Abstract
Background: People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments,
including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the
body’s stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single
case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary
evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is
needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best
effect.
This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised
controlled study, with the aims of:
1 Establishing the effectiveness of core stability training
2 Comparing core stability training with standardised physiotherapy exercise
3 Exploring underlying mechanisms of change associated with this intervention
Methods: This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be
recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core
stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will
receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All
will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week
follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS
walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to
determine “Difficulty in carrying a drink when walking”, and the Activities-specific Balance Confidence (ABC) Scale.
In addition, ultrasound imaging of the abdominal muscles will be performed before and after intervention to
assess changes in abdominal musculature at one of the four centres (Plymouth).
Discussion: This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with
MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory.
Trial registration: ClinicalTrials.gov: NCT01414725
Keywords: Multiple sclerosis, Mobility, Balance, Exercise, Physiotherapy, Core stability
