Effects of a 6-week treadmill training with and without virtual reality on frailty in people with multiple sclerosis: a randomized controlled trial

Research Objectives: To investigate the effects of a multimodal cognitive-motor rehabilitation intervention on frailty in people with multiple sclerosis (pwMS).

Design: Secondary analysis from the Virtual Reality for MS (VR4MS) study (NCT02427997), a 6-week multi-center randomized controlled trial investigating the effects of virtual reality treadmill training (VRTT), compared to treadmill training (TT) only, on measures of mobility and cognition.

Setting: The study was conducted at four clinical sites in Israel, United States, and Germany.

Participants: We studied a subset of 83 participants (mean age=49.4±9.3 years, 73.5% female, Expanded Disability Status Scale: 2.0-6.0) from the VR4MS study who completed the intervention, and with complete pre- and post-intervention frailty data.

Interventions: Participants completed six weeks of VRTT (n=44) or TT (n=39). Both groups received 13–18 (maximum) 60-minute training sessions (thrice weekly for six weeks). VRTT participants walked on a treadmill while navigating through a virtual environment projected on a TV screen by means of a VR system. TT participants walked on a treadmill without any VR component.

Main Outcome Measures: Frailty was assessed by means of a 40-item frailty index (FI) through standard validated procedures. Two sensitivity frailty indexes were also computed by removing health-related deficit items involving the cognitive (FI-physical) or physical (FI-cognitive) domain from the main FI.

Results: The mean FI of study participants at baseline was 0.33±0.13. FI scores improved in both VRTT and TT participants (time effect: F=10.49, p=0.002, ηp2=0.115), without any group-by-time interaction (F=0.82, p=0.367, ηp2=0.010). In addition, while FI-physical improved similarly in both groups, a significant group-by-time interaction was found for FI-cognitive (F=5.74, p=0.019, ηp2=0.066), indicating that FI-cognitive scores improved in VRTT participants but not in TT participants.

Conclusions: Treadmill training with or without virtual reality can reduce frailty levels in pwMS. While both TT and VRTT had a positive impact on overall frailty, only VRTT improved cognitive aspects of frailty, and it may therefore represent a suitable strategy to counteract frailty in pwMS.

Author(s) Disclosures: N/A.