Document Type : Research Paper


1 Ph.D of Sport Injury & Corrective Exercise, University of Isfahan

2 Associate Professor of Sport Injury & Corrective Exercise, University of Isfahan

3 Associate Professor of Sport Injury & Corrective Exercise, Shahid Rajaee Teacher Training University


The aim of the present study was to investigate the effect of ten-week combined training in stable and unstable surfaces on spatio-temporal parameters of gait in patients with multiple sclerosis. Thirty patients were divided into two exercise groups. spatio-temporal parameters were measured with camera. The timed 25-foot walk test, six-minute walk test and Multiple Sclerosis Walking Scale-12 test were used to assess walking speed and endurance and self-reports of walking ability, respectively. The results showed that there were significant improvements for all outcome measures in both exercise groups. Exercise group in unstable surface showed significantly larger improvement in ability of walking, percentage of single support, reduction of step width and percentage of a gait cycle in double support than exercise group in stable surface. According to research findings, exercise in stable and unstable surfaces resulted in considerable improvements in spatio-temporal parameters and ability of walking in patients with multiple sclerosis.


Main Subjects

1-       Doring A, Pfueller C F, Paul F, Dorr J. Exercise in multiple sclerosis an integral component of disease management. EPMA J. 2011;‌3(1):2-12.
2-       Ojeda E, Diaz-Cortes D, Rosales D, Duarte-Rey C, Anaya J.M, Rojas-Villarraga A. Prevalence and clinical features of multiple sclerosis in Latin America. Clin Neurol Neurosurg. 2013;115(4):381-7.
3-       McDonald WI, Compston A, Edan G, Goodkin D, Hartung H P, Lublin F D, et al. Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis. Annals of Neurology. 2001;50(1):121-7.
4-       Dalgas U, Stenager E, Ingemann-Hansen T. Review: Multiple sclerosis and physical exercise: Recommendations for the application of resistance‌, endurance-and combined training. Multiple Sclerosis. 2008;14(1):35-53.        
5-       Kalron A, Anat A,‌ Zeevi D. Muscular and gait abnormalities in persons with early onset multiple sclerosis. JNPT. 2011;35(4):164-9.
6-       Kjolhed T, Vissing K, Langeskov-Christensen D, Stenager E, Petersen T, Dalgas U. Relationship between muscle strength parameters and functional capacity in persons with mild to moderate degree multiple sclerosis. Multiple Sclerosis and Related Disorders. 2015;4(2);151-‌8.
7-       Lassmann H. The pathology of multiple sclerosis and its evolution. Philosophical transactions of the royal society of London. Series B: Biological sciences. 1999; 354(1390): 1635-‌40.
8-       Sosnoff JJ, Sandroff BM, Motl RW. Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability. Gait & Posture. 2012;36(1):154–6.
9-       Sosnoff JJ, Weikert M, Dlugonski D, Smith DC, Motl RW. Quantifying gait impairment in multiple sclerosis using GAITRiteTM technology. Gait & Posture. 2011;34(1):145–7.
10-   Barr CJ, Patritti BL, Bowes R, Crotty M, McLoughlin JV. Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis. Disability and rehabilitation. 2016;36(2):1-13.  
11-   Savci S, Inal-Ince D, Arikan H, Guclu-Gunduz A, Cetisli-Korkmaz N, Armutlu K et al. Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil. 2005;27(22):1365-71.   
12-   Motl RW, Sandroff BM, Suh Y. Energy cost of walking and its association with gait parameters, daily activity, and fatigue in persons with mild multiple sclerosis. Neurorehabil Neural Repair. 2012;26(8):1015–21.
13-   Nogueira LA, Teixeira L, Sabino P. Gait characteristics of multiple sclerosis patients in the absence of clinical disability. Disabil Rehabil. 2013;35(17):1472–8.
14-   Broekmans T, Gijbels D, Eijnde BO. The relationship between upper leg muscle strength and walking capacity in persons with multiple sclerosis. Mult Scler. 2013;19(1):112–9.
15-   Kjolhede T, Vissing K, Place L, Pedersen B G, Ringgaard S, Stenager E, et al. Neuromuscular adaptations to long-term progressive resistance training translates to improved functional capacity for people with multiple sclerosis and is maintained at follow-up. Multiple Sclerosis Journal. 2015;21(5):599–611.
