High-Intensity, dynamic-stability gait training in people with multiple sclerosis

项目摘要 这项I/II期多中心临床试验的目标是改善行走功能、动态稳定性和 使用高强度训练的新组合在多发性硬化症（MS）患者中进行社区活动 以及挑战动态平衡的环境。该提案有两个关键要素：1） 在跑步机行走过程中施加的平衡扰动将使参与者发展神经肌肉 保持直立姿势的策略，将通过反复练习进行改进和提高，以及2） 进行高强度训练的患者将改善他们的神经肌肉和心肺功能 以促进走得更快更远的能力。事实上，轻度或中度MS患者存在改变的 运动和姿势控制，这种2X2析因设计将描述个体和组合效应 在行走和高强度运动中反复暴露于姿势扰动， 运动和平衡控制在实验室条件下和在现实世界中，其中运动和 姿势要求很高。这项研究是基于研究者以前的经验， 在其他神经系统疾病患者中进行高强度训练，一项试点研究的结果令人鼓舞 证明MS患者动态平衡跑步机训练的可行性。本项目将 试图描述步行后运动能力的临床和实验室测量的变化- 在跑步机上进行高强度与低强度的特定运动训练，有或没有姿势扰动 目标1（Aim 1）目的2将证明这些策略对动态姿势控制的相对有效性 (i.e.,平衡），并改善对社区二级措施扰动的反应 福尔斯。最后，目标3将描述社区流动性和参与的变化， 练习范例。我们认为，高强度的运动训练与姿势扰动将引发 运动和平衡结果的最大变化，这些综合收益将提高身体 在社区开展活动，提高生活质量。

Project Summary The goal of this phase I/II multicenter clinical trial is to improve walking function, dynamic stability, and community mobility in people with multiple sclerosis (MS) using a novel combination of high-intensity training and an environment that challenges dynamic balance. There are two critical elements of this proposal: 1) balance perturbations applied during treadmill walking will allow participants to develop neuromuscular strategies to maintain upright posture, which will be refined and enhanced with repeated practice, and 2) patients who engage in high-intensity training will improve their neuromuscular and cardiorespiratory capacity to facilitate the ability to walk faster and further. Indeed, patients with mild or moderate MS present with altered locomotor and postural control, and this 2X2 factorial design will delineate the individual and combined effects of repeated exposure to postural perturbations during walking and high-intensity exercise that may enhance locomotor and balance control in both laboratory conditions and in the real-world, where the locomotor and postural demands are substantial. This study is predicated on the previous experience of the investigators with high-intensity training in patients with other neurological disorders and promising results of a pilot study demonstrating feasibility of dynamic balance treadmill training in people with MS. The present project will attempt to delineate changes in clinical and laboratory measures of locomotor capacity following walking- specific exercise training at high vs low intensity and with or without postural perturbations during treadmill stepping (Aim 1). Aim 2 will demonstrate the relative efficacy of these strategies on dynamic postural control (i.e., balance) and relate improvements in the response to perturbations to secondary measures of community falls. Finally, Aim 3 will delineate changes in community mobility and participation following these various exercise paradigms. We suggest that high-intensity locomotor training with postural perturbations will elicit the largest changes in both locomotor and balance outcomes, and these combined gains will boost physical activity in the community setting leading to improved quality of life.