Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study

Abstract

Purpose: To investigate the effects of a multimodal intervention including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on walking performance and balance of subjects with progressive multiple sclerosis (MS).

Materials and methods: Twenty subjects with mean (standard deviation) age of 51.7 (6.4) years and Expanded Disability Status Scale score of 6.2 (1) participated in a 12-month study. Assessments were completed at baseline, 3, 6, 9, and 12 months.

Results: The entire cohort did not show significant changes in any of the assessments over 12 months except higher speed of walking toward the 10 feet mark during timed up and go (TUG) test at 6 months compared with baseline (mean change 7.9 cm/s [95% confidence interval {CI}]: 0.3, 15.2; p=0.041). Sub-group analysis revealed that 50% subjects (n=10) showed decrease in TUG time from baseline to at least 3 of 4 time-points post-intervention and were considered as responders (TUG-Res), the remaining 10 subjects were considered as nonresponders (TUG-NRes). Over 12 months, TUG-Res showed decreased mean TUG time by 31% (95% CI: -52%, -2%), increased median Berg Balance Scale scores (42 to 47), 30% increase in mean timed 25-foot walk speed (>20% considered clinically significant) and increased speed of walk toward 10 feet mark during TUG by 11.6 cm/s (95% CI: -3.0, 25.9) associated with increases in step lengths and decrease in step duration. TUG-NRes showed deterioration in walking ability over 12 months. Comparison of TUG-Res and TUG-NRes showed no significant differences in adherence to intervention but better stride duration and longer step length at baseline for TUG-Res than for TUG-NRes (p<0.05).

Conclusion: A multimodal lifestyle intervention may improve walking performance and balance in subjects with progressive MS who have mild-to-moderate gait impairment, whereas subjects with severe gait impairments may not respond to this intervention. Future trials should assess effects of this intervention in subjects with MS during early stages of the disease.

Keywords: Paleolithic diet; balance; exercise; gait; multiple sclerosis; neuromuscular electrical stimulation.

Conflict of interest statement

Disclosure Dr Terry L Wahls has equity interest in the following companies: Dr Terry Wahls LLC; TZ Press LLC; RDT LLC; and the website www.terrywahls.com. She also owns the copyrights to the books Minding My Mitochondria, 2nd Edition, The Wahls Protocol, and The Wahls Protocol Cooking for Life. Dr Wahls has conflicts of interest management plans in place with both the University of Iowa and the Iowa City VA Healthcare System. All other authors report no conflicts of interest.

Figures

Figure 1

Flowchart of the screening, enrollment, and follow-up of participants in the study. Source: Copyright ©2014. Dove Medical Press. Reproduced from Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life of subjects with progressive multiple sclerosis: a pilot study. Degenerat Neurol Neuromuscul Dis. 2015;2015(5):19–35. Abbreviations: S, subject; NMES, neuromuscular electrical stimulation; MS, multiple sclerosis.

Figure 2

Time to complete timed up and go test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10). Note: Values are mean ± standard error.

Figure 3

Walking speed during 25-foot walk test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10). Note: Values are mean ± standard error. Abbreviation: TUG, timed up and go.

Figure 4

Speed to walk toward 10 feet mark during timed up and go test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10). Notes: Values are mean ± standard error. *p=0.041, significant difference from baseline for entire cohort.

Figure 5

Berg Balance Scale scores of the entire cohort (n=20), and responders (n=10) and nonresponders (n=10) to TUG test at baseline (B), 3, 6, 9, and 12 months. Notes: Upper and lower borders of the boxes represent 25th and 75th percentiles, respectively. The line within the boxes represents median and + sign represents mean. The whisker error bars show minimum and maximum values. **** represent lower quartile values overlapping with minimum values. Each black symbol represents individual subject’s score. Abbreviation: TUG, timed up and go.

Figure 6

Spatio temporal gait parameters during timed up and go test at baseline, 3, 6, 9, and 12 months of responders (n=10) and nonresponders (n=10). Notes: (A) longer step length, (B) shorter step length, and (C) step duration. Values are mean ± standard error.

Figure 7

Correlation between changes in fatigue severity scale scores over 3 months and change in 25-foot walk speed over 12 months. Notes: r, Pearson’s correlation coefficient; r(partial), Pearson’s partial correlation coefficient after removing the effect of baseline timed 25-foot walk speed. Abbreviations: CI, confidence interval.