Skip to main content
SpringerLink
Log in

Neural drive increases following resistance training in patients with multiple sclerosis

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The present study tested the hypothesis that lower body progressive resistance training (PRT) increases the neural drive expressed as surface electromyographical (EMG) activity in patients with multiple sclerosis (MS). The study was a randomised controlled trial (RCT) including a 12-week follow up period. Thirty-eight MS patients were randomized to an exercise group (n = 19) or a control group (n = 19). During the intervention period, the exercise group performed a 12-week supervised lower body PRT program, whereas the control group maintained their usual daily activity level. After the 12 week intervention period, the exercise group were encouraged to continue training on their own for a 12-week follow up period, while the control group completed the 12-week supervised PRT program. Surface EMG was recorded from vastus lateralis, rectus femoris and semitendinosus during maximal isometric knee extension and knee flexion, before and after the intervention and at follow up. From the recordings, the area under the rectified, low-pass filtered EMG signal (integrated EMG, iEMG) was calculated. Muscle strength was expressed as the angular impulse (AI) and was measured during the same period as the iEMG. After PRT significant improvements for iEMG of vastus lateralis and rectus femoris during maximal knee extension and for semitendinosus during maximal knee flexion and for AI during both maximal knee extension and flexion were found in the exercise group, when compared to the control group. When compared to the post values, all effects, except for AI during knee flexion, were maintained at follow up in the exercise group. When the control group was exposed to PRT, a similar pattern of improvements were found, albeit not all improvements were significant. In conclusion twelve weeks of intense PRT of the lower extremities improved the neural drive expressed as maximal surface EMG activity in patients with MS, with effects persisting 12 weeks after the intervention. The study was registered at clinicalTrials.gov, Protocol no. NCT00381576.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P (2002) Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol 93:1318–1326

    PubMed  Google Scholar 

  2. Aagaard P, Simonsen EB, Andersen JL, Magnusson SP, Bojsen-Moller F, Dyhre-Poulsen P (2000) Antagonist muscle coactivation during isokinetic knee extension. Scand J Med Sci Sports 10:58–67

    Article  PubMed  CAS  Google Scholar 

  3. Aagaard P, Thorstensson A (2003) Neuromuscular aspects of exercise—adaptive responses evoked by strength training. In: Kjaer M (ed) Textbook of Sport Medicine. Blackwell Press, pp 70–106

  4. Carroll CC, Gallagher PM, Seidle ME, Trappe SW (2005) Skeletal muscle characteristics of people with multiple sclerosis. Arch Phys Med Rehabil 86:224–229

    Article  PubMed  Google Scholar 

  5. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen H, Knudsen C, Overgaard K, Ingemann-Hansen T (2009) Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology 73:1478–1484

    Article  PubMed  CAS  Google Scholar 

  6. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen H, Knudsen C, Overgaard K, Ingemann-Hansen T (2010) Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Mult Scler 16:480–490

    Article  PubMed  CAS  Google Scholar 

  7. Dalgas U, Stenager E, Jakobsen J, Petersen T, Overgaard K, Ingemann-Hansen T (2010) Muscle fiber size increases following resistance training in multiple sclerosis. Mult Scler 16:1367–1376

    Article  PubMed  CAS  Google Scholar 

  8. de Haan A, de Ruiter CJ, Der Woude LH, Jongen PJ (2000) Contractile properties and fatigue of quadriceps muscles in multiple sclerosis. Muscle Nerve 23:1534–1541

    Article  PubMed  Google Scholar 

  9. Dorfman LJ, Howard JE, McGill KC (1989) Motor unit firing rates and firing rate variability in the detection of neuromuscular disorders. Electroencephalogr Clin Neurophysiol 73:215–224

    Article  PubMed  CAS  Google Scholar 

  10. Fimland MS, Helgerud J, Gruber M, Leivseth G, Hoff J (2010) Enhanced neural drive after maximal strength training in multiple sclerosis patients. Eur J Appl Physiol 110:435–443

    Article  PubMed  Google Scholar 

  11. Folland JP, Williams AG (2007) The adaptations to strength training: morphological and neurological contributions to increased strength. Sports Med 37:145–168

    Article  PubMed  Google Scholar 

  12. Formica CA, Cosman F, Nieves J, Herbert J, Lindsay R (1997) Reduced bone mass and fat-free mass in women with multiple sclerosis: effects of ambulatory status and glucocorticoid use. Calcif Tissue Int 61:129–133

    Article  PubMed  CAS  Google Scholar 

  13. Gabriel DA, Kamen G, Frost G (2006) Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med 36:133–149

    Article  PubMed  Google Scholar 

  14. Garner DJ, Widrick JJ (2003) Cross-bridge mechanisms of muscle weakness in multiple sclerosis. Muscle Nerve 27:456–464

    Article  PubMed  CAS  Google Scholar 

  15. Ingemann-Hansen T, Halkjaer-Kristensen J (1977) Lean and fat component of the human thigh. The effects of immobilization in plaster and subsequent physical training. Scand J Rehabil Med 9:67–72

    PubMed  CAS  Google Scholar 

  16. Kantarci OH (2008) Genetics and natural history of multiple sclerosis. Semin Neurol 28:7–16

    Article  PubMed  Google Scholar 

  17. Kent-Braun JA, Ng AV, Castro M, Weiner MW, Gelinas D, Dudley GA, Miller RG (1997) Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol 83:1998–2004

    PubMed  CAS  Google Scholar 

  18. Kjølhede T, Vissing K, Dalgas U (2012) Multiple sclerosis and progressive resistance training—a systematic review. Mult Scler 18:1215–1228

