{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:42:30Z","timestamp":1782272550496,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Sports Sci Med Rehabil"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Gait dysfunction is a pervasive and debilitating symptom in people with multiple sclerosis (pwMS), characterized by reduced walking speed, shorter stride length, increased gait variability, and compromised postural control, significantly reducing quality of life. The aim of this study is to examine the effects of various exercise modalities on gait biomechanics, evaluate the role of progressive training principles in optimizing outcomes, and provide an evidence-based framework for individualized gait rehabilitation in MS, with the goal of developing targeted exercise strategies to effectively address the multifactorial nature of gait impairments.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>This narrative review critically examines the biomechanical outcomes of structured exercise interventions for gait rehabilitation in pwMS, focusing on kinematic (e.g., joint angles), kinetic (e.g., ground reaction forces), and spatiotemporal (e.g., stride length, gait speed) parameters. It also assesses the role of progressive training principles, such as overload and task specificity, in optimizing functional outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus (2005 to February 2025) following PRISMA guidelines. Randomized controlled trials (RCTs) and non-randomized trials evaluating structured exercise interventions targeting gait biomechanics in pwMS were included. Although this is a narrative review, a PRISMA-style flowchart was used to transparently illustrate the literature selection process.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The review included 15 RCTs and 6 non RCTs with sample sizes ranging from 8 to 50 participants, covering resistance training, aerobic conditioning, balance exercises, cognitive-motor training, and multimodal approaches. Key findings indicated that resistance training improved joint torque and stride length, aerobic training enhanced gait speed and endurance, and multimodal protocols yielded the most comprehensive biomechanical benefits.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>High-intensity, task-specific training significantly improves gait biomechanics in pwMS, but the heterogeneity in study designs, small sample sizes, and limited follow-up periods highlight the need for more standardized RCTs. Personalized, progressive training remains essential for optimizing gait rehabilitation outcomes in this population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13102-025-01339-4","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:10:21Z","timestamp":1760443821000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical insights into gait rehabilitation for multiple sclerosis: a narrative review of exercise modalities and progressive training approaches"],"prefix":"10.1186","volume":"17","author":[{"given":"Sara","family":"Sepehrifar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour","family":"Sahebozamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"17","key":"1339_CR1","doi-asserted-by":"publisher","first-page":"6397","DOI":"10.3390\/ijerph17176397","volume":"17","author":"C Guti\u00e9rrez-Cruz","year":"2020","unstructured":"Guti\u00e9rrez-Cruz C, Rojas-Ruiz FJ, De la Cruz-M\u00e1rquez JC, Guti\u00e9rrez-D\u00e1vila M. Effect of a combined program of strength and dual cognitive-motor tasks in multiple sclerosis subjects. Int J Environ Res Public Health. 2020;17(17):6397.","journal-title":"Int J Environ Res Public Health"},{"key":"1339_CR2","doi-asserted-by":"publisher","first-page":"105113","DOI":"10.1016\/j.msard.2023.105113","volume":"80","author":"SS Far","year":"2023","unstructured":"Far SS, Amiri B, Sahebozamani M, Ebrahimi HA, Zemkov\u00e1 E. The effect of multi-function swing suspension training on upper and lower extremities function and quality of life in multiple sclerosis women with different disability status. Multiple Scler Relat Disorders. 