title: Effects of Moderate-Volume, High-Load Lower-Body Resistance Training on Strength and Function in Persons with Parkinson's Disease: A Pilot Study Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized sham exercise-controlled study. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis Randomized clinical trial of therapeutic exercise in subacute stroke. Effects of High-Intensity Resistance Training on Strength, Mobility, Balance, and Fatigue in Individuals With Multiple Sclerosis: A Randomized Controlled Trial Tai chi and postural stability in patients with Parkinson's disease. High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Effects of task-oriented training on mobility function in children with cerebral palsy. The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy: a randomized clinical trial. Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function. Quantification of level of effort at the plantarflexors and hip extensors and flexor muscles in healthy subjects walking at different cadences. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study. Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke
abstract: Background . Resistance training research has demonstrated positive effects for persons with Parkinson 's disease ( PD ) , but the number of acute training variables that can be manipulated makes it difficult to determine the optimal resistance training program . Objective . The purpose of this investigation was to examine the effects of an 8-week resistance training intervention on strength and function in persons with PD . Methods . Eighteen men and women were r and omized to training or st and ard care for the 8-week intervention . The training group performed 3 sets of 5–8 repetitions of the leg press , leg curl , and calf press twice weekly . Tests included leg press strength relative to body mass , timed up- and -go , six-minute walk , and Activities-specific Balance Confidence question naire . Results . There was a significant group-by-time effect for maximum leg press strength relative to body mass , with the training group significantly increasing their maximum relative strength ( P < .05 ) . No other significant interactions were noted ( P > .05 ) . Conclusions . Moderate volume , high-load weight training is effective for increasing lower-body strength in persons with PD OBJECTIVES To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke . DESIGN A sham exercise-controlled , r and omized two-by-two factorial design , in which the two factors investigated were cycle training ( AEROBIC ) and resistance training ( STRENGTH ) . SETTING University exercise laboratory . PARTICIPANTS Fifty-two individuals with a history of stroke ( aged 63+/-9 ; time since stroke , 57+/-54 months ) . INTERVENTION Participants undertook 30 exercise sessions over 10 to 12 weeks . Depending on group allocation , individuals underwent aerobic cycling plus sham progressive resistance training ( PRT ) ( n=13 ) , sham cycling plus PRT ( n=13 ) , aerobic cycling plus PRT ( n=14 ) , or sham cycling plus sham PRT ( n=12 ) . MEASUREMENTS Primary outcomes were 6-minute walk distance , habitual and fast gait velocities , and stair climbing power . Secondary outcomes included measures of cardiorespiratory fitness ; muscle strength , power , and endurance ; and psychosocial attributes . RESULTS Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise , although STRENGTH significantly improved participants ' stair climbing power by 17 % ( P=.009 ) , as well as their muscle strength , power , and endurance ; cycling peak power output ; and self-efficacy . Conversely , AEROBIC improved indicators of cardiorespiratory fitness only . Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes . CONCLUSION Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments . The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise OBJECTIVE To determine whether progressive resistance training improves muscle strength , muscle endurance , and physical function in adults with Down syndrome . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Adults ( N=20 ) with Down syndrome ( 13 men , 7 women ; mean age , 26.8+/-7.8 y ) were r and omly assigned through a concealed allocation block r and omized method to either an intervention group ( n=9 ) or a control group ( n=11 ) . INTERVENTION The intervention was a supervised , group progressive resistance training program , consisting of 6 exercises using weight machines performed twice a week for 10 weeks . Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue . The control group continued with their usual activities . MAIN OUTCOME MEASURES The outcomes measured by blinded assessors were muscle strength ( 1-repetition maximum [ 1-RM ] ) , muscle endurance ( number of repetitions at 50 % of 1-RM ) for chest press and leg press , timed stairs test , and the grocery shelving task . RESULTS The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group ( mean difference in the number of repetitions of the chest press at 50 % of 1-RM was 16.7 , 95 % confidence interval , [ CI ] 7.1 - 26.2 ) ; and a trend toward an improvement in upper-limb muscle strength ( mean difference in chest press 1-RM , 8.6 kg ; 95 % CI , -1.3 to 18.5 kg ) and in upper-limb function ( mean difference in grocery shelving task , -20.3s ; 95 % CI , -45.7 to 5.2s ) . There were no significant differences between the groups for lower-limb muscle performance or physical function measures . No major adverse events for the intervention were noted . CONCLUSIONS Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome ( ACTR identifier ACTRN 012606000515594 . ) Background : Resistance training studies in multiple sclerosis ( MS ) often use short intervention periods . Furthermore , training efficiency could be optimized by unilateral training and /or electrical stimulation . Objective : To examine the effect(s ) of unilateral long-term ( 20 weeks ) st and ardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility . Methods : A r and omized controlled trial involving 36 persons with MS . At baseline ( PRE ) and after 10 ( MID ) and 20 ( POST ) weeks of st and ardized ( ACSM ) light to moderately intense unilateral leg resistance training ( RESO , n = 11 ) only or resistance training with simultaneous electro-stimulation ( RESE , n = 11 , 100 Hz , biphasic symmetrical wave , 400 µs ) , maximal isometric strength of the knee extensors and flexors ( 45 ° , 90 ° knee angle ) and dynamic ( 60–180 ° /s ) knee-extensor strength was measured and compared with a control group ( CON , n = 14 ) . Functional mobility was evaluated using the Timed Get Up and Go , Timed 25 Foot Walk , Two-Minute Walk Test , Functional Reach and Rivermead Mobility Index . Results : Maximal isometric knee extensor ( 90 ° , MID : + 10 ± 3 % , POST : + 10 ± 4 % ) in RESO and knee flexor ( 45 ° , POST : + 7 ± 4 % ; 90 ° , POST : + 9 ± 5 % ) in RESE strength increased ( p < 0.05 ) compared with CON but RESO and RESE did not differ . Also , impaired legs responded positively to resistance training ( unilateral leg strength analysis ) and functional reaching increased significantly in RESO ( + 18 % ) compared with CON . Dynamic muscle strength and the remaining functional mobility tests did not change . Conclusion : Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background and Purpose : Resistance exercise via negative , eccentrically induced work ( RENEW ) has been shown to be associated with improvements in strength , mobility , and balance in multiple clinical population s. However , RENEW has not been reported for individuals with multiple sclerosis ( MS ) . Methods : Nineteen individuals with MS ( 8 men , 11 women ; age mean = 49 ± 11 years ; Exp and ed Disability Status Scale [ EDSS ] mean = 5.2 ± 0.9 ) were r and omized into either st and ard exercise ( ST AND ) or st and ard exercise and RENEW training ( RENEW ) for 3 × /week for 12 weeks . Outcome measures were lower extremity strength ( hip/knee flexion and extension , ankle plantar and dorsiflexion , and the sum of these individual values [ sum strength ] ) ; Timed Up and Go ( TUG ) , 10-m walk , self-selected pace ( TMWSS ) and maximal-pace ( TMWMP ) , stair ascent ( S-A ) and descent ( S-D ) and 6-Minute Walk Test ( 6MWT ) , Berg Balance Scale ( BBS ) , Fatigue Severity Scale ( FSS ) . Results : No significant time effects or interactions were observed for strength , TUG , TMWSS , TMWMP , or 6MWT . However , the mean difference in sum strength in the RENEW group was 38.60 ( representing a 15 % increase ) compared to the sum strength observed in the ST AND group with a mean difference of 5.58 ( a 2 % increase ) . A significant interaction was observed for S-A , S-D , and BBS as the ST AND group improved whereas the RENEW group did not improve in these measures . Discussion and Conclusions : Contrary to results in other population s , the addition of eccentric training to st and ard exercises did not result in significantly greater lower extremity strength gains in this group of individuals with MS . Further this training was not as effective as st and ard exercise alone in improving balance or the ability to ascend and descend stairs . Following data collection , re assessment of required sample size indicates we were likely underpowered to detect strength differences between groups BACKGROUND Patients with Parkinson 's disease have substantially impaired balance , leading to diminished functional ability and an increased risk of falling . Although exercise is routinely encouraged by health care providers , few programs have been proven effective . METHODS We conducted a r and omized , controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson 's disease . We r and omly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale ( which ranges from 1 to 5 , with higher stages indicating more severe disease ) to one of three groups : tai chi , resistance training , or stretching . The patients participated in 60-minute exercise sessions twice weekly for 24 weeks . The primary outcomes were changes from