Prescribed exercise valuable in delivering fitness and function in MS patients
MULTIPLE sclerosis (MS) is one of the most common diseases of the central nervous system (CNS) among young adults in Australia, and most commonly occurs between the ages of 20 and 40. It is a chronic disease where the covering of the nerve fibres (myelin) in the brain and spinal cord become damaged. This may cause a range of symptoms including fatigue, muscular weakness, loss of balance, and other impairments in the person’s autonomy and quality of life. The disabling nature of the disease often has a significant psychological impact, resulting in depression and/or anxiety.
There is now strong evidence that exercise can improve fitness and function for those with mild MS, and assist in maintaining function in those with moderate to severe disability. Several different forms of exercise programs, lasting from six to 15 weeks, have been investigated, including both facility and homebased routines.
These studies have shown that exercise therapy increases muscle strength and endurance, exercise capacity, decreases fatigue and improves quality of life ( Annales de Reeadap- tation et de Medecine Physique , 2007;50:373-376). Many MS experts view exercise therapy as a cornerstone treatment alongside drugs, and advise that it be performed continually to maintain and restore maximum function and quality of life.
Many people with MS, however, still limit their physical activity because they fear exacerbating their symptoms. In fact, decreased physical activity results in deconditioning and reduced fitness, which inevitably results in an increase in symptoms. General Tips: Exercise in a cool environment. Avoid exercise during warmer periods of the day (10am to 2pm).
For people beginning exercise, start with 10-minute bouts and progressively increase duration while monitoring symptoms during and following exercise.
Reduce or stop exercising if you experience any significant discomfort, or vision is affected.
Exercise in a safe environment — avoid slippery floors, or areas with potential tripping hazards.
Cardiovascular or aerobic exercise: MS patients have been shown to significantly improve their cardiorespiratory fitness and walking capacity in as little as eight weeks of an aerobic exercise program using a stationary bicycle ( Physical Therapy , 2007;87(5):545-555).
It is recommended that people with MS use the rating of perceived exertion (RPE) scale (or Borg Scale), which ranges from 6 to 20 (6 means no exertion at all, and 20 means maximal exertion). Ratings of 11-14 represent moderate intensity; however, this scale enables the person to adjust their exercise workload to accommodate changes in symptoms. Strength levels may be deficient and require resistance (strength) training prior to aerobic exercise.
Resistance training: Resistance (strength) training increases strength and function to tolerate daily activities, thus reducing fatigue. Programs should comprise six-eight exercises addressing the upper and lower limbs performed two-three sessions per week (nonconsecutive days). It is advised the program is commenced at a light intensity during the first few weeks, and progresses to higher resistances (subject to symptoms during and following strength training sessions). Exercise sessions should not exceed 30 minutes duration.
Strength training may be performed using elastic exercise bands or calisthenic-based exercises, enabling home-based exercise for patients who are unable to access strength training machines.
Water-based activities: Hydrotherapy or aquatic exercise assists patients with weakened limbs to increase their range of motion and maintain or enhance cardiorespiratory fitness. Chest-high water enables people with greater disability to support themselves to stand and maintain balance with less effort than landbased activities. Moderately cool water temperatures (27-29C) are recommended to help dissipate body heat generated during exercise.
Flexibility exercises: Stretching may increase joint mobility, counteract the effects of spasticity, and maintain posture and balance. Current consensus recommends stretching daily for all major muscle groups, including the shoulders and hips. Stretches are best performed after aerobic or resistance training sessions and should be held for 30-45 seconds.
People with MS present with their own complex and unique circumstances including varying symptoms and their triggers, as well as physical ability. Consequently, they require tailored exercise prescription and management to ensure optimum outcomes minimise any potential adverse effects. An exercise program may often require alterations during exacerbation of symptoms in order to increase adherence. It is advised that people with MS who wish to commence an exercise program consult with their local exercise physiologist. Chris Tzar is an exercise physiologist and director of the Lifestyle Clinic, Faculty of Medicine, University of NSW