The Effects of Cool Pool Exercise on Gait and Balance in Individuals with Multiple Sclerosis

Abstract

The altered conduction of impulses from demyelinated neurons can disturb motor functions of people with Multiple Sclerosis (MS). Individuals with MS also experience heat sensitivity, which may exacerbate the neurological symptoms. PURPOSE: The purpose of this study was to examine the effects of a 12-week cool pool exercise program on gait and balance outcomes in individuals with MS. METHODS: 24 individuals with MS were recruited and randomly assigned to two groups. The aquatic group (n=13) participated in a 50-minute cool pool exercise program (82-84° F) 3 times a week for 12 weeks. The control was recommended to exercise at home. Gait variables included spatiotemporal, peak joint angles and joint excursions in the lower extremities. Balance was measured based on the time of a sit-to-stand performance and Biodex balance test scores. All participants walked on a 10-meter walkway at their maximum speed for three trails with 30-second rest in between. The Vicon Motion Analysis system was used to capture and process gait data, applying the Plug-in-Gait model. RESULTS:. A multivariate analysis of variance showed the aquatic group increased cadence, stride length and walking velocity after the 12-week intervention (Ps<.05). Significantly increased peak angles of hip flexion and extension, knee flexion, and ankle dorsi-flexion were found while decreases in hip abduction and external rotation were noted (Ps<.05). Significant improvements were found in the joint excursions in the hip, knee and ankle (Ps<.05). The aquatic group also showed significant reduction in the sit-to-stand time, but no changes in the Biodex balance test scores. No significant improvements were found in the control group. CONCLUSIONS:The study findings suggest that a structured exercise program in the cool pool can help people with MS improve gait and balance. These findings will also assist clinicians to develop evidence-based interventions for individuals with MS or similar neurological disorders.