Document Type : Research Paper


1 PhD Student of Sport Injury & Corrective Exercise in University of Isfahan

2 Assistant Professor of Sport Injury & Corrective Exercise at Sports Sciences Research Institute


The aim of the present study was to investigate the effect of ten-week combined training in stable and unstable surfaces on muscle strength and functional capacity in patients with multiple sclerosis. 30 patients were divided into two exercise groups and a control group. 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 muscle strength and 5-time sit-to-stand test and Stair- climbing test than exercise group in stable surface and control group. According to research findings, exercise in stable and unstable surfaces resulted in considerable improvements in isometric muscle strength and functional capacity in patients with multiple sclerosis. 


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.
2-       McDonald W I, 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.
3-       Smith R M, Adeney-Steel M, Fulcher G, Longley W A. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Archives of Physical Medicine and Rehabilitation. 2006; 87(5): 723-‌7.               
4-       Cattaneo D, Jonsdottir J, Zocchi M, Regola A. Effects of balance exercises on people with multiple sclerosis: A pilot study. Clinical Rehabilitation. 2007; 21(9): 771-‌81.
5-       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.  
6-       Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A. Physical training and multiple sclerosis. Paper Presented at the Annales de Réadaptation et de Médecine Physique. 2007; 50(6): 373-6.
7-        Cameron M.H, Wagner J.M. Gait abnormalities in multiple sclerosis: Pathogenesis, evaluation, and advances in treatment. Curr Neurol Neurosci Rep. 2011; 11(5):          507–15.
8-       Kalron A, Anat A,‌ Zeevi D. Muscular and gait abnormalities in persons with early onset multiple sclerosis. JNPT. 2011; 35(4): 164-9.
9-       White L J, McCoy S C, Castellano V, Ferguson M A, Hou W, Dressendorfer R H. Effect of resistance training on risk of coronary artery disease in women with multiple sclerosis. Scand J Clin Lab Invest. 2006; 66(4): 351-‌5.        
10-   Ng A.V, Miller R.G, Gelinas D, Kent-Braun J.A. Functional relationships of central and peripheral muscle alterations in multiple sclerosis. Muscle Nerve. 2004; 29(6): 843-‌52.
11-   Lambert C.P, Archer R.L, Evans W.J. Muscle strength and fatigue during isokinetic exercise in individuals with multiple sclerosis. Med Sci Sports Exerc. 2001; 33(10): 1613-‌9.
12-   Kjolhed T, Vissing K, Langeskov-Christensen D, Stenager E, Petersen Th, 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.
13-   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.
14-   Prosperini L, Leonardi L, De Carli P, Mannocchi M L, Pozzilli C. Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis. Mult Scler. 2010; 16(4): 491–9.
15-   Dalgas S, Jakobsen J. Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology. 2009; 73(18): 1478-84.    
16-   Martin C.L, Phillips B.A, Kilpatrick T.J. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler. 2006; 12(5): 620-‌8.
17-   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.
18-   Ferreira B L APereira W MRossi L PKerpers I IRodrigues de Pa A 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.
19-   Myers J B, Riemann B LHwang J HFu F HLephart S M. Effect of peripheral afferent alteration of the lateral ankle ligaments on dynamic stability. Am J Sports Med. 2003; 31(4): 498-506.
20-   Anderson K, Behm D.G. The‌ impact of instability resistance training on balance and stability. Sports Medicine‌. 2005; 35‌(1): 43-53.
21-   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.
22-   Cattaneo DJonsdottir JRepetti S. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disabil Rehabil. 2007; 29(24): 1920-5.
23-   Ravnborg MGronbech-Jensen MJonsson 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.
24-   Sandra M.M, Feng Y.Sh, Maeurer M, Dippel F.W, 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): 93-5.
25-   Bolgla L AMalone T RUmberger B RUhl T L. Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. Int J Sports Phys Ther. 2011; 6(4): 285-96.
26-   Thorborg KBandholm THölmich P. Hip ‌and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc. 2013; 21(3): 550-5.
27-   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.
28-   Gijbels DDalgas URomberg Ade Groot VBethoux FVaney C, et al. Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set. Mult Scler. 2012; 18(3): 364-71.
29-   Fry D.K, Pfalzer L.A. Reliability of four functional tests and rating of perceived exertion in persons with multiple sclerosis. Physiother Can. 2006; 58(3): 212-2‌20.
30-   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.
31-   Moller A B, Bibby B M, Skjerbæk A G, Jensen E, Sorensen H, Stenager E, et al. Validity and variability of the 5-repetition sit-to-stand test in patients with multiple sclerosis. Disability & Rehabilitation. 2012; 34(26): 2251–‌58.
32-   Silva P.FQuintino L.FFranco JFaria C.D. Measurement properties and feasibility of clinical tests to assess sit-to-stand/stand-to-sit tasks in subjects with neurological disease: A systematic review. Braz J Phys Ther. 2014; 18(2): 99-110.
33-   Tarakci E, Yeldan I, Huseyinsinoglu B.E, 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.
34-   White L.J, McCoy S.C, Castellano VGutierrez GStevens J.EWalter G.AVandenborne K. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler. 2004; 10(6): 668‌–‌74.
35-   Remple M.S, Rochelle M, Bruneau P.M, Vanden B, Crystal G, Jeffrey A.K. Sensitivity of cortical movement representations to motor experience: Evidence that‌ skill‌ learning‌ but not strength training‌ induces cortical reorganization. Behavioural Brain Research‌. 2001; 123(2): 133-‌41.
36-   Kibele A, Behm D.G. 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.
37-   Behm D, Juan C.C. The effectiveness of resistance training using unstable surfaces and devices for rehabilitation. International Journal of Sports Physical Therapy‌. 2012; 7(2): 226.
38-   Learmonth Y.C, Paul L, Miller L, Mattison P, McFadyen A.K. 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.
39-   Taylor N.F, Dodd K.J, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil. 2006; 28(18): 1119–26.
40-   Reuter I, Martin‌ E,‌ Klaus‌ S, Horst  B. Therapeutic value of exercise training in Parkinson's disease. Medicine and Science in Sports and Exercise‌. 1999; 31(11): 1544-‌9.