Rutgers, The State University of New Jersey, Blackwood, New Jersey, USA.
RWJ Sports Physical Therapy, Princeton, New Jersey, USA.
Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzaa224.
Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS.
The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale, Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 lower extremity strength tests.
The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). Fatigue Severity Scale was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the Fatigue Severity Scale score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC.
The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS.
Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS.
Blood flow restriction, which has been used to help improve strength in healthy adults and in some people with chronic disease, applies pressure around the arm or leg to limit the flow of blood to that body part during exercise, helping to reduce fatigue. Blood flow restriction coupled with low-intensity strengthening exercises can be used for a person with MS.
血流限制（BFR）训练，通过可膨胀袖带部分阻塞肢体近端的血流，结合低强度阻力训练（LIRT），已在健康人群中产生与传统渐进性抗阻运动相当的效果。在多发性硬化症（MS）患者中使用 BFR 和 LIRT 可能使他们在不增加疲劳的情况下增强力量。本病例报告的目的是描述 BFR/LIRT 方案在 MS 患者中的应用。
患者为 54 岁女性，原发性进展型 MS 病史 13 年，扩展残疾严重程度评分（EDSS）为 3.0 分（满分 10 分）。她接受了为期 12 周、每两周一次的双侧下肢 BFR/LIRT 治疗。在基线和 6 周、12 周时评估的结果包括 12 项多发性硬化症步行量表（MSWS-12）、疲劳严重程度量表、患者特定功能量表（PSFS）（目标：跑步锻炼和娱乐 45 分钟，100%有信心上下一段楼梯，不受限制地自信和安全地驾驶）和 14 项下肢力量测试。
干预措施耐受良好，无不良事件发生。治疗 6 周后，MSWS-12 评分有所改善，但未超过最小可检测变化值（MDC）。疲劳严重程度评分无变化。所有 PSFS 目标均有改善，且 MDC 超过 14 项测试中的 8 项。治疗 12 周后，MSWS-12 改善持续，疲劳严重程度评分有所改善，但均未超过 MDC。PSFS 改善仍持续。14 项力量测试中有 8 项超过 MDC。其余 6 项力量测试虽有改善，但未超过 MDC。
患者在使用 BFR/LIRT 方案后有可测量的改善。BFR/LIRT 可能是 MS 患者进行力量训练的一种选择；然而，还需要研究其在 MS 人群中的安全性和有效性。
传统的物理治疗师干预措施已被证明对 MS 患者有益；然而，由于疲劳的限制，其应用效果有限。越来越多的文献已经证明了 BFR/LIRT 方案对健康人群和患有慢性疾病人群的力量和其他身体功能测量的影响。本病例报告增加了现有文献中的缺失信息，并为 BFR/LIRT 在原发性进展型 MS 患者中的有效性研究提供了方向。
血流限制是一种通过可膨胀袖带限制肢体血流来减少疲劳的方法，已被用于帮助健康成年人和一些患有慢性疾病的人增强力量。血流限制与低强度强化锻炼相结合，可用于治疗多发性硬化症患者。