2023;80:105113.","journal-title":"Multiple Scler Relat Disorders"},{"issue":"1","key":"1339_CR3","doi-asserted-by":"publisher","first-page":"e086941","DOI":"10.1136\/bmjopen-2024-086941","volume":"15","author":"SNS Ahmad","year":"2025","unstructured":"Ahmad SNS, Shojaedin SS, Tazji MK. Comparative effects of dual-task training versus combined exercise training in water and on land on patients with multiple sclerosis: a study protocol of a randomised factorial trial. BMJ Open. 2025;15(1):e086941.","journal-title":"BMJ Open"},{"issue":"15","key":"1339_CR4","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1080\/09638288.2016.1224935","volume":"39","author":"A Peruzzi","year":"2017","unstructured":"Peruzzi A, Zarbo IR, Cereatti A, Della Croce U, Mirelman A. An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis. Disabil Rehabil. 2017;39(15):1557\u201363.","journal-title":"Disabil Rehabil"},{"issue":"7","key":"1339_CR5","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.apmr.2015.02.011","volume":"96","author":"M Pearson","year":"2015","unstructured":"Pearson M, Dieberg G, Smart N. Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta-analysis. Arch Phys Med Rehabil. 2015;96(7):1339\u201348. e7.","journal-title":"Arch Phys Med Rehabil"},{"key":"1339_CR6","doi-asserted-by":"crossref","unstructured":"Uzuno\u011flu GE, Yeldan \u0130, Gozubatik-Celik RG, Kuchimov SN, T\u00fct\u00fcnc\u00fc M. Effect of vestibular rehabilitation on kinetic and kinematic parameters of gait in patients with multiple sclerosis: A single-blind randomized controlled study. Multiple Scler Relat Disorders. 2025:106283.","DOI":"10.1016\/j.msard.2025.106283"},{"key":"1339_CR7","doi-asserted-by":"publisher","first-page":"101698","DOI":"10.1016\/j.arr.2022.101698","volume":"80","author":"T Hortob\u00e1gyi","year":"2022","unstructured":"Hortob\u00e1gyi T, Vetrovsky T, Balbim GM, Silva NCBS, Manca A, Deriu F, et al. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing Res Rev. 2022;80:101698.","journal-title":"Ageing Res Rev"},{"key":"1339_CR8","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/j.jbmt.2024.06.013","volume":"40","author":"AR Alashram","year":"2024","unstructured":"Alashram AR. Effects of closed kinetic chain exercises on balance and gait in people with multiple sclerosis: A randomized controlled trial. J Bodyw Mov Ther. 2024;40:914\u201320.","journal-title":"J Bodyw Mov Ther"},{"issue":"10","key":"1339_CR9","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1177\/02692155211010372","volume":"35","author":"A Martino Cinnera","year":"2021","unstructured":"Martino Cinnera A, Bisirri A, Leone E, Morone G, Gaeta A. Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis. Clin Rehabil. 2021;35(10):1399\u2013412.","journal-title":"Clin Rehabil"},{"key":"1339_CR10","doi-asserted-by":"publisher","first-page":"102794","DOI":"10.1016\/j.msard.2021.102794","volume":"49","author":"N Morelli","year":"2021","unstructured":"Morelli N, Morelli H. Dual task training effects on gait and balance outcomes in multiple sclerosis: A systematic review. Multiple Scler Relat Disorders. 2021;49:102794.","journal-title":"Multiple Scler Relat Disorders"},{"key":"1339_CR11","doi-asserted-by":"publisher","first-page":"105415","DOI":"10.1016\/j.msard.2023.105415","volume":"82","author":"M Parsaei","year":"2024","unstructured":"Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Moghadasi AN. Effects of non-pharmacological interventions on gait and balance of persons with multiple sclerosis: A narrative review. Multiple Scler Relat Disorders. 2024;82:105415.","journal-title":"Multiple Scler Relat Disorders"},{"issue":"8","key":"1339_CR12","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.2522\/ptj.20100399","volume":"91","author":"JR Hebert","year":"2011","unstructured":"Hebert JR, Corboy JR, Manago MM, Schenkman M. Effects of vestibular rehabilitation on multiple sclerosis\u2013related fatigue and upright postural control: a randomized controlled trial. Phys Ther. 2011;91(8):1166\u201383.","journal-title":"Phys Ther"},{"issue":"9","key":"1339_CR13","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1016\/j.apmr.2005.04.008","volume":"86","author":"GM Gutierrez","year":"2005","unstructured":"Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Castellano V, White LJ. Resistance training improves gait kinematics in persons with multiple sclerosis. Arch Phys Med Rehabil. 