Resistance training program didn’t cut cardiovascular risk in SPMS
Patients in small study improved muscle strength
While a four-month progressive resistance training program improved muscle strength in people with secondary progressive multiple sclerosis (SPMS) in the Netherlands, it did not significantly change their risk of developing cardiovascular disease, a small study showed.
Individual cardiovascular risk factors and 10-year risk estimation tools showed no significant changes after the training program. The fact that patients enrolled in the study were physically active and had low initial cardiovascular risk might have contributed to the absence of major changes, the researchers said.
They noted that “exercise therapy effects on CVR [cardiovascular risk] factors might be more prominent in people with a higher CVR, and a more sedentary lifestyle.” Future studies are needed to confirm the potential benefits of progressive resistance training in a less active group, they said.
The study, “Effects of progressive resistance training on cardiovascular risk factors in people with progressive multiple sclerosis,” was published in Archives of Physical Medicine and Rehabilitation.
Progressive resistance training program
Most people with multiple sclerosis (MS) are first diagnosed with relapsing-remitting MS, which is marked by relapses, periods in which symptoms worsen suddenly, and periods of remission, when MS symptoms ease or disappear. Over time, the disease may progress to SPMS, in which symptoms get gradually worse over time independent of relapse activity.
Research suggests that people with MS may be at a higher risk of developing cardiovascular diseases due to inflammation, side effects of disease-modifying treatments (DMTs), and motor impairments that lead to a more sedentary lifestyle.
Resistance training — which involves working muscles against a force such as weights, bands, or body weight — is commonly performed to help manage MS symptoms, “but can also positively affect CVR factors,” the researchers wrote.
The team of researchers at the MS Center Amsterdam conducted a clinical trial, called Exercise PRO-MS, to analyze the effect of progressive resistance training on cardiovascular risk factors in 30 people with SPMS.
Participants’ mean age was 54, and 66.7% were women. They had been living with MS for a mean of 20.2 years and had a median Expanded Disability Status Scale score of 4, meaning they were self-sufficient and able to walk unassisted for some distance. Half were receiving DMTs, and most reported moderate (30%) to high (48%) levels of physical activity.
A total of 26 participants were evaluated at study’s start (baseline) twice, four months apart, to initially establish the natural fluctuations in cardiovascular risk factors. These included body mass index, or BMI (a ratio of height and weight), percentage of body fat, blood pressure, blood levels of fatty molecules (cholesterol and triglycerides), and blood sugar levels.
Patients were generally overweight at baseline, according to BMI and body fat percentage measures, and had slightly elevated total cholesterol levels. However, they had normal circulating levels of triglycerides and blood sugar.
“The observed natural fluctuations in cardiovascular risk factors were small in this population, with overall baseline cardiovascular risk comparable to Dutch norms,” the researchers wrote.
All but one of the 26 patients completed the progressive resistance training program, which consisted of a one-hour session three times per week, over four months.
At least two sessions were supervised by a physiotherapist, while the third could be performed at home. Sessions involved exercises for the legs, arms, abdomen, and back, with gradually increasing resistance.
Participants completed 87% of the scheduled sessions. Muscle strength significantly improved after the program for all exercises except the leg press, where there was a trend of improvement.
However, there were no significant changes in any of the evaluated cardiovascular risk factors after the program.
Patients’ overall cardiovascular risk was determined using the Systematic Coronary Risk Estimation (SCORE) and the Framingham Risk Score.
SCORE estimates the 10-year risk of death due to cardiovascular disease based on sex, age, blood pressure, total cholesterol, and smoking status.
The Framingham Risk Score estimates the 10-year cardiovascular risk based on the same factors plus high-density lipoprotein (commonly known as good cholesterol), medications to regulate blood pressure, and diabetes.
Values of both risk scores were low before the resistance training program, and showed no significant change after the program, indicating that the program did not lead to a reduction in cardiovascular risk in people with SPMS.
“Although our exercise program had a convincing effect on muscle strength as was expected, [progressive resistance training] did not result in improvements in 10-year CVR, nor did it result in improvements in individual CVR factors,” the researchers wrote.
The patients in the study “exhibited low cardiovascular risk at baseline, likely contributing to the small observed effect sizes in the intervention period,” the researchers wrote, adding that “more sedentary people with a higher CVR are expected to benefit more from a physically active lifestyle and exercise.”
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