MILAN — A specially adapted frame to support individuals with walking and balance disabilities could help people with multiple sclerosis engage in moderate-to-vigorous physical activity and improve their physical function, a pilot study suggests.
‘Frame running’ uses a three-wheeled frame with a saddle and body supports but no pedals to allow individuals with disabilities and balance impairments to walk and run under their own power.
Eight individuals with multiple sclerosis and moderate-to-severe walking impairments took part in a 12-week frame running intervention, which improved both objective physical performance and patient-reported outcomes measures.
“Frame running presents a feasible and enjoyable exercise option for people with multiple sclerosis,” lead author Gary McEwan, PhD, research fellow at the Centre for Health, Activity and Rehabilitation Research at Queen Margaret University in Edinburgh, UK, and colleagues conclude.
It may, they add, “have potential to improve measures of physical function and the ability to perform mobility-related daily activities.”
The findings were presented at the 9th Joint European Committee for Treatment and Research in Multiple Sclerosis-Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS) 2023.
Dearth of Exercise Opportunities
The authors note regular physical activity and exercise are “amongst the most important adjunct therapies for managing the symptoms of multiple sclerosis,” and yet people with the disease are significantly less physically active than the general population.
This is particularly the case for individuals at the upper end of the disability spectrum, they continue, and may reflect the “relative dearth of exercise opportunities that are suitable for those with more severe mobility impairments.”
In recent years, frame running has emerged as a form of exercise that allows individuals with walking difficulties to engage in moderate-to-vigorous physical activity in a safe manner, but its feasibility in multiple sclerosis has not been investigated.
The researchers recruited people with multiple sclerosis who had moderate-to-severe walking impairments to take part in a 12-week frame running intervention, comprising a 1-hour session every week.
The 6-minute frame running test (6MFRT) and an adapted shuttle frame running test (SFRT) were used to assess physical function at baseline and after the intervention. Recruitment, retention, and attendance rates were recorded.
The participants also completed a series of patient-reported outcome measures, alongside the Canadian Occupational Performance Measure, to calculate self-perceived abilities in activities of daily living, and semi-structured interviews to capture their experiences of the intervention.
The Camaraderie of Physical Activity
With six females and two males enrolled in the study, the team reported that the recruitment rate was 47.1%, the retention rate was 75%, and attendance was 86.7%. No adverse events were reported, they note.
The results indicate there were improvements in performance on the physical measures, with small effect sizes on both the 6MFRT (d = 0.37) and the SFRT (d = 0.30).
There were also improvements on the Multiple Sclerosis Walking Scale (d = 0.27), the Fatigue Scale for Motor and Cognitive Functions (d = 0.20), and the Exercise Self-Efficacy Scale (d = 0.46), again with small effect sizes.
A medium effect size was seen for improvements on the Godin Leisure Time Exercise Questionnaire (d = 0.73), and 80% of the participants reported “changes in performance and in satisfaction with their activities of daily living,” the team says.
The qualitative data also suggested the patients found frame running to be “safe and enjoyable,” with key highlights being the “social aspect and camaraderie developed amongst participants.”
Mix of Physical Interventions
Approached for comment, Robert Motl, MD, professor of kinesiology and nutrition, College of Applied Health Sciences, University of Illinois Chicago, said it “makes a lot of sense” that frame running can improve walking-related outcomes.
He told Medscape Medical News that, “for people who have balanced-related problems, using their legs in that rhythmical way could really have some great benefits for walking.”
However, Motl said he is a “little more skeptical about the benefits for balance, because to improve balance you have to be doing something that challenges upright posture.”
With the frame, “I don’t think you’re having to regulate upright posture while you’re doing that intervention, because you have stability with three points and the ground,” he said. “So, I wonder a little bit about that as an outcome.”
Motl nevertheless underlined that walking can certainly improve physical activity, “and all the other things like vascular function, cardiovascular fitness,” etc.
Consequently, frame running “could be part of the mix of things for people who are having a disability, particularly individuals who have some balance dysfunction and [for whom] ambulating might put them at risk of falling.”
The study was supported by a research grant from the Multiple Sclerosis Society UK. The study authors and Modl report no relevant financial relationships.
9th Joint European Committee for Treatment and Research in Multiple Sclerosis-Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS) 2023: Abstract P1609. Presented October 11, 2023.
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