16-   Kalron A, Rosenblum U, Frid L, Achiron A. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: A randomized controlled trial. Clinical Rehabilitation. 2016;25(11):1-10.
17-   Motl RW, Smith DC, Elliott J, Weikert M, Dlugonski D, Sosnoff JJ. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: A pilot study. J Neurol Phys Ther. 2012;36(1):32-7.
18-   Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23(2):108-16.
19-   Sandroff BM, Sosnoff JJ, Motl RW. Physical fitness, walking performance, and gait in multiple sclerosis. J Neurol Sci. 2013;328(1-2):70-6.
20-   Ferreira BLA, Pereira WM, Rossi LP, Kerpers II, Rodrigues de PA Jr .Analysis of electromyographic activity of ankle muscles on stable and unstable surfaces with eyes open and closed. J of Bodyw Mov Ther. 2011;15(4):496-501.
21-   Myers JB, Riemann BL, Hwang JH, Fu FH, Lephart SM. Effect of peripheral afferent alteration of the lateral ankle ligaments on dynamic stability. Am J Sports Med. 2003;31(4):498-506.
22-   Anderson K, Behm D.G. The impact of instability resistance training on balance and stability. Sports Medicine. 2005;35(1):43-53.
23-   Cameron M.H, Horak F.B, Herndon R.R, Bourdette D. Imbalance in multiple sclerosis: A result of slowed spinal somatosensory conduction. Somatosens Mot Res. 2008;25(2):113–22.
24-   Lanzetta D, Cattaneo D, Pellegatta D, Cardini R. Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. Arch Phys Med Rehabil. 2004;85(2):279–83.
25-   Cattaneo D, Jonsdottir J, Repetti S. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disabil Rehabil. 2007;29(24):1920-5.
26-   Ravnborg M, Gronbech-Jensen M, Jonsson A. The MS impairment scale: A pragmatic approach to the assessment of impairment in patients with multiple sclerosis. Mult Scler. 1997;3(1):31-42.
27-   Sandra MM, Feng YS, Maeurer M, Dippel FW, Kohlmann TH. Systematic literature review and validity evaluation of the expanded disability status scale (EDSS) and the multiple sclerosis functional composite (MSFC) in patients with multiple sclerosis. BMC Neurology. 2014;14(58).
28-   Martin CL, Phillips BA, Kilpatrick TJ. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler. 2006;12(5):620-8.
29-   Guner S, Inanici F. Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance. J Bodyw Mov Ther. 2015;19(1):72-81.
30-   Erry J, Burnfield J.M. Gait analysis: normal and pathological function. 2th ed. USA: SLACK Incorporated; 2010.
31-   Fry DK, Pfalzer LA. Reliability of four functional tests and rating of perceived exertion in persons with multiple sclerosis. Physiother Can. 2006;58(3):212-20.
32-   Negahban H, Rezaieand S, Goharpey Sh. Massage therapy and exercise therapy in patients with multiple sclerosis: A randomized controlled pilot study. Clinical Rehabilitation. 2013;27(12):1126-36.
33-   Pilutti LA, Dlugonski D, Sandroff BM, Suh Y, Pula JH, Sosnoff JJ, Motl RW. Further validation of multiple sclerosis walking scale-12 scores based on spatiotemporal gait parameters. Arch Phys Med Rehabil. 2013;94(3):575-8.
34-   Tarakci E, Yeldan I, Huseyinsinoglu BE, Zenginler Y, Eraksoy M. Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: A randomized controlled trial. Clinical Rehabilitation. 2013;27(9): 813-22.
35-   Park KH, Lim JY, Kim TH. The effects of ankle strategy exercises on unstable surfaces on dynamic balance and changes in the COP. J Phys Ther Sci. 2016;28(2):456–9.
36-   Menz HB, Lord SR, Fitzpatrick RC. Age-related differences in walking stability. Age Ageing. 2003;32(2):137-42.
37-   Kibele A, Behm DG. Seven weeks of instability and traditional resistance training effects on strength, balance and functional performance. The Journal of Strength & Conditioning Research. 2009;23(9):2443-50.
38-   Forestier N, Terrier R, Teasdale N. Ankle muscular proprioceptive signals’ relevance for balance control on various support surfaces: An exploratory study. Am J Phys Med Rehabil. 2015;94(1):20–7.
39-   Learmonth YC, Paul L, Miller L, Mattison P, McFadyen AK. The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: A randomized controlled pilot study. Clin Rehabil. 2012;26(7):579–93.
40-   Taylor NF, Dodd KJ, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil. 2006;28(18):1119–26.