***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate the acute effects of long-term whole-body vibration on leg muscle performance and functional capacity in persons with multiple sclerosis . DESIGN A r and omized controlled trial . SUBJECTS Twenty-five patients with multiple sclerosis ( mean age 47.9 ± 1.9 years ; Exp and ed Disability Status Scale 4.3 ± 0.2 ) were assigned r and omly to whole-body vibration training ( n = 11 ) or to a control group ( n = 14 ) . METHODS The whole-body vibration group performed static and dynamic leg squats and lunges on a vibration platform ( 25 - 45 Hz , 2.5 mm amplitude ) during a 20-week training period ( 5 training sessions per 2-week cycle ) , and the control group maintained their usual lifestyle . PRE- , MID- ( 10 weeks ) and POST- ( 20 weeks ) knee-muscle maximal isometric and dynamic strength , strength endurance and speed of movement were measured using isokinetic dynamometry . Function was determined through the Berg Balance Scale , Timed Up and Go , Two-minute Walk Test and the Timed 25-Foot Walk Test . RESULTS Leg muscle performance and functional capacity were not altered following 10 or 20 weeks of whole-body vibration . CONCLUSION Under the conditions of the present study , the applied 20-week whole-body vibration exercise protocol did not improve leg muscle performance or functional capacity in mild- to moderately impaired persons with multiple sclerosis during and immediately after the training programme BACKGROUND Balance disorders are common in multiple sclerosis . AIM Aim of the study is to investigate the effectiveness of an Internet-based home training program ( e-Training ) to improve balance in patients with multiple sclerosis . DESIGN A r and omized , controlled study . SETTING Academic teaching hospital in cooperation with the therapeutic riding center Gut Üttingshof , Bad Mergentheim . POPULATION Eighteen multiple sclerosis patients ( mean EDSS 3,5 ) took part in the trial . Outcome of patients using e-Training  ( N.=9 ) was compared to the outcome of patients receiving hippotherapy ( N.=9 ) , which can be considered as an advanced concept for the improvement of balance and postural control in multiple sclerosis . METHODS After simple r and om allocation patients received hippotherapy or Internet-based home training ( balance , postural control and strength training ) twice a week for 12 weeks . Assessment s were done before and after the intervention and included static and dynamic balance ( primary outcome ) . Isometric muscle strength of the knee and trunk extension/flexion ( dynamometer ) , walking capacity , fatigue and quality of life served as secondary outcome parameters . RESULTS Both intervention groups showed comparable and highly significant improvement in static and dynamic balance capacity , no difference was seen between the both intervention groups . However looking at fatigue and quality of life only the group receiving hippotherapy improved significantly . CONCLUSION Since e-Training shows even comparable effects to hippotherapy to improve balance , we believe that the established Internet-based home training program , specialized on balance and postural control training , is feasible for a balance and strength training in persons with multiple sclerosis . CLINICAL REHABILITATION IMPACT We demonstrated that Internet-based home training is possible in patients with multiple sclerosis Background Patients suffering from Multiple Sclerosis ( MS ) experience a wide array of symptoms , including balance problems , mobility impairment , fatigue and depression . Physical exercise has recently been acknowledged as a treatment option complementary to medication . However , information regarding putative effects of structured exercise programs on neurological symptoms is sparse . Tai Chi , a Chinese martial art incorporating physical exercise and mindfulness training , has been shown to yield health benefits in various neurological groups . It seems particularly suitable for patients with motoric deficits as it challenges coordination and balance . The purpose of the current study was to explore the therapeutic value of structured Tai Chi training for coordination , balance , fatigue and depression in mildly disabled MS patients . Methods A sample of 32 MS patients ( Exp and ed Disability Status Scale , EDSS < 5 ) was examined . A structured Tai Chi course was devised and a Tai Chi group participated in two weekly sessions of 90 minutes duration for six months , while a comparison group received treatment as usual ( TAU ) . Both groups were examined prior to and following the six-months interval with regards to balance and coordination performance as well as measures of fatigue , depression and life satisfaction . Results Following