Document Type : Research Paper I Open Access I Released under CC BY-NC 4.0 license


1 Department of sport physiology and Biomechanics. Faculty of sport Sciences. University of Mazandaran. Babolsar. Iran

2 Department of Exercise Physiology, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran

3 Department of Neurology, Mobility impairment Research Center, Health Research Institue, Babol University of Medical Sciences, Babol,Iran

4 Department of Sport Biomechanics and Motor Behavior, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran


Multiple sclerosis affects normal life of the patients as it affects their motor performance. This study aimed to investigate strength, range of motion and balance in multiple sclerosis patients in the active and inactive groups. In this cross-sectional, ex-post facto study, 72 patients with MS and 38 healthy subjects as the control group from Mazandaran province participated voluntarily in this study. They were divided into four groups: active control (n=18), inactive control (n=20), active MS (n=27) and inactive MS (n=45). The maximum strength of quadriceps, trunk extensors, range of motion of quadriceps, hamstring, gastrocnemius and soleus muscles in both legs and balance were assessed through static and dynamic plantar pressure MAT tests. All findings were analyzed by one-way ANOVA test. The results showed significant differences in maximal strength (P=0.008), strength of the trunk extensors (P=0.001), static balance (P=0.006), COP changes with open eyes (P=0.001), and closed eyes (P=0.001) between the active and inactive groups. Contrary to the perception of those involved in MS (i.e. physical activity does not affect their functional or physiological symptoms), the results showed that given the difference between active and inactive subjects, it seems that physical activity in these patients minimizes those symptoms associated with the disease, especially in balance and strength.


1.   Stedman TL. Stedman's medical dictionary for the health professions and nursing: Lippincott Williams & Wilkins; 2005.
2.   Kent-Braun J, Ng A, Castro M, Weiner M, Gelinas D, Dudley G, et al. Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J APPL PHYSIOL. 1997;83(6):1998-2004.
3.   Ingram D, Thompson A, Swash M. Central motor conduction in multiple sclerosis: evaluation of abnormalities revealed by transcutaneous magnetic stimulation of the brain. J Neurol Neurosurg Psychiatry. 1988;51(4):487-94.
4.   Van der Kamp W, de Noordhout AM, Thompson P, Rothwell J, Day B, Marsden C. Correlation of phasic muscle strength and corticomotoneuron conduction time in multiple sclerosis. Ann Neurol. 1991;29(1):6-12.
5.   McDonald I, Compston A. The symptoms and signs of multiple sclerosis. McAlpine's multiple sclerosis. 2006; 4:327-33.
6.   Huntley A, Ernst E. Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review. COMPLEMENT THER MED . 2000;8(2):97-105.
7.   Howard J, Trevick S, Younger DS. Epidemiology of multiple sclerosis. NEUROL CLIN . 2016;34(4):919-39.
8.   Ahmadi A, Nikbakh M, Arastoo A, Habibi A-H. The effects of a yoga intervention on balance, speed and endurance of walking, fatigue and quality of life in people with multiple sclerosis. J Hum Kinet . 2010; 23:71-8.
9.   Kamalian Lari S, Haghgoo HA, Farzad M, Hosseinzadeh S. Investigation of the Validity and Reliability of Balance Evaluation Systems Test (BESTest) in Assessment of Balance Disorders in People with Multiple Sclerosis. Arch Phys Med Rehabil . 2018;18(4):288-95.
10. Cattaneo D, De Nuzzo C, Fascia T, Macalli M, Pisoni I, Cardini R. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil . 2002;83(6):864-7.
11. Bernier JN, Perrin DH. Effect of coordination training on proprioception of the functionally unstable ankle. J Orthop Sports Phys Ther . 1998;27(4):264-75.
12. Da Cunha Jr IT, Lim PA, Qureshy H, Henson H, Monga T, Protas EJ. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Arch Phys Med Rehabil . 2002;83(9):1258-65.
13. Krishnan V, Kanekar N, Aruin AS. Anticipatory postural adjustments in individuals with multiple sclerosis.  Neurosci. Lett. 2012;506(2):256-60.
14. Sandrini G, Homberg V, Saltuari L, Smania N, Pedrocchi A, editors. Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Springer; 2018 Jan 30. 47-67.
15. Varalta V, Fonte C, Munari D. The Influence of Cognitive Factors on Balance and Gait. Advanced Technologies for the Rehabilitation of Gait and Balance Disorders: Springer; 2018. p. 121-34.
16. Karst GM, Venema DM, Roehrs TG, Tyler AE. Center of pressure measures during standing tasks in minimally impaired persons with multiple sclerosis. J Neurol Phys Ther. 2005;29(4):170-80.
17. Pratt C, Horak F, Herndon R. Differential effects of somatosensory and motor system deficits on postural dyscontrol in multiple sclerosis patients. GAIT POSTURE. 1992; 2:118-21.
18. DePino GM, Webright WG, Arnold BL. Duration of maintained hamstring flexibility after cessation of an acute static stretching protocol. J Athl Train. 2000;35(1):56.
19. Zakas A, Balaska P, Grammatikopoulou MG, Zakas N, Vergou A. Acute effects of stretching duration on the range of motion of elderly women. J Bodyw Mov Ther. 2005; 9(4): 270-276.
20. Mannion A, Adams M, Cooper R, Dolan P. Prediction of maximal back muscle strength from indices of body mass and fat-free body mass. Rheumatology (Oxford). 1999;38(7):652-5.
21. Yang Y-R, Lee Y-Y, Cheng S-J, Lin P-Y, Wang R-Y. Relationships between gait and dynamic balance in early Parkinson's disease. Gait Posture . 2008;27(4):611-5.
22. Frzovic D, Morris ME, Vowels L. Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehabil. 2000;81(2):215-21.
23. Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Med Prog Technol. 1990;16(1-2):31-51.
24. Nakamura H, Tsuchida T, Mano Y. The assessment of posture control in the elderly using the displacement of the center of pressure after forward platform translation. J Electromyogr Kinesiol. 2001;11(6):395-403.
25. Peurala SH, Könönen P, Pitkänen K, Sivenius J, Tarkka IM. Postural instability in patients with chronic stroke. Restor Neurol Neurosci. 2007;25(2):101-8.
26. Ghaffari S, Ahmadi F, Nabavi SM, Kazem-Nezhad A. Effects of applying hydrotherapy on quality of life in women with multiple sclerosis. J Rehabil. 2008;9(3):43-50.
27. Farhadian M, Bozorgi J, Asghar A, Ahmadi Fakhreh M, Morovati Z, Qafarizadeh F. Effect of gait retraining on balance, activities of daily living, quality of life and depression in stroke patients. IRAN Rehabil J. 2015;13(4):116-9.
28. Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to resistance exercise and training. Sports Med. 2005;35(4):339-61.
29. Garner DJ, Widrick JJ. Cross‐bridge mechanisms of muscle weakness in multiple sclerosis. Muscle Nerve 2003;27(4):456-64.
30. Rice CL, Vollmer TL, Bigland‐Ritchie B. Neuromuscular responses of patients with multiple sclerosis.  Muscle Nerve. 1992;15(10):1123-32.
31.  White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports med. 2004;34(15):1077-100.