Resistance Training for Muscle Weakness in Multiple Sclerosis: Direct Versus Contralateral Approach in Individuals With Ankle Dorsiflexors' Disparity in Strength.
To compare effects of contralateral strength training (CST) and direct strength training of the more affected ankle dorsiflexors on muscle performance and clinical functional outcomes in people with multiple sclerosis (MS) exhibiting interlimb strength asymmetry.



Randomized controlled trial.



University hospital.



Individuals with relapsing-remitting MS (N=30) and mild-to-moderate disability (Expanded Disability Status Scale score ≤6) presenting with ankle dorsiflexors' strength disparity.



Participants were randomly assigned to a CST (n=15) or direct strength training (n=15) group performing 6 weeks of maximal intensity strength training of the less or more affected dorsiflexors, respectively.



Maximal strength, endurance to fatigue, and mobility outcomes were assessed before, at the intervention end, and at 12-week follow-up. Strength and fatigue parameters were measured after 3 weeks of training (midintervention).



In the more affected limb of both groups, pre- to postintervention significant increases in maximal strength (P≤.006) and fatigue endurance (P≤.04) were detected along with consistent retention of these improvements at follow-up (P≤.04). At midintervention, the direct strength training group showed significant improvements (P≤.002), with no further increase at postintervention, despite training continuation. Conversely, the CST group showed nonsignificant strength gains, increasing to significance at postintervention (P≤.003). In both groups, significant pre- to postintervention improvements in mobility outcomes (P≤.03), not retained at follow-up, were observed.



After 6 weeks of training, CST proved as effective as direct strength training in enhancing performance of the more affected limb with a different time course, which may have practical implications in management of severely weakened limbs where direct strength training is not initially possible.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Andrea
A
Manca
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Maria Paola
MP
Cabboi
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Daniele
D
Dragone
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Francesca
F
Ginatempo
Neurology Unit, "A. Segni" Hospital - ASL n. 1, Sassari, Italy.
Enzo
E
Ortu
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Edoardo Rosario
ER
De Natale
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Beniamina
B
Mercante
Neurorehabilitation Unit, Policlinico Sassarese, Sassari, Italy.
Giovanni
G
Mureddu
Neurorehabilitation Unit, Policlinico Sassarese, Sassari, Italy.
Guido
G
Bua
Department of Biomedical Sciences, University of Sassari, Sassari, Italy. Electronic address: deriuf@uniss.it.
Franca
F
Deriu
D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology*; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000503:physiopathology / Q000534:rehabilitation*; D053580:Muscle Strength / Q000502:physiology; D053581:Muscle Strength Dynamometer; D018908:Muscle Weakness / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D055070:Resistance Training / Q000379:methods*; D012720:Severity of Illness Index
Ankle; Multiple sclerosis; Muscle fatigue; Muscle weakness; Rehabilitation; Resistance training