Cardiopulmonary Exercise Testing Using the Modified Balke Protocol in Fully Ambulatory People With Multiple Sclerosis

Area of Science:

• Exercise Physiology
• Neurology
• Rehabilitation Medicine

Background:

• Multiple sclerosis (MS) is a chronic neurological disease affecting ambulatory function.
• Assessing aerobic capacity in MS is crucial for understanding disease impact and guiding rehabilitation.
• Standardized exercise testing protocols are needed to evaluate physiological responses in MS populations.

Purpose of the Study:

• To evaluate the safety, feasibility, and validity of cardiopulmonary exercise testing (CPET) using a modified Balke protocol in fully ambulatory individuals with MS.
• To examine the relationship between CPET-derived outcomes and established measures of disability, walking endurance, and cognitive function in MS.

Main Methods:

• Twenty fully ambulatory individuals with MS underwent a maximal CPET on a motor-driven treadmill with indirect calorimetry.
• Assessments included disability (EDSS), walking endurance (6MWD), and cognition (SDMT).
• Physiological outcomes (e.g., peak V̇o₂, VE, HR) and test validity (maximal effort) were recorded; correlations with clinical measures were analyzed.

Main Results:

• The modified Balke protocol CPET was safe, with no serious adverse events.
• Seventeen out of 20 tests were deemed maximal and interpretable.
• Peak oxygen uptake (V̇o₂ peak) in the MS group was lower than normative values for healthy individuals.
• V̇o₂ peak positively correlated with cognitive function (SDMT) and walking endurance (6MWD), and negatively correlated with disability (EDSS).

Conclusions:

• Cardiopulmonary exercise testing (CPET) utilizing a modified Balke protocol on a motorized treadmill is a safe and feasible method for assessing aerobic capacity in ambulatory individuals with MS.
• The CPET protocol is valid, as its outcomes correlate significantly with key clinical indicators of MS.
• This testing can provide valuable physiological data to complement clinical assessments in MS management.