Date of Degree


Document Type

Capstone Project

Degree Name



Physical Therapy


Herb Karpatkin

Subject Categories

Physical Therapy


Background: Physical Therapy strength training programs utilizing mild to moderate intensity are commonly prescribed to address many of the deficits found in multiple sclerosis, but studies examining the effectiveness of higher intensity strength training in gait and balance have not been performed. Maximal strength training (MST), which involves lifting nearly maximal weights (85-95% of an individual’s one repetition maximum [1RM]) with low repetitions, has been shown to improve functional abilities in both healthy and non-MS impaired populations. The higher intensity training used in MST may result in greater activation of the CNS, providing a greater stimulus to improvement than lower intensity training. However, due to concerns regarding fatigue, clinicians have avoided using maximal loads for resistance training. To date there are no studies that have examined the effects of MST on functional measures in PwMS.

Purpose: The purpose of this study was to examine the effects of MST on gait and balance in PwMS and assess whether MST could be tolerated by this population. We hypothesized that MST would result in improved gait and balance measurements in MS patients, and offer clinicians another tool with which to improve function in this population.

Subjects: Subjects with a definitive diagnosis of MS were recruited from a MS specialty practice. Inclusionary criteria required the ability to ambulate for 6 minutes, with or without an assistive device. Exclusionary criteria included any type of orthopedic or cardiopulmonary condition restricting the ability to walk for 6 minutes, and any exacerbations, either immediately prior (2 weeks or less) or during the study.

Methodology: A pretest/posttest design was used. Baseline measures included subjects’ Berg Balance Scale (BBS), 6-minute walk test (6MWT), followed by their 1RM lift for each leg using a leg-press machine. Fatigue Severity Scale (FSS) and the MSIS-29 were also collected during the initial session. Subjects completed an 8 week protocol consisting of 2 sessions per week, performing 4 sets of 4 repetitions using the leg-press for each leg at 85-95% of their 1RM. Increases in weight per session were determined by subject capability and preference as well as the ability to complete 4 sets of 4 repetitions of the given weight. Fatigue was measured each session using the Visual Analog Fatigue Scale (VAFS) and weekly with the FSS.

Results: 7 subjects (5 female, 2 male, EDSS 3.57) completed the 8 week MST protocol. There were significant changes found in all objective measures from pre to post testing. (1RM, BBS, and 6MWT). Right leg 1RM increased significantly by 82.86 pounds (F(1,6) = 20.26, p = .004), and left leg 1RM increased significantly by 72.14 pounds (F(1,6) = 63.03, p < .001). The BBS increased significantly by 5.28 points (F(1,6) = 15.56, p = .008). The 6MWT increased significantly by 150.69 feet (F(1,6) = 6.35, p = .045). Subjective perceptions of fatigue while walking were not significantly different for the two walking conditions.

Conclusion: All subjects who completed the study did so without any adverse effects. Significant improvements were seen in all objective measures (1RM, BBS, and 6MWT) following the MST protocol. This suggests that MST may be a safe and effective measure to improve gait and endurance in PwMS.