2005;86(9):1824\u20139.","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"1339_CR14","doi-asserted-by":"publisher","first-page":"6","DOI":"10.7224\/1537-2073-12.1.6","volume":"12","author":"ML Filipi","year":"2010","unstructured":"Filipi ML, Leuschen MP, Huisinga J, Schmaderer L, Vogel J, Kucera D, et al. Impact of resistance training on balance and gait in multiple sclerosis. Int J MS Care. 2010;12(1):6\u201312.","journal-title":"Int J MS Care"},{"issue":"11","key":"1339_CR15","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1177\/1352458519865740","volume":"26","author":"J Callesen","year":"2020","unstructured":"Callesen J, Cattaneo D, Brincks J, Kjeldgaard J\u00f8rgensen M-L, Dalgas U. How do resistance training and balance and motor control training affect gait performance and fatigue impact in people with multiple sclerosis? A randomized controlled multi-center study. Multiple Scler J. 2020;26(11):1420\u201332.","journal-title":"Multiple Scler J"},{"issue":"4","key":"1339_CR16","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1002\/pri.1636","volume":"21","author":"SM Br\u00e6ndvik","year":"2016","unstructured":"Br\u00e6ndvik SM, Koret T, Helbostad JL, Lor\u00e5s H, Br\u00e5then G, Hovdal HO, et al. Treadmill training or progressive strength training to improve walking in people with multiple sclerosis? A randomized parallel group trial. Physiotherapy Res Int. 2016;21(4):228\u201336.","journal-title":"Physiotherapy Res Int"},{"issue":"1","key":"1339_CR17","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/NPT.0b013e3182477c92","volume":"36","author":"RW Motl","year":"2012","unstructured":"Motl RW, Smith DC, Elliott J, Weikert M, Dlugonski D, Sosnoff JJ. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study. J Neurol Phys Ther. 2012;36(1):32\u20137.","journal-title":"J Neurol Phys Ther"},{"key":"1339_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clinbiomech.2018.12.012","volume":"62","author":"M Heine","year":"2019","unstructured":"Heine M, Richards R, Geurtz B, Los F, Rietberg M, Harlaar J, et al. Preliminary effectiveness of a sequential exercise intervention on gait function in ambulant patients with multiple sclerosis\u2014A pilot study. Clin Biomech Elsevier Ltd. 2019;62:1\u20136.","journal-title":"Clin Biomech Elsevier Ltd"},{"issue":"6","key":"1339_CR19","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/1357633X17702757","volume":"24","author":"SS Conroy","year":"2018","unstructured":"Conroy SS, Zhan M, Culpepper WJ, Royal W III, Wallin MT. Self-directed exercise in multiple sclerosis: evaluation of a home automated tele-management system. J Telemed Telecare. 2018;24(6):410\u20139.","journal-title":"J Telemed Telecare"},{"issue":"3","key":"1339_CR20","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1177\/0269215516637202","volume":"31","author":"A Kalron","year":"2017","unstructured":"Kalron A, Rosenblum U, Frid L, Achiron A. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: A randomized controlled trial. Clin Rehabil. 2017;31(3):319\u201328.","journal-title":"Clin Rehabil"},{"issue":"2","key":"1339_CR21","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/1352458512450088","volume":"19","author":"YE Nilsag\u00e5rd","year":"2013","unstructured":"Nilsag\u00e5rd YE, Forsberg AS, von Koch L. Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Multiple Scler J. 2013;19(2):209\u201316.","journal-title":"Multiple Scler J"},{"issue":"4","key":"1339_CR22","doi-asserted-by":"publisher","first-page":"292","DOI":"10.3138\/ptc.2016-19","volume":"69","author":"S Escudero-Uribe","year":"2017","unstructured":"Escudero-Uribe S, Hochsprung A, Heredia-Camacho B, Izquierdo-Ayuso G. Effect of training exercises incorporating mechanical devices on fatigue and gait pattern in persons with relapsing-remitting multiple sclerosis. Physiotherapy Can. 2017;69(4):292\u2013302.","journal-title":"Physiotherapy Can"},{"issue":"12","key":"1339_CR23","doi-asserted-by":"publisher","first-page":"2095","DOI":"10.1016\/j.apmr.2016.05.024","volume":"97","author":"BL Davies","year":"2016","unstructured":"Davies BL, Arpin DJ, Liu M, Reelfs H, Volkman KG, Healey K, et al. Two different types of high-frequency physical therapy promote improvements in the balance and mobility of persons with multiple sclerosis. Arch Phys Med Rehabil. 