baseline in the limits-of-stability test ( maximum excursion and directional control ; range , 0 to 100 % ) . Secondary outcomes included measures of gait and strength , scores on functional-reach and timed up- and -go tests , motor scores on the Unified Parkinson 's Disease Rating Scale , and number of falls . RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion ( between-group difference in the change from baseline , 5.55 percentage points ; 95 % confidence interval [ CI ] , 1.12 to 9.97 ; and 11.98 percentage points ; 95 % CI , 7.21 to 16.74 , respectively ) and in directional control ( 10.45 percentage points ; 95 % CI , 3.89 to 17.00 ; and 11.38 percentage points ; 95 % CI , 5.50 to 17.27 , respectively ) . The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach .  Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training . The effects of tai chi training were maintained at 3 months after the intervention . No serious adverse events were observed . CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson 's disease , with additional benefits of improved functional capacity and reduced falls . ( Funded by the National Institute of Neurological Disorders and Stroke ; Clinical Trials.gov number , NCT00611481 . ) Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability OBJECTIVE To evaluate the impact of a program of muscle strengthening and physical conditioning on  impairment and disability in chronic stroke subjects . DESIGN A r and omized pretest and posttest control group , followed by a single-group pretest and posttest design . SUBJECTS Thirteen community-dwelling stroke survivors of at least 9 months . INTERVENTION A 10-week ( 3 days/week ) program consisting of a warm-up , aerobic exercises , lower extremity muscle strengthening , and a cool-down . MAIN OUTCOME MEASURES Peak isokinetic torque of the major muscle groups of the affected lower limb , quadriceps and ankle plantarflexor spasticity , gait speed , rate of stair climbing , the Human Activity Profile ( HAP ) , and the Nottingham Health Profile ( NHP ) were recorded twice for the treatment group and three times for the control group . RESULTS Significant improvements were found for all the selected outcome measures ( HAP , NHP , and gait speed ) for the treatment group ( p < .001 ) . In terms of overall training effects , the 13 subjects demonstrated increases in strength of the affected major muscle groups , in HAP and NHP profiles , and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity . CONCLUSIONS The 10-week combined program of muscle strengthening and physical conditioning result ed in gains in all measures of impairment and disability . These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors OBJECTIVE The aim of this study was to evaluate the effect on spasticity , muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy . METHODS Fourteen persons with spastic diplegia ( 21 - 41 years ) were r and omized to intervention with either whole-body vibration training ( n=7 ) or resistance training ( n=7 ) . Pre- and post-training measures of spasticity using the modified Ashworth scale , muscle strength using isokinetic dynamometry , walking ability using Six-Minute Walk Test , balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed . RESULTS Spasticity decreased in knee extensors in the whole-body vibration group . Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s . Six-Minute Walk Test and Timed Up and Go test did not change significantly . Gross Motor Function Measure increased in the whole-body vibration group . CONCLUSION These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength , without negative effect on spasticity , in adults with cerebral palsy BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population This r and omized controlled trial with blinded assessment aim ed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson 's disease ( PD ) . Forty-eight participants with PD who had fallen or were at risk of falling were r and omized into exercise or control groups . The exercise group attended a monthly exercise class and exercised at home three times weekly . The intervention targeted leg muscle strength , balance , and freezing . The primary outcome measure was a PD falls risk score . The exercise group had no major adverse events and showed a greater improvement than the control group in the falls risk score , which was not statistically significant ( between group mean difference = -7 % , 95 % CI -20 to 5 , P = 0.26 ) . There were statistically significant improvements in the exercise group compared with the control group for two secondary outcomes : Freezing of Gait Question naire ( P = 0.03 ) and timed sit-to-st and ( P = 0.03 ) . There were statistically nonsignificant trends toward greater improvements in the exercise group for measures of muscle strength , walking , and fear of falling , but not for the measures of st and ing balance . Further investigation of the impact of exercise on falls in people with PD is warranted OBJECTIVE