Effects of home or community-based strength training on muscle, walking, mobility, and balance performances in patients with multiple sclerosis: A systematic review and meta-analysis

Introduction: Multiple sclerosis (MS) is a chronic disabling disorder with several features affecting muscle, mobility, gait, and balance performance. Home or community-based strength training (HCBST), alone or combined with other types of training, can be used to improve the aforementioned outcomes of interest. This systematic review and meta-analysis assessed the scientific evidence regarding the effects of HCBST on muscle, walking, mobility, and balance performances in patients with MS. Methods: The Cochrane library, EMBASE, PEDro, Web of Science, and PubMed databases were searched. Randomized controlled trials were retrieved, and their risk of bias and methodological quality were evaluated using the Cochrane risk-of-bias tool and PEDro scale respectively. Qualitative and quantitative syntheses were used for data analysis. Results: The results revealed that, in patients with multiple sclerosis, HCBST combined with balance training significantly improved balance performance (standardized mean difference [SMD]= 1.08, P < 0.0001), postural sway (mean difference [MD] = −29.40, P < 0. 00001), physiologic fall risk (P = 0.02), physical activity (P < 0.00001), psychological impact of MS (P = 0.01), and satisfaction with life (P < 0.0001) compared with the control condition. Additionally, strength training (ST) alone significantly improved leg strength (SMD = 0.42, 95 % CI:0.01 to 0.84, P = 0.05), functional mobility (MD = −8.20, P = 0.01), waking speed (P < 0.00001), walking ability (p = 0.01) and physical fatigue (P = 0.03) compared with comparison groups. Conclusions: In patients with MS, HCBST significantly improves leg strength, walking, mobility and physical fatigue; while HCBST combined with balance training significantly improved walking, balance, fall, physical activity and quality of life.