2016;97(12):2095\u2013101. e3.","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"1339_CR24","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1007\/s00415-022-11469-1","volume":"270","author":"I Galperin","year":"2023","unstructured":"Galperin I, Mirelman A, Schmitz-H\u00fcbsch T, Hsieh KL, Regev K, Karni A, et al. Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial. J Neurol. 2023;270(3):1388\u2013401.","journal-title":"J Neurol"},{"issue":"2","key":"1339_CR25","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1080\/09638288.2016.1244291","volume":"40","author":"M Pau","year":"2018","unstructured":"Pau M, Corona F, Coghe G, Marongiu E, Loi A, Crisafulli A, et al. Quantitative assessment of the effects of 6 months of adapted physical activity on gait in people with multiple sclerosis: a randomized controlled trial. Disabil Rehabil. 2018;40(2):144\u201351.","journal-title":"Disabil Rehabil"},{"issue":"5","key":"1339_CR26","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1111\/ane.13704","volume":"146","author":"L Andreu-Caravaca","year":"2022","unstructured":"Andreu-Caravaca L, Ramos\u2010Campo DJ, Chung LH, Manonelles P, Abell\u00e1n\u2010Ayn\u00e9s O, Rubio\u2010Arias J\u00c1. Effects of fast\u2010velocity concentric resistance training in people with multiple sclerosis: A randomized controlled trial. Acta Neurol Scand. 2022;146(5):652\u201361.","journal-title":"Acta Neurol Scand"},{"issue":"1","key":"1339_CR27","first-page":"27","volume":"60","author":"M Tramontano","year":"2023","unstructured":"Tramontano M, Argento O, Bustos ASO, De Angelis S, Montemurro R, Bossa M, et al. Cognitive-motor dual-task training improves dynamic stability during straight and curved gait in patients with multiple sclerosis: a randomized controlled trial. Eur J Phys Rehabil Med. 2023;60(1):27.","journal-title":"Eur J Phys Rehabil Med"},{"key":"1339_CR28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.gaitpost.2020.02.017","volume":"78","author":"A Manca","year":"2020","unstructured":"Manca A, Peruzzi A, Aiello E, Cereatti A, Martinez G, Deriu F, et al. Gait changes following direct versus contralateral strength training: A randomized controlled pilot study in individuals with multiple sclerosis. Gait Posture. 2020;78:13\u20138.","journal-title":"Gait Posture"},{"issue":"11","key":"1339_CR29","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1177\/1352458511409084","volume":"17","author":"KJ Dodd","year":"2011","unstructured":"Dodd KJ, Taylor N, Shields N, Prasad D, McDonald E, Gillon A. Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial. Multiple Scler J. 2011;17(11):1362\u201374.","journal-title":"Multiple Scler J"},{"issue":"1","key":"1339_CR30","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12883-015-0281-9","volume":"15","author":"A Kalron","year":"2015","unstructured":"Kalron A, Nitzani D, Magalashvili D, Dolev M, Menascu S, Stern Y, et al. A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort. BMC Neurol. 2015;15(1):21.","journal-title":"BMC Neurol"}],"container-title":["BMC Sports Science, Medicine and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13102-025-01339-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13102-025-01339-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13102-025-01339-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:02:10Z","timestamp":1760486530000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsportsscimedrehabil.biomedcentral.com\/articles\/10.1186\/s13102-025-01339-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1339"],"URL":"https:\/\/doi.org\/10.1186\/s13102-025-01339-4","relation":{},"ISSN":["2052-1847"],"issn-type":[{"value":"2052-1847","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"24 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"297"}}