Pre­scribed ex­er­cise valu­able in de­liv­er­ing fit­ness and func­tion in MS pa­tients

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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

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