The effect of cycling using active passive trainers on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe Multiple Sclerosis

Barclay, Alison (2023) The effect of cycling using active passive trainers on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe Multiple Sclerosis. PhD thesis, University of Glasgow.

Abstract

Background: Exercise is an important treatment strategy for people with Multiple Sclerosis (MS). However, exercise options are limited for those with higher levels of disability, as is the evidence to support the benefits. Lower limb active passive trainers (APTs) are used for people with higher levels of disability but there is little evidence on their efficacy. The aim of this thesis was to investigate the effects of lower limb APTs on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe MS.

Included studies: The first study included was a systematic review of the effects of cycling using lower limb APTs on spasticity, cardiovascular fitness, function and quality of life in people with neurological conditions. The second was anintervention study to explore the effects of a four-week programme of lower limb APT cycling on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe MS. The final study was to determine if a single session of APT cycling reduced spasticity, measured using neurophysiology (Hoffmans reflex/H-reflex), in people with moderate to severe MS.

Main findings: The systematic review identified that APT interventions may improve walking endurance (6MWT performance, p<0.001) but not walking speed(p=0.31), however this meta-analysis only included a small number of stroke studies. The effects in other conditions and on other outcomes was unclear, as was whether electrically stimulated cycling was more beneficial than APT cycling alone. The intervention study found APT cycling to be safe and feasible in people with moderate to severe MS. Improvements were noted in the majority of outcome measures, although no significant group differences were found. The APT group also showed significant improvements in their average speed, power output and distance cycled (all p<0.001). It was felt some of the outcome measures used lacked sensitivity, especially for spasticity. The H-reflex study found that a single session of APT cycling did not change spasticity measured using H-reflex, clinical scales or patient reported measures. The H-reflex was found to be a feasible and safe outcome measure, however it appeared to be easily influenced by other factors and was time consuming to complete.

Conclusion: This thesis highlighted that APT cycling is a safe and feasible intervention in people with moderate to severe MS, however measuring the effects of the intervention especially in relation to spasticity remain challenging. In addition, the dose, intensity and frequency required to improve symptoms, function and quality of life remains unclear. Further research is merited regarding the benefits of APT interventions and outcomes used in people with higher disability levels associated with MS.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: Q Science > QP Physiology
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Supervisor's Name: Gray, Professor Stuart and Paul, Professor Lorna
• Date of Award: 2023
• Depositing User: Theses Team
• Unique ID: glathesis:2023-84010
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 08 Jan 2024 11:11
• Last Modified: 10 Jan 2024 13:43
• Thesis DOI: 10.5525/gla.thesis.84010
• URI: https://theses.gla.ac.uk/id/eprint/84010

Related URLs

• Article DOI
• Article DOI