapted physical activity (APA); gait; kinematics; motion analysis