To evaluate the effects of progressive resistance training on muscle strength , muscle tone , gait performance and perceived participation after stroke . DESIGN A r and omized controlled trial . SUBJECTS Twenty-four subjects ( mean age 61 years ( st and ard deviation 5 ) ) 6 - 48 months post-stroke . METHODS The training group ( n = 15 ) participated in supervised progressive resistance training of the knee muscles ( 80 % of maximum ) twice weekly for 10 weeks , and the control group ( n = 9 ) continued their usual daily activities . Both groups were assessed before and after the intervention and at follow-up after 5 months . Muscle strength was evaluated dynamically and isokinetically ( 60 degrees /sec ) and muscle tone by the Modified Ashworth Scale . Gait performance was evaluated by Timed " Up & Go " , Fast Gait Speed and 6-Minute Walk tests , and perceived participation by Stroke Impact Scale . RESULTS Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up . Both groups improved in gait performance , but at follow-up only Timed " Up & Go " and perceived participation were significantly better for the training group . CONCLUSIONS Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke . There appear to be long-term benefits , but further studies are needed to clarify the effects , specifically of progressive resistance training on gait performance and participation OBJECTIVE To examine the effects of an 8-week home-based resistance exercise program on balance , power , and mobility in adults with multiple sclerosis . DESIGN Experimental group design . SETTING General community . PARTICIPANTS Twenty-nine women ( age , 50.3+/-8.5 y ) and 8 men ( age , 51.1+/-7.1 y ) were stratified by disability level and age and were r and omized into exercise ( n=19 ) and control ( n=17 ) groups . INTERVENTION The exercise group had lower-extremity resistance training 3 times a week . The control group maintained current level of physical activity . Main outcome measures Primary outcome measures included balance , as measured by anteroposterior sway , mediolateral sway , and sway velocity using the AccuSway(PLUS ) force platform ; mobility as assessed with the Up and Go test ; and leg power as assessed with the Leg Extensor Power Rig . RESULTS Leg extensor power improved significantly in the exercise group ( pretest , 3.19+/-1.36 W/kg ; posttest , 3.95+/-1.23 W/kg ; P=.004 ) , although measures of balance and mobility did not change . CONCLUSIONS The home-based resistance program was well tolerated by participants and offered a practical means to improve leg extensor power in a short period of time Objective : To establish the effects of a 12-week , community-based group exercise intervention for people moderately affected with multiple sclerosis . Design : R and omized controlled pilot trial . Setting : Two community leisure centres . Participants : Thirty-two participants with multiple sclerosis r and omized into intervention or control groups . Intervention : The intervention group received 12 weeks of twice weekly , 60-minute group exercise sessions , including mobility , balance and resistance exercises . The control group received usual care . Main outcome measures : An assessor blinded to group allocation assessed participants at baseline , after eight weeks and after 12 weeks . The primary outcome measure was 25-foot ( 7.6 m ) walk time , secondary outcomes assessed walking endurance , balance , physical function , leg strength , body mass index , activity levels , fatigue , anxiety and depression , quality of life and goal attainment . Results : The intervention made no statistically significant difference to the results of participants ’ 25-foot walk time . However the intervention led to many improvements . In the intervention group levels of physical activity improved statistically between baseline and week 8 ( P < 0.001 ) and baseline and week 12 ( P = 0.005 ) . Balance confidence results showed a significant difference between baseline and week 12 ( P = 0.013 ) . Good effect sizes were found for dynamic balance ( d = 0.80 ) , leg strength ( d = 1.33 ) , activity levels ( d = 1.05 ) and perceived balance ( d = 0.94 ) . Conclusion : The results of the study suggest that community-based group exercise classes are a feasible option for people moderately affected with multiple sclerosis , and offer benefits such as improved physical activity levels , balance and leg strength After stroke , physiotherapy can promote brain reorganization and motor recovery . Combining muscle strength and functional training ( functional strength training , FST ) may be beneficial . The aim of the authors was to compare FST with conventional physiotherapy ( CPT ) while controlling for the potential confounder of therapy intensity in a multicenter , r and omized controlled observer-blind trial . The mean age of the participants was 68.3 ( st and ard deviation [ SD ] = 12.03 ) years at a mean of 34 ( SD = 20 ) days after stroke , with mean peak paretic knee extension torque ( torque ) of 