Multiples Sclerosis – Pathology and Exercise Intervention (Part 2)

Continuing from our previous discussion on Multiple Sclerosis (MS), we will now focus on the mode and intensity of exercise.

Several studies in recent years have produced exciting results about the benefit of exercise in people with MS (Giacobbi, Deitrich, Larson, White p.224, 2012). Generally, the goal of exercise may simply be to slow any further physical deterioration and optimize remaining function. Exercise can break the progressive cycle of deconditioning and aid to prevent comorbidities. An individual with MS will generally anticipate a reduction in symptoms when undergoing treatment as physical activity can reduce feelings of fatigue by increasing the efficiency of energy utilisation.

When addressing the relief of symptoms associated with MS, a patient and an Exercise Physiologist must aim to increase one’s balance and proprioception. Impairment in balance can incur a variety of issues such as reduced gait speed, increased sway in stance and reduced ankle ROM. To aid in balance and proprioception an Exercise Physiologist may implement hydrotherapy as well as yoga and pilates. Furthermore, investigations into the effects of hydrotherapy indicated improvements in strength, cardiovascular endurance, fatigue, quality of life and psychological well-being.

When implementing a balance programme, the training goal is to reduce falls and enhance an individual’s confidence and freedom to complete activities of daily living (MS Australia- Balance, 2009). Spasticity is a common sign of MS resulting in sudden contractions of muscles that cause extension or flexion (MS Australia – Spasticity, 2009). Stretch and resistance training are common modalities to help aid spasticity. This can include utilizing body weight, free weights and machines with high repetitions and low weight to assist in everyday activities.

Cardiorespiratory training includes exercise at a low to moderate intensity which has potential effects on both physiology and psychology among people with MS (MS Australia – Strength and Cardiorespiratory, 2009). Cardio training improves lung function, aerobic threshold and oxygen uptake.

A health professional will maximize therapy by taking into patient temperature. Ideally, one would train in cooler environments (hydrotherapy pools) and in shorter bouts to avoid impaired thermoregulation. To maximise the benefits of exercise, full recovery days between strength and training are ideal and allows for alternating sessions between aerobic and strength.

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

 

References

Giacobbi, P., Dietrich, F., Larson, R., White, L. (2012). Exercise and Quality of Life in Women with Multiple Sclerosis. Adapted Physical Activity Quarterly, 29, 224-242.

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. (2009). Practice: Management of complex symptoms in Multiple Sclerosis (MS). Retrieved from http://www.msaustralia.org.au/documents/MS-Practice/complex-management.pdf

MS Australia. (2009). Practice: Strength and cardiorespiratory exercise for people with multiple sclerosis (MS). Retrieved from http://www.msaustralia.org.au/documents/MS-Practice/strength.pdf