No RCTs or CCTs in patients with MS were identified which assessed interventions to treat weakness. Four RCTs assessed interventions for cardiovascular dysfunction. Two trials examined the efficacy of expiratory muscle training vs sham training in patients who were bedridden or wheelchair bound (EDSS score 6.5-9.5). The first trial reported no overall significant improvement in the intervention group, whilst the second trial showed mixed results. Significant beneficial effects were reported for expiratory muscle strength, but not for inspiratory strength.319,320 The third study examined the effectiveness of an aerobic exercise training program. The results indicated positive effects on four out of eleven of the outcome measures assessed, namely aerobic capacity, physical work capacity, isometric strength and skinfold thickness. No effect however was seen on any of the general health indices measured.321 The last trial assessed the use of music therapy with relaxation and diaphragmatic breathing in patients who were wheelchair bound. The results showed no significant effect322 (Ib).
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