    Article  PubMed  Google Scholar 

  19. Lambert CP, Lee AR, Evans WJ (2002) Body composition in ambulatory women with multiple sclerosis. Arch Phys Med Rehabil 83:1559–1561

    Article  PubMed  Google Scholar 

  20. Lexell J, Taylor CC (1989) Variability in muscle fibre areas in whole human quadriceps muscle. How much and why? Acta Physiol Scand 136:561–568

    Article  PubMed  CAS  Google Scholar 

  21. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, Van den NS, Weinshenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  PubMed  CAS  Google Scholar 

  22. Moritani T, deVries HA (1980) Potential for gross muscle hypertrophy in older men. J Gerontol 35:672–682

    Article  PubMed  CAS  Google Scholar 

  23. Ng AV, Miller RG, Gelinas D, Kent-Braun JA (2004) Functional relationships of central and peripheral muscle alterations in multiple sclerosis. Muscle Nerve 29:843–852

    Article  PubMed  CAS  Google Scholar 

  24. Rice CL, Vollmer TL, Bigland-Ritchie B (1992) Neuromuscular responses of patients with multiple sclerosis. Muscle Nerve 15:1123–1132

    Article  PubMed  CAS  Google Scholar 

  25. Rosenfalck A, Andreassen S (1980) Impaired regulation of force and firing pattern of single motor units in patients with spasticity. J Neurol Neurosurg Psychiatry 43:907–916

    Article  PubMed  CAS  Google Scholar 

  26. Savci S, Inal-Inc Arikan H, Guclu-Gunduz A, Cetisli-Korkmaz N, Armutlu K, Karabudak R (2005) Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil 27:1365–1371

    Article  PubMed  Google Scholar 

  27. Schwid SR, Thornton CA, Pandya S, Manzur KL, Sanjak M, Petrie MD, McDermott MP, Goodman AD (1999) Quantitative assessment of motor fatigue and strength in MS. Neurology 53:743–750

    Article  PubMed  CAS  Google Scholar 

  28. Scott SM, Hughes AR, Galloway SD, Hunter AM (2011) Surface EMG characteristics of people with multiple sclerosis during static contractions of the knee extensors. Clin Physiol Funct Imaging 31:11–17

    Article  PubMed  Google Scholar 

  29. Sharma KR, Kent-Braun J, Mynhier MA, Weiner MW, Miller RG (1995) Evidence of an abnormal intramuscular component of fatigue in multiple sclerosis. Muscle Nerve 18:1403–1411

    Article  PubMed  CAS  Google Scholar 

  30. Sheean GL, Murray NM, Rothwell JC, Miller DH, Thompson AJ (1997) An electrophysiological study of the mechanism of fatigue in multiple sclerosis. Brain 120(Pt 2):299–315

    Article  PubMed  Google Scholar 

  31. Thickbroom GW, Sacco P, Faulkner DL, Kermode AG, Mastaglia FL (2008) Enhanced corticomotor excitability with dynamic fatiguing exercise of the lower limb in multiple sclerosis. J Neurol 255:1001–1005

    Article  PubMed  Google Scholar 

  32. Thoumie P, Mevellec E (2002) Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis. J Neurol Neurosurg Psychiatry 73:313–315

    Article  PubMed  CAS  Google Scholar 

  33. White LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, Vandenborne K (2004) Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler 10:668–674

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Vivi Brandt from The MS Clinic at Aarhus University Hospital for helping with recruiting patients, as well as the handling of logistical matters. Tue Kjølhede, PhD student at Section of Sport Science, Department of Public Health, Aarhus University, is acknowledged for his valuable comments to the manuscript. Financial support was received from the National Multiple Sclerosis Society, The Research Foundation of the MS Clinic of Southern Denmark (Vejle, Esbjerg and Soenderborg), Director Werner Richter and wife`s Grant, the Augustinus-Foundation, Engineer Bent Boegh and wife Inge Boeghs Foundation, Vilhelm Bangs Foundation, Manufacturer Mads Clausen′s Foundation, The Toyota-Foundation, Mrs. Benthine Lund′s Foundation and AP Moeller′s Foundation. None of the sponsors played a role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the paper for publication.

Conflicts of interest

UD has received research support, travel grants and/or teaching honorary from Biogen Idec, Merck Serono and Sanofi Aventis. ES has received research support and travel grants from Biogen Idec, Merck Serono and Bayer Schering and travel grants from Sanofi Aventis. TP has received research support and travel grants from Biogen Idec, Merck Serono, Bayer Schering and Sanofi Aventis. KO, HS, CL, CR and TIH have no disclosures.

Author information

Authors and Affiliations

  1. Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark

    Ulrik Dalgas, Caroline Lund, Cuno Rasmussen, Henrik Sørensen, Thorsten Ingemann-Hansen & Kristian Overgaard

  2. Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Sønderborg Hospital, Sønderborg, Denmark

    Egon Stenager

  3. Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

    Egon Stenager

  4. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

    Thor Petersen

Authors
  1. Ulrik Dalgas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Egon Stenager
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline Lund
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cuno Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thor Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henrik Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thorsten Ingemann-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristian Overgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrik Dalgas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dalgas, U., Stenager, E., Lund, C. et al. Neural drive increases following resistance training in patients with multiple sclerosis. J Neurol 260, 1822–1832 (2013). https://doi.org/10.1007/s00415-013-6884-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-013-6884-4

Keywords

Search

Navigation