the intervention , the Tai Chi group showed significant , consistent improvements in balance , coordination , and depression , relative to the TAU group ( range of effect-sizes : partial η2 = 0.16 – 0.20 ) . Additionally , life satisfaction improved ( partial η2 = 0.31 ) . Fatigue deteriorated in the comparison group , whereas it remained relatively stable in the Tai Chi group ( partial η2 = 0.24 ) . Conclusions The consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients . Further research is needed to determine underlying working mechanisms , and to verify the results in a larger sample and different MS subgroups Background Multiple Sclerosis ( MS ) is a disease of the central nervous system that results in many symptoms including mobility limitation and fatigue . Patients and Methods Thirty-one MS patients , all female with mean of age of 36.75 years and Exp and ed Disability Status Scale scores ( EDSS ) of 1.0 to 4.0 were recruited . Subjects were r and omly assigned to one of the three groups : treadmill training , yoga or control groups . Treadmill training and yoga practice consisted of 8 weeks ( 24 sessions , thrice weekly ) . The control group followed their own routine treatment program . Balance , speed and endurance of walking , fatigue , depression and anxiety were measured by Berg Balance scores , time for 10 m walk and distance for a two minute walk , Fatigue Severity Scale ( FFS ) , Beck Depression Inventory ( BDI ) and Beck Anxiety Inventory ( BAI ) , respectively . Results Comparison of results have shown that pre- and post- interventions produced significant improvements in the balance score , walking endurance , FFS score , BDI score and BAI score in the treadmill training group and yoga group . However , 10 m walk time decreased in the treadmill training group but did not show any clear change in the yoga group . Moreover , the analysis showed significant differences between the treadmill training group and yoga group for BAI score . Conclusions These results suggest that treadmill training and yoga practice improved ambulatory function , fatigue and mood status in the individuals with mild to moderate MS Objective : The primary aim was to investigate the comparative effects of massage therapy and exercise therapy on patients with multiple sclerosis . The secondary aim was to investigate whether combination of both massage and exercise has an additive effect . Design : R and omized controlled pilot trial with repeated measurements and blinded assessment s. Setting : Local Multiple Sclerosis Society . Subjects : A total of 48 patients with multiple sclerosis were r and omly assigned to four equal subgroups labelled as massage therapy , exercise therapy , combined massage – exercise therapy and control group . Interventions : The treatment group received 15 sessions of supervised intervention for five weeks . The massage therapy group received a st and ard Swedish massage . The exercise therapy group was given a combined set of strength , stretch , endurance and balance exercises . Patients in the massage – exercise therapy received a combined set of massage and exercise treatments . Patients in the control group were asked to continue their st and ard medical care . Main measures : Pain , fatigue , spasticity , balance , gait and quality of life were assessed before and after intervention . Results : Massage therapy result ed in significantly larger improvement in pain reduction ( mean change 2.75 points , P = 0.001 ) , dynamic balance ( mean change , 3.69 seconds , P = 0.009 ) and walking speed ( mean change , 7.84 seconds , P = 0.007 ) than exercise therapy . Patients involved in the combined massage – exercise therapy showed significantly larger improvement in pain reduction than those in the exercise therapy ( mean change , 1.67 points , P = 0.001 ) . Conclusions : Massage therapy could be more effective than exercise therapy . Moreover , the combination of massage and exercise therapy may be a little more effective than exercise therapy alone Background : Resistance training studies in multiple sclerosis ( MS ) often use short intervention periods . Furthermore , training efficiency could be optimized by unilateral training and /or electrical stimulation . Objective : To examine the effect(s ) of unilateral long-term ( 20 weeks ) st and ardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility . Methods : A r and omized controlled trial involving 36 persons with MS . At baseline ( PRE ) and after 10 ( MID ) and 20 ( POST ) weeks of st and ardized ( ACSM ) light to moderately intense unilateral leg resistance training ( RESO , n = 11 ) only or resistance training with simultaneous electro-stimulation ( RESE , n = 11 , 100 Hz , biphasic symmetrical wave , 400 µs ) , maximal