Spasticity and limited walking ability are common and severe symptoms of multiple sclerosis (MS). Besides physiotherapy the treatment consists of endurance training. This randomized, controlled study investigated the influence of endurance training in normobaric, hypoxic conditions on mobility and endurance capacity of MS patients. PATIENTS AND METHODS: Participation was offered to all MS patients with sustained walking ability who have been admitted to inpatient rehabilitation in the Neurological Rehabilitation Center Quellenhof during the study period. These patients were randomized to one of three therapy groups. All patients received their individualized, symptom-specific rehabilitation program. Two of the groups participated in endurance training on a bicycle ergometer, six days a week for two weeks, either with mean sea level (ergometer group, EG) or hypoxic conditions (high altitude chamber group, HCG) (2,500m above sea level/15.5% vol%O2). The patients in the control group (CG) received their rehabilitation program only. At baseline, demographic and clinical data, EDSS, Barthel Index, walking ability (6-minute walking test, 6minWT, 10 meter walking test, 10mWT) and spasticity (Multiple Sclerosis Spasticity Scale, MSSS-88) were recorded and reevaluated at the end of the two week treatment period. RESULTS: Data of 32 patients were analyzed (age 43.4 +/- 7.5 years; m:f 10:22, EDSS 4.3 +/- 1.5). Eleven patients served as controls (CG). The patients in the training groups completed the bicycle ergometer training with an average duration of 526.6 +/- 40.2 minutes, eight patients under sea-level conditions (EG age 44.5 +/- 11.3 years; m:f 4:4), 13 under hypoxic conditions (HCG age 42.3 +/- 6.0 years; m:w 4:9). The total group (n = 32) showed a significant improvement (p <= 0.01) in the 6minWT and the MSSS-88 over time. In both training groups a significant improvement in spasticity was seen (MSSS-88: HCG p <= 0.01, EG p <= 0.05), but not in the CG. Walking distance (6minWT) was only significantly increased in the HCG (p <= 0.01). CONCLUSION: Endurance training is feasible in MS patients with sustained walking ability and has additional benefit compared to rehabilitation performed as usual. The combination of endurance training and exposure to hypoxic conditions is well tolerated by MS patients and increases endurance capacity compared to endurance training under normal conditions.

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