It’s common knowledge that walking is good for your health. Walking on flat ground, walking in water, walking/marching in place, walking up and down the stairs. If you can do it, it’s all good. But not all forms of walking are created equal or offer the same benefits. Using a treadmill to walk on a slope just may help you to improve muscle performance, functional activity, and balance control if you live with multiple sclerosis (MS).
MS is a disease of the central nervous system that can impair mobility when symptoms affect sensory and motor function. Weakness, numbness, fatigue, balance problems are all symptoms of MS that interfere with mobility, stability, and quality of life. Neurological rehabilitation, exercise therapy, strength training, and conditioning are important interventions to help people with MS stay strong and active.
What is the effect of uphill or downhill walking on MS?
To investigate the specific effects of uphill and downhill walking exercise on mobility, functional activities, and muscle strength in MS patients, researchers at the Neuromuscular Rehabilitation Research Center at Semnan University of Medical Sciences conducted a study in 34 people with MS (aged 18-50, diagnosed with RRMS, have some difficulty walking, but able to walk 10 meters in less than 10 minutes with or without a cane).
Participants were randomly assigned to one of two treatment groups. Each group participated in 12 sessions (3 times/week) of 30 minutes walking on either a 10 percent negative slope (downhill walking) or a 10 percent positive slope (uphill walking). Intensity of training was measured by percentage of maximum heart rate (MHR; based on age and gender). Walking speed was initiated at 55 percent MHR and gradually increased each week to reach 85 percent MHR during the final week of training sessions.
Primary outcomes included functional activity, muscle strength, and balance control; and disability, mobility, and fatigue were considered to be secondary outcomes. Measurements related to outcomes were taken before and after the intervention and after a 4-week follow-up to assess the sustainability of possible changes in outcomes.
Concentric vs eccentric exercise
When you think of building muscles, what comes to mind? Do you picture Popeye and his spinach-enhanced bulging arms quickly doing 100 bicep curls? If so, you are picturing a typical concentric exercise.
Concentric muscle contraction involves the tightening of muscle accompanied by a shortening of muscle length. Concentric contraction helps to improve functional activity and causes muscular hypertrophy, an increase in muscle mass and cross-sectional area. Endurance training is often designed around concentric contraction of the involved muscles and walking uphill, as in the present study, is an example of concentric exercise.
Eccentric muscle contraction involves the tightening of muscle accompanied by an elongation of muscle length. To concentrate on eccentric contraction of the biceps, you would very slowly lower the barbell against gravity while you uncurl your arm in a controlled manner. Common examples of eccentric exercises include going downstairs, running downhill, lowering weights, and downward motion of squats. Eccentric exercises, such as walking downhill, have been shown to improve balance in elderly persons and increase muscle strength in people with Parkinson’s disease and MS.
The study results
Researchers found that aerobic downhill walking on a treadmill (eccentric exercise) is more effective in improving mobility, functional activity, and balance control, as well as reducing disability and fatigue in patients with MS, compared with aerobic uphill treadmill walking.
Eccentric muscle activity is needed to control human body movement against gravity, but is also associated with greater muscle soreness following training sessions. Researchers note that downhill treadmill walking requires less energy compared with uphill walking due to the lower total load placed on the involved muscles, which may explain the reduction in fatigue in this patient group.
In the present study, the downhill group experienced increased quadriceps muscle strength, accompanied by better functional activity as evidenced by the group’s ability to walk longer distances in the two-minute walk test and to need less time to complete other mobility tasks than the uphill group. Participants in the downhill group also experienced greater increase in balance control compared to the uphill group.
It should be noted that there were improvements in many of the outcome measures in this trial seen in both groups; however, the results were significantly in favor of downhill treadmill walking. Future research studying the effect of a combination of uphill and downhill training for people with MS could be of value. Limitations of this include the exclusion of non-ambulatory patients with MS and those with progressive disease, which reduce the transferability of results to other, more severely disabled, patient populations.
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Samael A, Bakhtiary AH, Hajihasani A, et al. Uphill and Downhill Walking in Multiple Sclerosis: A Randomized Controlled Trial. Int J MS Care. 2016 Jan-Feb;18(1):34-41. doi: 10.7224/1537-2073.2014-072.
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.