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Exercise and Multiple Sclerosis: What are the facts?

What is MS?

MS is a progressive, autoimmune disorder involving neurodegeneration of the myelin sheath. The myelin sheath is what insulates our axons and allows for our electrical impulses to travel with speed and efficiency between nerve cells. In individuals with MS, this incurable and often debilitating neurological condition means the body’s own immune system mistakenly attacks this myelin in regions of the spinal cord and brain. This typically can occur at any time point between the ages of 20-50 years of age. While exact causation is still largely unknown, it involves interactions between our genetic makeup and the environment (1).


There are 4 main types of MS, all of which are varied in the way the conditions progress and the severity experienced. Clinically isolated syndrome can progress to the most common type, Relapsing-remitting MS, while primary progressive and secondary progressive are less common (2).


Prevalence

The most recent reports of the prevalence of MS in Australia is sitting at 25,600 individuals living with the condition, with >10 Australians diagnosed with MS weekly. Estimates on the cost to the community with MS is close to the $2.0 billion mark, with only 4 in 10 Australians considering MS to be a health priority in the community.



Common impairments and symptoms experienced

There are many factors that lead to a reduced quality of life in individuals with MS. Individuals can experience a range of symptoms which can vary from person to person and depend on a number of factors. Some of the most commonly experienced symptoms related to MS include muscle weakness and joint contractures, altered sensory functions, impaired cognition, bladder dysfunction and fatigue (2). These types of experiences can lead to a reduced quality of life, ability to perform activities of daily living, mobility and substantially increased falls risk which can have a cascading, detrimental effect level on physical activity levels, employment status, social participation and development of comorbidities (2,4).


Can exercise help?

Absolutely. To the degree at which exercise can help will vary and depend on the severity, accompanying conditions and the period of relapse or remission. The evidence base to date is strong and consistent in support of the many benefits of exercise, most notably in regards to improvements in muscular strength and cardiorespiratory fitness within this population (2). Other important benefits of exercise include improved mobility, balance, health-related quality of life, as well as reduced fatigue levels. Evidence supporting a positive effect of exercise for reducing the instances of relapses in re-lapse-remitting type MS, slowing of disability progression and possible disease-modifying effect is accumulating. Exercise also plays a very important role in reducing the risk of developing comorbidities (2,5).


PA Guidelines for adults with MS recommends aerobic training to initially starting from 10 minutes, progressing to 30 of moderate-intensity aerobic exercise on 2 days per week and progressing to 3 days when able to. Strength training is recommended 2-3 days per week, working all major muscle groups (2).


Is it safe?

Yes! Exercise training for individuals with MS has shown that exercise is not associated with increased risk or relapse of adverse events. There is however an increased susceptibility to delayed onset muscle soreness, increasing the need for a gradual progress of volume and intensity over time (6).

An exercise physiologist in this instance can become invaluable. Supervision, close control of variables, monitoring of fatigue levels and heat sensitivity are just some of the important factors our exercise physiologists consider when implementing safe and effective exercise programs to achieve the desired outcome.


References

  1. Cossburn, M., Ingram, G., Hirst, C., Ben-Shlomo, Y., Pickersgill, T. P., & Robertson, N. P. (2011, 2012/01/01). Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis. Multiple Sclerosis Journal, 18(1), 45-54. https://doi.org/10.1177/1352458511417479

  2. Hoang, P. D., Lord, S., Gandevia, S., & Menant, J. (2022, 2022/02/01/). Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. Journal of science and medicine in sport, 25(2), 146-154. https://doi.org/https://doi.org/10.1016/j.jsams.2021.08.015

  3. MS Australia, 2022. MS on the rise but still flying under the radar. https://www.msaustralia.org.au/news/ms-rise-australia-still-flying-radar/

  4. Mikula, P., Nagyova, I., Krokavcova, M., Vitkova, M., Rosenberger, J., Szilasiova, J., Gdovinova, Z., Groothoff, J. W., & van Dijk, J. P. (2015, 2015/01/01/). Social participation and health-related quality of life in people with multiple sclerosis. Disability and Health Journal, 8(1), 29-34. https://doi.org/https://doi.org/10.1016/j.dhjo.2014.07.002

  5. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta A, Mackibbon KA, et al. The effects of exercise training on fitness, mobility, fatigue, and health related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94(9):1800–28.

  6. Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci. 2014;343(1–2):3–7.






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