Fitness and exercise and multiple sclerosis

January 18, 2015   Fitness Articles
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Introduction

Multiple Sclerosis (MS) is an inflammatory condition which damages myelin sheats around the axons of the brain and spinal cord. The myelin sheath improves nerve conduction velocity and is crucial for communication between nerve cells. Damage or demyelination decreases nerve function which can lead to muscle weakness, muscle spasm and ataxia.1 These are some of the more common symptoms of MS, but is can take many different forms.1,2 Scientists have not found the cause of MS, however more evidence is pointing towards that MS is an auto-immune disorder.1 Patients suffering from MS are usually treated with medicines aimed at improving symptoms and physiotherapy or exercise therapy.3,4 The aim of these therapies is maintaining functioning, such as performing everyday tasks.5 Recently more research is performed to the effects of physical training on MS symptoms,4 however a complete overview is still lacking. The aim of this article is to review the effects of different forms of training on MS symptoms.

Cardiovascular training in MS patients

One study compared a group MS patients performing a weekly 90 minute Hatha Yoga class for six months with a group which performed weekly aerobic exercise on stationary bikes. Training intensity of the aerobic training was low. Before and after the six month training period, fatigue and mental health of the patients were assessed.5 Both groups showed improvements in quality of life and fatigue, particularly in energy level and mental health. These results are supported by a review by White & Dressendorfer, which claims that because of its effects on depression it should be recommended to MS patients as well since they are at increased risk of developing a from of depression.12 Aerobic exercise reduces fatigue and improves outlook on life and social participation.14 Additionally it improves endurance, breathing function, systolic blood pressure, resting heart rate and daily functioning.6,9,12,14,15 Furthermore it reduces risk of developing secondary complications caused by a sedentary lifestyle such as obesity, cardiovascular disease, diabetes and osteoporosis.14 According to reviews by Petajan et al. (2004), Rietberg et al. (2006) and Dalgas et al. (2008) aerobic training can safely be performed by MS patients to improve endurance, as long no exacerbations take place.6,9,10 Training intensity varied greatly between studies, from light on a BORG scale, to as much as 85% of maximum heart frequency if possible, which is according to ACSM guidelines for aerobic training.16 Whenever possible 30 to 60 minutes of exercise was performed each session. From the studies above it can be concluded that cardiovascular training has many advantages and can safely be prescribed for MS patients.

Resistance exercise in MS patients

Most people suffering from MS are sedentary because of a decreased ability to coordinate their muscles, which in turn causes muscle strength and daily functioning to decrease leading to a more sedentary lifestyle. 7,8,9 The decrease in muscle strength can be prevented or reversed by performing regular resistance exercise. 7,8,11 Additionally one study reports an improvement in walking pattern as a result of resistance exercise.8 Aside from this resistance exercise was found to have beneficial effects on fatigue, muscle endurance, osteoporosis, systolic and diastolic blood pressure, resting heart frequency, cardiovascular disease, daily functioning and psychosocial health. However resistance exercise did not have any effect on maintaining balance in MS patients. 6,8,9,11,12 The intensity and duration of training applied in these studies were adapted to the patients, taking a sedentary lifestyle and decreased exercise capacity into account, but one study exercised the patients at 10-15 repetitions at 70% of calculated 1 Repetition Maximum (1RM). According to several reviews, resistance training is a safe and effective method for MS patients to maintain muscle strength and daily functioning and to improve many symptoms of MS when training is adapted to the individual capabilities of the patient. 6,9,10

Other forms of exercise

Although less research has been performed to investigate the effects of different forms of training in MS patients, there is some evidence that training forms other than cardiovascular or resistance exercise have beneficial effects for MS patients. Exercises using a Swiss ball have considerable effects on maintaining balance. Additionally Tai Chi is seen as a useful form of exercise which is not only effective in maintaining strength and balance, but range of motion as well. Patients unable to perform these exercises are advised to perform balance and coordination exercises in a swimming pool, which improves flexibility, posture muscle tone and coordination.9

Conclusion

From the studies described in this article it can be concluded that a training program involving resistance and cardiovascular exercise are and effective methods to maintain muscle strength and coordination, balance, daily functioning and quality of life. Next to these effects important to MS patients, these exercise forms yield other beneficial effects pursued by healthy persons as well, such as increasing endurance, and decreasing the risk of cardiovascular disease and osteoporosis. Through training, MS patients are able to improve their health, are able to longer live independently. To achieve these effects it is vital that the training program is customized to the needs and capabilities of the MS patient, but when exercise status and general health permits, more intensive training has been proven very effective. All studies do recommend however that a physician is consulted prior to starting the training program.

References

  1. Kira, J. Etiology of Multiple Sclerosis. In: Cabrera-Gómez, J.A., Clerico, M., Contessa, G., Durelli, L., Giordano, L., Herndon, R.M., Kira, J., Lee, M.A., McDonnel, G.V., Palace, J., Shapire, R.T., Singhal, B.S. Multiple Sclerosis for the Practicing Neurologist. New York: Demos Medical Publishing, LLC; 2007. p. 1-6.2. McDonnel, G.V. Clinical Features of Multiple Sclerosis. In: Cabrera-Gómez, J.A., Clerico, M., Contessa, G., Durelli, L., Giordano, L., Herndon, R.M., Kira, J., Lee, M.A., McDonnel, G.V., Palace, J., Shapire, R.T., Singhal, B.S. Multiple Sclerosis for the Practicing Neurologist. New York: Demos Medical Publishing, LLC; 2007. p. 7-18.3. Eysink, P.E.D. In: Nationaal Kompas Volksgezondheid: Multiple sclerose (MS). (2010). RIVM. URL: http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/zenuwstelsel-en-zintuigen/multiple-sclerose-ms/4. Cabrera-Gomez, J.A. Rehabilitation in Multiple Sclerosis. In: Cabrera-Gómez, J.A., Clerico, M., Contessa, G., Durelli, L., Giordano, L., Herndon, R.M., Kira, J., Lee, M.A., McDonnel, G.V., Palace, J., Shapire, R.T., Singhal, B.S. Multiple Sclerosis for the Practicing Neurologist. New York: Demos Medical Publishing, LLC; 2007. p. 75-83.

    5. Oken, B.S., Kishiyama, S., Zajdel, D., Bourdette, D., Carlsen, J., Haas, M., Hugos, C., Kraemer, D.F., Lawrence, J., Mass, M. Randomized controlled trial of yoga and exercise in multiple sclerosis.(2004). Neurology, 62, 2058-2064.

    6. Dalgas, U., Stenager, E., Ingemann-Hansen, T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. (2008). Multiple Sclerosis 2008; 14: 35–53.

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    13. White, L.J., McCoy, S.C., Castellano, V., Stevens, J.E., Walter, G.A., Vandenborne, K. Resistance training improves strength and functional capacity in persons with multiple sclerosis. (2004). Multiple Sclerosis, 10, 668-674.

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