Backward vs Forward Walking Training for Multiple Sclerosis

(TRAIN-BW Trial)

Overseen By Nora Fritz, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Wayne State University

Disqualifiers: Neurological disorder, Orthopedic injury, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 8 weeks

90 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to reduce the risk of falls in people with multiple sclerosis (MS) by comparing backward walking training to traditional forward walking training. Falling is a common issue for people with MS, and the study will explore whether practicing backward walking can improve balance and reduce falls more effectively. Participants will join one of two programs: backward walking or forward walking training, each lasting eight weeks with sessions once a week plus home exercises. Individuals diagnosed with MS, who have trouble walking, and have experienced two or more falls in the past six months might be a good fit.

As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance mobility and safety for individuals with MS.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this walking training is safe for individuals with multiple sclerosis?

Research has shown that backward walking exercises are safe for people with multiple sclerosis (MS). In one study, nearly all participants adhered to the program without safety issues, indicating they could follow it without major problems.

Similarly, forward walking exercises are also safe for people with MS. A study comparing backward and forward walking found no harmful effects, suggesting both exercise types are generally safe for those with MS.

Both backward and forward walking exercises aim to improve strength and balance, helping reduce the risk of falls in people with MS. Overall, these walking programs are considered safe, with no major safety concerns reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring a novel approach to improve mobility for people with Multiple Sclerosis (MS) through specific walking techniques. Unlike traditional physical therapy that often focuses on forward walking and general exercises, this trial compares the effects of backward walking training alongside forward walking training. Backward walking may engage different muscle groups and improve balance in ways that forward walking does not. By comparing these two methods, the trial could uncover new strategies to enhance walking ability and quality of life for those with MS.

What evidence suggests that this trial's treatments could be effective for reducing fall risk in multiple sclerosis?

This trial will compare Backward Walking Training (BWT) with Forward Walking Training (FWT) for individuals with multiple sclerosis (MS). Research has shown that practicing walking backward can improve balance, walking skills, and overall movement in people with MS. Studies indicate that this training can make walking steadier and safer, potentially reducing the risk of falls, a common concern for those with MS. Conversely, walking forward is the usual practice and has also been proven to enhance balance in people with MS. Both backward and forward walking exercises can improve walking ability and may help reduce fatigue in people with MS. These findings suggest that both methods can effectively address mobility challenges in MS. ^{2 5 6 7 8}

Who Is on the Research Team?

Nora Fritz, PhD

Principal Investigator

Wayne State University

Are You a Good Fit for This Trial?

This trial is for individuals with multiple sclerosis who have trouble walking or have fallen at least twice in the past six months. They must be able to walk with or without help most of the time and not be in a current MS relapse. People can't join if they have other neurological disorders, can't follow instructions, or have recent orthopedic injuries.

Inclusion Criteria

I can walk with or without help more than half the time.

I have been diagnosed with multiple sclerosis (MS).

I often have trouble walking or have fallen twice or more in the last 6 months.

Exclusion Criteria

I have had an MS flare-up in the last 30 days.

I have a neurological disorder.

I can follow instructions related to the study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo backward walking training or forward walking training once a week for 8 weeks, along with a home exercise program

8 weeks

8 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including the number of falls reported in a 6-month period

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Backward Walking Training
• Forward Walking Training

Trial Overview The study compares backward walking training (BW) to forward walking training (FW) to see which is better at improving motor function and reducing fall risk in people with multiple sclerosis. It's checking if BW training could be a feasible and acceptable method for these patients.

How Is the Trial Designed?

Group I: TRAIN-BW Experimental Treatment 1 Intervention

1x/week for 8 weeks + home exercise program

Group II: TRAIN-FW Active Control 1 Intervention

1x/week for 8 weeks + home exercise program

Who Is Running the Clinical Trial?

Wayne State University

Lead Sponsor

Trials

318

Recruited

111,000+

Published Research Related to This Trial

Backward walking training (BWT) significantly improved various motor functions in stroke patients, including walking speed, cadence, balance, and step lengths, based on a meta-analysis of seven studies.

The analysis showed that BWT led to measurable improvements in the 10-meter walk test, cadence (4 steps/minute increase), and balance (4.38 points on the Berg balance scale), indicating its effectiveness as a rehabilitation strategy for stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Backward Walking Training Impacts Positive Effect on Improving Walking Capacity after Stroke: A Meta-Analysis. Wen, H., Wang, M.[2023]

An eight-week study involving 29 participants with Parkinson's disease showed that both forward and backward gait retraining programs improved usual gait speed, with backward walking showing additional benefits in cadence and stride length.

