Balance training helps both in easing fatigue, restoring balance: Small trial

Both balance and endurance training can help to ease fatigue in people with multiple sclerosis (MS) — but if problems with balance are a concern, then balance training would be the best choice as it targets both fatigue and balance, a small study found.

The study, “Fatigue may improve equally after balance and endurance training in multiple sclerosis: a randomised, crossover clinical trial,” was published in Frontiers in Neurology.

MS is caused by mistaken immune system attacks in the brain and the spinal cord, resulting in a variety of disease symptoms, from difficulty walking and problems with coordination and balance to fatigue and numbness or tingling in the limbs.

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It is generally recommended that all people, including those with MS, take steps to stay physically active and engage in exercise. Regular exercise by patients is thought to raise energy levels, improve mood, and help with some symptoms.

Aerobic cycling workouts, as well as strength exercises and yoga practice all have been shown to reduce fatigue. Now, researchers in Italy tested whether balance training would further help with fatigue due to MS.

Their crossover study (NCT06051019) enrolled 31 patients, ages 30 to 64, who were randomly assigned to 15 sessions of balance or endurance training. After a two-month break, patients given balance training moved to endurance training, and vice versa. Each session, given five days a week over 21 days, lasted 1.5 hours (90 minutes).

Balance training involved five exercises focusing on maintaining an upright stance: standing with feet together, with eyes closed, on unstable surfaces, and while moving the arms or rotating the head.

During endurance training, patients warmed up on a stationary bike for 10 minutes, stretched their upper and lower limbs for 10 minutes, and rested for another 10 minutes. They then cycled for 15 minutes in two sessions, adjusting the resistance to maintain heart rate, with another 10-minute stretching and resting period between each session.

Six patients left the study, with MS relapse and hip pain among the reasons given.

Between the two training periods, no patient showed worsening fatigue

Data covering 25 patients were included in the study’s analyses, which spanned pre-training assessments, the two training periods, and post-session assessments one month later. Thirteen of these people had symptom stability between the two training periods, while 12 others showed gains.

“No participant significantly worsened their fatigue,” the researchers wrote.

Both types of training were equally helpful in reducing fatigue over time, as measured using the Modified Fatigue Impact Scale, a 21-item questionnaire that assesses how often fatigue interferes with everyday life.

When it came to balance, however, only the balance training showed a significant improvement on the Equiscale, a measure of balance, and the EquiTest, a measure of postural sway.

Data show that “endurance and balance training could be equally effective on fatigue in MS, physical and cognitive, in the short term,” the researchers concluded. “However, only balance training improved the patients’ balance.”