PT Critically Appraised Topics

Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

The patient who led me to pursue this question is a 45 year old male with a diagnosis of multiple sclerosis whose primary complaint was decreased walking ability secondary to fatigue. Medical treatment for this diagnosis to date has included aerobic exercise, resistance training (Guiterrez et al, 2005), and neurorehabilitation training (Rampello et al, 2007) for increasing walking ability and decreasing fatigue. Problems identified with multiple sclerosis include a decrease in sensory and motor functions such as balance, coordination, postural control, and gait (Guiterrez et al, 2005). According to Rampello et al (2007), poor exercise tolerance and exertion fatigue are common complaints of patients with multiple sclerosis.

Clinical Question

Does aerobic exercise significantly increase walking ability and decrease fatigue for patients with multiple sclerosis?

Clinical Bottom Line

Based on the results of the outcomes from Costello et al (2009) and Sabapathy and Minahan (2011), aerobic exercise may significantly improve walking ability and decrease fatigue in patients diagnosed with multiple sclerosis. The studies included participants who were similar to the patient of interest. Also, the studies were similar between populations, interventions, comparisons, and outcomes measured (Table 1). Treatment included an aerobic home walking program and aerobic circuit training. Controls included either not participating in regular exercise or performing resistance exercises. Outcome measures focused on gait and fatigue and included the six minute walk test (6MWT), timed up and go test (TUG), physiological cost index (PCI), FSS, and MFIS. In both of the studies, the aerobic treatment group demonstrated significant improvements in gait as compared to within-group pre-treatment scores; however effect sizes were small (Sabapathy and Minahan, 2011) and medium (Costello et al, 2009) resulting in a variable clinical value. The 95% confidence intervals (CI) also varied among experiments: positive, negative, and large CI’s. All experiments included randomization, acceptable external validity, had fair to good internal validity, and feasible parameters. The primary cost of aerobic treatment was the expense of the equipment for the circuit training and time commitments for the home walking program. The primary benefits of treatment were improved gait and fatigue (Sabapathy and Minahan, 2011) in the participants which correlates to increased community participation. From a clinical perspective, the benefits of treatment outweigh the cost.