22 ( SD = 25 ) Nm . The estimated sample size was 102 to detect a between-group difference of 0.2 m/s in walking speed . After baseline measures , participants were allocated r and omly to CPT or CPT + CPT or CPT + FST for 6 weeks . Additional experimental therapy was provided for up to 1 hour a day , 4 times each week . Outcomes were measured 6 weeks after baseline and at follow-up 12 weeks thereafter . Measures included walking speed , knee extensor torque , and functional mobility ( Rivermead ) . At outcome , both extraintensity groups showed greater increases in walking speed than the CPT group , but this reached significance only for the CPT + CPT group ( P = .031 ) . The CPT + CPT group also had a greater number of participants who walked at 0.8 m/s or above . No significant differences were observed for torque about the knee or for the Rivermead score . At follow-up , no significant differences were observed . These phase I results justify a subsequent trial of CPT + CPT versus CPT + FST Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy ( CP ) . However , the effectiveness of this type of training is still disputed . The most recently published systematic review with meta- analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP . Thus , the aim of this article is to evaluate the extent to which training protocol s from the most recent r and omized controlled trials are in keeping with the evidence for effective resistance  training in children who are developing typically , as reflected in the training guidelines of the National Strength and Conditioning Association . Recommendations for resistance training protocol s , based on this evidence and appropriate to children with CP , are provided to help guide both future research and clinical practice for resistance training in children with CP A r and omized clinical trial on the effects of strength training was performed in myotonic dystrophy ( MyD ) patients and patients with hereditary motor and sensory neuropathy ( HMSN ) . Training and most measurement tools involved the proximal lower extremity muscles . The participants trained 3 times a week for 24 weeks with weights adapted to their force . Strength was evaluated by isokinetically measured knee torque . Fatiguability was assessed by the time an isometric contraction could be sustained . Functional performance was measured by timed motor performance and by question naires on functional performance . Serum myoglobin ( Mb ) levels were determined to detect changes in muscle fiber membrane permeability . The MyD group included 33 participants , and the HMSN group included 29 participants . Within each diagnostic group , patients were individually matched and subsequently r and omized for treatment allocation . In the MyD patients , none of the measurement techniques showed any training effect . Neither were there signs of deterioration caused by the training . In the HMSN group , knee torques increased . Timed motor performance did not change , although the question naires showed an improvement on items related to upper-leg function . Mb levels did not change significantly as a result of the training . In conclusion , the MyD group showed neither positive nor negative effects of the training protocol , whereas the training produced a moderate increase in strength and leg-related functional performance in the HMSN group The effects of training with isokinetic maximal voluntary knee extensions were studied in stroke patients . Two groups of 10 patients each trained twice a week for 6 weeks . One group trained exclusively eccentric movements and the other exclusively concentric movements . The effects were evaluated from the following tests before and after the training period . The maximal voluntary strength in concentric and eccentric actions of the knee extensor and flexor muscles was recorded together with surface electromyography at constant velocities of 60 , 120 , and 180 deg.s-1 on three different days . The body weight distribution on the legs while rising and sitting down was measured with two force plates . The self-selected and maximal walking speeds and the swing to stride ratio of the paretic leg were measured . After the training period , the knee extensor strength had increased in eccentric and concentric actions in both groups ( p < .05 ) . The eccentric and the concentric strength in the paretic leg relative to that of the nonparetic leg increased in the eccentrically trained group ( p < .05 ) but not in the concentrically trained group . The restraint of the antagonistic muscles in concentric movements increased after concentric ( p < .05 ) but not eccentric training . A nearly symmetrical body weight distribution on the legs in rising from a sitting position was noted after eccentric ( p < .05 ) but not concentric training . Changes in walking variables were not significantly different between the groups . Eccentric knee extensor training was thus found to have some advantages as compared to concentric training in stroke patients