Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials.

Cognitive dual-task training was represented by only 2 studies, so the significant mobility effect for that subgroup rests on a very small evidence base. Only 2 of 18 studies (11%) monitored physical activity in the control groups, so it is unclear how much the control participants were already moving on their own. The limited number of studies per training type meant the authors could not test whether the effect depended on intervention duration or the patient's disability level. The overall composite score effect came with moderate heterogeneity (I² = 52%), and the effect sizes are small to moderate, which the authors note is hard to translate into meaningful change on the specific clinical tests used in practice. There is no standardized way to define or report intensity in balance training, so it is not possible to compare how hard different programs challenged the patient relative to their capacity.

Ulrik Dalgas has received research support, travel grants, and/or teaching honoraria from Biogen Idec, Bristol Myers Squibb, Merck Serono, Novartis, Bayer Schering, and Sanofi Aventis, as well as honoraria from serving on the scientific advisory boards of Biogen Idec and Genzyme. All other authors declare no conflict of interest. The authors received no financial support for the research, authorship, or publication.

Do not read the task-oriented training effect (ES = 0.76) as proof it outperforms other types. That subgroup did not reach significance, and the overall composite score effect came with 52% heterogeneity. Gait speed did not change for any training type, so a patient's walking speed is not a reliable indicator of whether balance training is working.