Multiple Sclerosis – Pathology and Exercise Intervention (Part 1)

Multiple Sclerosis is a chronic neurological disease that is characterised by partial inflammation of the sheath surrounding nerves within the central nervous system (Cochrane Collaboration, 2011). As a result, the damaged sheath surrounding the nerves forms scar tissue and prevents nerve cells to transmit signals – resulting in unpredictable symptoms that range from numbness or tingling to blindness and paralysis, these losses can be temporary or permanent (Multiple Sclerosis Australia, 2012). It is the third most common cause of neurological disability in adults between 18 to 50 years and affects 2.5 million people worldwide. Among the 23 000 Australians who are affected, 75% of this population is female. Despite some disability, most people with MS can anticipate a near normal life expectancy, however in some cases it presents so malignant that it is terminal.

As damage occurs to the nervous system throughout the body, resulting symptoms of MS are vast and unpredictable. These symptoms can include irregularities to heart rate, temperature regulation, blood pressure, respiratory rate, sleep and sexual function. Specifically, MS Australia suggests that 60-90% of people with MS will suffer from heat sensitivity. It is a significant issue as even a small rise in body temperature can reduce the speed of transmitted signals and decrease muscle movement capacity. Generally, the symptoms experienced by an individual with MS are associated with one another. For example, sleep dysfunction is experienced by 45-60% of patients (MS Australia, 2009) and is a result of sleep related breathing disturbances, immobility, leg muscle spasms and pain. The lack of sleep experienced can cause daytime fatigue, which is the primary issue reported amongst the MS population.

Each symptom can pose different challenges to an individual, and exercise intervention plays a key role in overcoming these issues and minimising their effects. A patient and health professional must be sensitive to daily variations in symptoms and be aware of factors that exacerbate them to gain the most benefit with least regression.

 

20 years ago, patients were commonly advised to avoid strenuous physical activity or exercise based on preserving energy, avoiding fatigue and eliminating the risk of exacerbation of disease symptoms. However, one of the primary aims of rehabilitation for patients with MS is to increase their levels of activity and participation in exercise to increase their independence (Cochrane Collaboration, 2011). Since then, a growing body of evidence has indicated that exercise is of benefit and a holistic approach, that includes medication and exercise, is best. Despite research being unable to provide a gold standard of exercise guidelines, ACSM (2006) advocates for exercise as a treatment to increase muscular strength, cardiorespiratory endurance, reduce feelings of fatigue and depression, increase balance and proprioception and increase quality of life as MS patients can perform most activities of daily life.

 

Part 2 of our blog on MS will focus on specific exercise intervention and how it can maintain and improve the daily life of those with the motor neuron condition. Stay tuned!

Ed Daccache, B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist

 

References

MS Australia. (2012). Understanding MS: An introduction for people living with MS. Retrieved form http://www.mssociety.org.au/documents/publications/Understanding-MS-Aug2012.pdf

MS Australia (2009). Practice: Aquatic Exercise for people with multiple sclerosis (MS). Retrieved from http://www.msaustralia.org.au/documents/MS-Practice/aquatic.pdf

MS Australia (2006). Strength and cardiorespiratory exercise for people with multiple sclerosis (MS). Retrieved from https://www.msaustralia.org.au/file/279/download?token=BV-Rv_Ly

Kan, F., Turner-Stokes, L., Ng, L., Kilpatrick, T. and Amatya, B (2007). Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews. Retrieved from http://www.cochrane.org/CD006036/MS_multidisciplinary-rehabilitation-as-supportive-treatment-for-adults-with-multiple-sclerosis