Backward walking training (BWG) was particularly effective, leading to significant improvements in gait parameters, which may help reduce fall risk and enhance mobility in daily activities for individuals with Parkinson's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson's disease: A randomized controlled trial. Grobbelaar, R., Venter, R., Welman, KE.[2018]

A backward walking (BW) intervention was found to be feasible and safe for individuals with multiple sclerosis (MS), with a high adherence rate of 99.7% and no safety concerns reported during the study.

Participants in the BW group showed significant improvements in dominant hip flexion strength compared to those in the forward walking (FW) group, suggesting that BW may be an effective method to enhance strength in individuals with MS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. DelMastro, HM., Ruiz, JA., Simaitis, LB., et al.[2023]

Backward walking (BW) training using body weight supported treadmill training (BWSTT) showed greater improvements in the 5-repetition sit-to-stand test compared to forward walking (FW) training in a 57-year-old male with incomplete spinal cord injury, indicating its potential efficacy for enhancing specific functional movements.

Both BW and FW training resulted in similar improvements in overall gait parameters and aerobic endurance, suggesting that BWSTT can be a beneficial alternative to traditional forward walking training for individuals with spinal cord injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: a single subject design. Moriello, G., Pathare, N., Cirone, C., et al.[2022]

In a study involving 19 people with multiple sclerosis, backward walking training (BWT) combined with conventional walking training (CWT) led to significant improvements in balance, gait, and functional mobility compared to CWT alone after 8 weeks of training.

The experimental group that received BWT showed enhanced performance in multiple assessments, including the Berg Balance Scale and the Dynamic Gait Index, indicating that BWT can be an effective addition to rehabilitation strategies for individuals with MS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study. Soke, F., Aydin, F., Karakoc, S., et al.[2023]

Body weight supported (BWS) treadmill training results in smaller trunk and pelvis movement amplitudes in persons with multiple sclerosis (PwMS) compared to walking without BWS, indicating a potential limitation in the effectiveness of this training method.

The study suggests that using a BWS level lower than 30% may be more beneficial for treadmill training, as higher levels may restrict natural movement patterns essential for rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trunk kinematics during walking in persons with multiple sclerosis: the influence of body weight support. Swinnen, E., Baeyens, JP., Pintens, S., et al.[2014]

An additional backward walking (BW) training program, combined with standard inpatient rehabilitation, led to significant improvements in balance and walking ability in eight patients less than two weeks post-stroke, despite their severe impairments.

All participants showed clinically meaningful increases in forward walking speed, indicating that BW training can be an effective intervention for enhancing rehabilitation outcomes in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical application of backward walking training to improve walking function, balance, and fall-risk in acute stroke: a case series. DeMark, L., Fox, EJ., Spigel, PM., et al.[2020]

Backward walking (BW) training significantly improves gait velocity and balance in stroke patients compared to conventional treatments, based on a meta-analysis of ten studies.

The improvements in balance (Berg balance score) and walking performance were statistically significant, indicating that BW training can be an effective rehabilitation strategy for stroke patients, although more high-quality research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of backward walking for people affected by stroke: A systematic review and meta-analysis of randomized controlled trials. Chen, ZH., Ye, XL., Chen, WJ., et al.[2021]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/37683559/

Effects of backward walking training on balance, gait, and ... Conclusion: BWT in addition to CWT is an effective way to improve balance, gait, and functional mobility for PwMS. These results suggest that BWT may be a ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04091464

TRAIN-BW: Backward Walking Training in Multiple Sclerosis The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure.

3. ijmsc.org ijmsc.org/view/effect-of-backward-and-forward-walking-on-lower-limb-strength-balance-and-gait-in-multiple-sclerosis-a-randomized-feasibility-trial

Effect of Backward and Forward Walking on Lower Limb ... Backward walking (BW) interventions have improved gait and balance in persons with stroke, cerebral palsy, and Parkinson disease but have not ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40668389/

Structural and Functional Changes With 8 Weeks of ... Participants demonstrated decreases in sway area during static balance tasks (7/8), decreases in postural latency during reactive stepping (7/8) ...

5. lermagazine.com lermagazine.com/special-section/conference-coverage/backward-walking-training-in-ms

Backward Walking Training in MS… They concluded that a single session of PBBT may be effective in improving fall risk outcome measures in MS in a clinic setting where time and resources are ...

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1551714424002040

Study protocol of a randomized controlled trial comparing ... This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7495208/

Backward Walking and Dual-Task Assessment Improve ... In MS, deficits in balance and postural control are increased during backward walking and significantly correlate with severity on clinical ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11988391/

Backward Walking as a Marker of Mobility and Disability in ... Conclusions: The B-T25FW is a clinically relevant, practical, and sensitive tool for assessing mobility impairments in individuals with MS. Its ...