isometric strength of the knee extensors and flexors ( 45 ° , 90 ° knee angle ) and dynamic ( 60–180 ° /s ) knee-extensor strength was measured and compared with a control group ( CON , n = 14 ) . Functional mobility was evaluated using the Timed Get Up and Go , Timed 25 Foot Walk , Two-Minute Walk Test , Functional Reach and Rivermead Mobility Index . Results : Maximal isometric knee extensor ( 90 ° , MID : + 10 ± 3 % , POST : + 10 ± 4 % ) in RESO and knee flexor ( 45 ° , POST : + 7 ± 4 % ; 90 ° , POST : + 9 ± 5 % ) in RESE strength increased ( p < 0.05 ) compared with CON but RESO and RESE did not differ . Also , impaired legs responded positively to resistance training ( unilateral leg strength analysis ) and functional reaching increased significantly in RESO ( + 18 % ) compared with CON . Dynamic muscle strength and the remaining functional mobility tests did not change . Conclusion : Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome BACKGROUND People with Multiple Sclerosis ( PwMS ) are less physically active than the general population and pragmatic approaches design ed to equip them with the skills and confidence to participate in long-term physical activity are required . OBJECTIVE The objective of this study was to determine the feasibility of a pragmatic exercise intervention in PwMS . METHODS A voluntary sample of 30 PwMS ( male n = 4 , female n = 26 ; mean age = 40 years ; range = 24 - 49 years ) , with mild to moderate disability ( EDSS ≤ 5.5 ) , were recruited from eligible participants attending outpatient clinics . A total of 28 participants were r and omised to a 10 week pragmatic exercise intervention ( 2 × supervised and 1 × home-based session per week ) or usual care . Clinical , functional and quality of life ( MSQoL-54 ) outcomes were assessed at baseline , immediately and 3 months after the intervention . RESULTS Attrition was low ( 2 participants lost to immediate follow-up and 4 participants lost to 3 month follow-up ) , with high compliance rates ( > 75 % of all sessions ) . The intervention group achieved progression of exercise volume ( 24.3 ± 7.0 to 30.9 ± 5.5 min per session ) , intensity ( 60.4 ± 8.8 to 67.7 ± 6.9 % HR max ) and training impulse ( min × average HR = training impulse/load [ arbitrary units ; AU ] ) ( 2600 ± 1105 to 3210 ± 1269AU ) during the intervention , whilst significantly increasing(P = 0.050 ) their physical composite score ( MSQOL-54 ) at 10 weeks and readiness to exercise ( P = 0.003 ) at 3 months compared with usual care . CONCLUSION This pragmatic intervention was feasible for PwMS , but further research is needed to assess its long-term impact on physical activity behaviour Background : Extensive research on both healthy subjects and patients with central nervous damage has eluci date d a crucial role of postural adjustment reactions and central sensory integration processes in generating and “ shaping ” locomotor function , respectively . Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis ( MS ) patients is not fully investigated in literature . Purpose : The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training ( RAGT ) and sensory integration balance training ( SIBT ) in improving walking and balance performance in patients with MS . Methods : Twenty-two patients with MS ( EDSS : 1.5–6.5 ) were r and omly assigned to two groups . The RAGT group ( n = 12 ) underwent end-effector system training . The SIBT group ( n = 10 ) underwent specific balance exercises . Each patient received twelve 50-min treatment sessions ( 2 days/week ) . A blinded rater evaluated patients before and after treatment as well as 1 month post treatment . Primary outcomes were walking speed and Berg Balance Scale . Secondary outcomes were the Activities-specific Balance Confidence Scale , Sensory Organization Balance Test , Stabilometric Assessment , Fatigue Severity Scale , cadence , step length , single and double support time , Multiple Sclerosis Quality of Life-54 . Results : Between groups comparisons showed no significant differences on primary and secondary outcome measures over time . Within group comparisons showed significant improvements in both groups on the Berg Balance Scale ( P = 0.001 ) . Changes approaching significance were found on gait speed ( P = 0.07 ) only in the 
    Output:
    
Given the number of MS relapses reported for the exercise condition ( N = 25 ) and non-exercise control condition ( N = 26 ) , exercise does not seem to be associated with a significant risk of a MS relapse .
However , in general , MS relapses were defined and reported poorly .
Exercise therapy can be prescribed in people with MS without harm .
Exercise therapy , and particularly endurance , mixed , or ' other ' training , may reduce self reported fatigue .