The plantarflexor , hip extensor and hip flexor muscle groups contribute by their concentric action to generate most of the energy during level gait in healthy subjects . The goal of the present study was to determine , during the main energy generation phases , the relative dem and of these three groups in 14 healthy subjects walking at four cadences ( self-selected , 60 , 80 and 120 steps/min ) . The muscular utilization ratio ( MUR ) , that compares the net joint moment obtained during gait to the maximal potential moment ( MPM ) at each percentage of the gait cycle , was used to estimate the mechanical relative dem and . The MPM values were obtained by regression equations developed from torque data measured with a Biodex dynamometric system . The results showed that the peak MURs increased with gait cadence . The peak values were not significantly different between sides for all cadences despite mean absolute lateral differences ranging from 7 % to 10 % . The mean peak MURs of both sides ranged from 51.3 % to 62.6 % , from 20.7 % to 49.9 % and from 14.9 % to 42.5 % , for the plantarflexors , hip flexors and hip extensors , respectively . Highly significant associations were found between the MURs and net moments ( numerator of the MUR ratio ) , with Pearson coefficients ( r ) superior to 0.80 for all muscles groups . The association between the MURs and the maximal potential moments ( denominator of MUR ratio ) was lower ( 0.01<r<0.60 ) . The results of this study indicated that the mechanical relative dem and during gait increased with gait cadence . The plantarflexor MUR values were always the highest . However , when gait cadence increased , the MURs at the hip reached similar values of those of the ankle , which suggests that these muscles also work significantly at elevated gait cadences . The changes in the MUR values were mainly explained by changes in the net joint moments Persons with Parkinson disease ( PD ) often demonstrate bradykinesia during mobility tasks . Bradykinesia combined with other PD-related movement deficits may contribute to self-reported reductions in quality of life . At this time , no studies have examined the effects of resistance exercise as an intervention to reduce bradykinesia and improve self-reported quality of life . Therefore , we examined changes in muscle force production , clinical measures of bradykinesia , and quality of life following 12 weeks of a high intensity eccentric resistance exercise program in persons with mild to moderate PD . Twenty individuals with idiopathic PD were matched into an experimental or an active control group . All participants were tested prior to and following a 12-week intervention period . The experimental group performed high intensity quadriceps contractions on an eccentric ergometer 3 days a week for 12 weeks . The active control group participated in an evidence based exercise program of PD . The outcome variables were quadriceps muscle force , clinical bradykinesia measures ( gait speed , timed up and go ) and disease specific quality of life ( Parkinson 's disease question naire-39 [ PDQ-39 ] ) . Data was analyzed using separate 2 ( group ) x 2 ( time period ) ANOVAs . Results demonstrated significant time by group interaction effects for gait speed , timed up and go , and the composite PDQ-39 score ( p < 0.05 ) . Muscle force , bradykinesia , and QOL were improved to a greater degree in those that performed high intensity eccentric resistance training compared to an active control group . Additional research is needed to determine if this type of training has long-term impact and if it results in an alteration of the natural history of mobility and QOL decline in persons with PD Background : Few high- quality trials have examined the effects of progressive resistance training ( PRT ) on people with multiple sclerosis ( MS ) . Objective : To determine the effectiveness of PRT for people with MS , focusing on improving the gait deficits common in this population . Methods : Using a single blind r and omized controlled trial , people with relapsing – remitting MS were r and omly allocated to either a PRT program targeting the lower limb muscles twice a week for 10 weeks ( n = 36 ) , or usual care plus an attention and social program conducted once a week for 10 weeks ( n = 35 ) . Outcomes were recorded at baseline , week 10 and week 22 . Results : Participants attended 92 % of training sessions , with no serious adverse events . At 10 weeks , no differences were detected in walking performance . However , compared with the comparison group PRT demonstrated increased leg press strength ( 16.8 % , SD 4.5 ) , increased reverse leg press strength ( 29.8 % , SD 12.7 ) , and increased muscle endurance of the reverse leg press ( 38.7 % , SD 32.8 ) . Improvements in favor of PRT were also found for physical fatigue ( Mean difference −3.9 units , 95%CI −6.6 to −1.3 ) , and the physical health domain of quality of life ( Mean difference 1.5 units , 95%CI 0.1 to 2.9 ) . At week 22 almost no