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Table 1 Recommendations for exercise testing in MS patients [53,54,55]

From: Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations

Fitness Parameter Measures Comments
Aerobic fitness
 6-min walk test
 It is used to measure improvements and differences in Pre and Post program performances but not to compare them to “healthy individuals.”
Total distance walked, heart rate, RPEa, BP.
The HR response to exercise may be decreased due to autonomic dysfunction. Therefore, the use of the RPE scale is preferred in these patients.
Using air conditioner for all aerobic testing. Spasticity, lower limb weakness, and paralysis will preclude walking tests in some patients.
 Submaximal, upright, or recumbent leg cycle ergometry. Intermittent instead of continuous protocol may be indicated. Increase work rate by 12–25 W per stage. Workload and steady-state heart rate to predict VO2peak; RPE. Toe clips and foot straps may be necessary in persons with tremors, spasticity, or weakness in the lower extremities. Begin with a warm-up of unloaded pedaling or cranking.
 Combination arm/leg cycle ergometry. Workload and steady-state heart rate to predict VO2peak; RPE. May reduce difficulty in individuals with lower extremity uncoordination
Experience.
 Arm ergometry—increase work rate 8–12 W per stage. Workload and steady-state heart rate to predict VO2peak;RPE. Alternative for persons with lower extremity weakness or paralysis.
Muscular Strength/Endurance
 30-s sit-to-stand test
 These tests are used to measure improvements and differences in pre- and postprogram performance but not to compare them to “healthy individuals.”
Number of times patient comes to a full stand with arms crossing a standard size chair. A functional measure of lower extremity strength, power, and muscle endurance.
 10RM Testing. Maximal weight lifted for 10 repetitions (reps). Machines provide test reliability, support, and joint stability. Remind patients to exhale on concentric action and avoid breath holding.
Flexibility
 Modified bench sit and reach test (1 ft on floor and other straight). Distance reached in hip/trunk flexion. Administer test with client seated on a table.
 Goniometry. Range of motion. Focus on flexibility of hamstrings, hip flexors, ankle plantar flexors, shoulder adductors, and internal rotators.
Power/functional
 Timed up and go test. Time to stand from a chair, walk a 3-m round trip, and sit back down on the same chair. Results correlate with gait speed, balance, functional level, the ability to go out.
 Five-times sit-to-stand test. Time to stand and sit 5 consecutive times on a standard size chair. Most useful in patients ≤60 y.
  1. BP blood pressure, RPE ratings of perceived exertion, HR heart rate, MS multiple sclerosis; RM, repetition maximum
  2. aRPE is a subjective rating scale ranging from six to 20 that gives an indication of the workout intensity level