Background: Exercise improves cardiorespiratory and musculoskeletal fitness for people with multiple sclerosis (MS). Recent work suggests that employing a task-oriented approach to exercise, which involves repetitive, goal-directed task practice that targets specific functional deficits, may enhance motor function in people with MS. Yet, whether task-oriented exercise is superior to other types of exercise in improving motor function in people with MS is not known.
Objectives: To conduct a scoping review that: 1) Characterizes task-oriented exercise interventions used in research for people with MS, and 2) Considers evidence for task-oriented exercise effects on motor function that are distinct from other types of exercise.
Methods: A comprehensive search of multiple databases was performed to identify studies published between 2000 and 2021 that evaluated exercise effects on upper- and/or lower-extremity motor function in people with MS. Study designs included were randomized controlled trials, single group pre/post, and quasi-experimental designs evaluating the effects of task-oriented, cardiorespiratory, resistance, or other (e.g., balance, flexibility) exercise on motor function. Studies were excluded if the intervention was inadequately described or <2 weeks in duration. Two reviewers extracted relevant data from each study.
Results: Thirty-seven studies were initially identified, with 32 meeting review criteria. Exercise interventions included elements of cardiorespiratory, resistance, neuromotor, task-oriented training, and various combinations. Eight of the 32 studies included task-oriented elements, with four focused on the upper-extremity, one on the lower-extremity, and three on both the upper-and lower-extremity. When task-oriented elements were included, they were commonly delivered in circuit formats, with variable frequencies (2-5×/week) and durations (2-18 weeks). Activities focused on walking, balance, agility, functional tasks, and hand dexterity (grasping, reaching, pinching targets, and other bimanual tasks). Task-oriented exercise interventions appeared to enhance walking, balance, and arm and hand function in people with MS, with limited evidence for maintenance of functional gains. It is not currently possible to determine if task-oriented exercise effects on motor function are distinct from, or greater than, those elicited by other types of exercise.
Conclusions: The results indicate a need to systematically develop and compare targeted exercise intervention strategies to determine which are most effective for improving motor function for people with MS.
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