between-group differences remained . Conclusion : PRT is a relatively safe intervention that can have short-term effects on reducing physical fatigue , increasing muscle endurance and can lead to small improvements in muscle strength and quality of life in people with relapsing – remitting MS . However , no improvements in walking performance were observed and benefits do not appear to persist if training is completely stopped OBJECTIVE To determine , using the Muscular Utilization Ratio ( MUR ) method , whether plantarflexor weakness is among the factors preventing stroke subjects from walking at faster speeds . Potential compensations by the hip flexors were also examined . DESIGN A convenience sample of 17 chronic stroke subjects in a context of a descriptive study . BACKGROUND Gait speed is correlated with the residual strength of the muscles involved in gait in stroke subjects . However , it has not been established if this residual strength limits gait speed . METHODS  Kinetic and kinematic data for comfortable and maximal gait speeds were collected on the paretic side , and were used to determine the  moments in plantarflexion ( mechanical dem and : MUR numerator ) during the push-off phase . The maximal potential moment ( MUR denominator ) of the plantarflexors during gait was predicted using an equation derived from dynamometric data collected with a Biodex system . The MURs of the plantarflexors  were then calculated at every 1 % interval of the push-off phase . The pull-off phase of gait and the hip flexor strength were also examined . RESULTS Ten subjects of the sample had a MUR value between 80 and 150 % at maximal gait speed . These subjects produced the lowest peak torques in plantarflexion . Each of the four fastest subjects of this group had a large hip flexion moment during the pull-off phase of gait and produced high hip flexion torque values on the dynamometer . Each of the seven remaining subjects had a MUR value under 70 % when they walked at maximal speed . CONCLUSIONS Weakness of the plantarflexors should be considered as one factor limiting gait speed in 10 hemiparetic subjects . Some subjects with weak plantarflexors could walk rapidly because they compensated with the hip flexors . For the remaining stroke subjects , factors other than weakness of the plantarflexors have to be considered in order to explain the reduction in their gait speed OBJECTIVES The goal most often stated by persons with stroke is improved walking function . The purpose of this study was to determine the effects of isokinetic strength training on walking performance , muscle strength , and health-related quality of life in survivors of chronic stroke . METHODS Twenty participants ( age , 61.2 + /- 8.4 years ) with chronic stroke were r and omized into 2 groups . The experimental group undertook maximal concentric isokinetic strength training , whereas the control group received passive range of motion of the paretic lower extremity 3 times a week for 6 weeks . The Kin-Com Isokinetic Dynamometer ( Chattanooga Group Inc. , TN ) was used for both the strengthening and passive range of motion exercises . The Mann-Whitney U test was used to compare the changes in scores ( postintervention minus baseline ) between the control and experimental groups for a composite lower extremity strength score , walking speed ( level-walking and stair-walking ) and health-related quality of life measure ( 36-Item Short Form Health Survey [ SF-36 ] ) . RESULTS Both the experimental and control groups increased their strength and walking speed postintervention ; however , there were no differences in the changes in walking speed between the groups . There was a trend ( P = .06 ) toward greater strength improvement in the experimental group compared with the control group . No changes in SF-36 scores were found in either group . CONCLUSIONS Intervention aim ed at increasing strength did not result in improvements in walking . The results of this study stress the importance of controlled clinical trials in determining the effect of specific treatment approaches . Strength training in conjunction with other task-related training may be indicated Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities
target: The results revealed that despite significant strength gains , many studies failed to show a significant improvement in walking capacity .
  Strength testing and strengthening exercises were prioritized for the knee extensors and flexors , despite their relatively minor role in human walking .
  Strengthening exercises performed in the neurologic population are not specific to the main muscle groups responsible for the power generation required for walking .
  There is a predisposition for strength testing and strengthening exercises to focus on the knee flexors and extensors despite their relatively minor role during walking .
background: The aim of this systematic review was to investigate the task specificity of strength training programs for walking in neurologic rehabilitation .