# Exercise as it relates to Disease/The effect of exercise on the management of Meniere's disease
### Background

Meniere's disease is an inner ear condition that is a result of excess fluid in the inner ear, this fluid disrupts the vestibular mechanism and results in a range of symptoms such as: (1,2)
* Balance disturbance at the low end moving to Vertigo at the extreme
* Tinnitus (continuous ringing in the ear) at the low end moving to complete loss of hearing
* A vague feeling of uneasiness to Nausea
* Increased pressure in the ear to headaches

## Explanation

Meniere's disease is thought to affect somewhere around one in every 600 Australians, numbers may be higher as there is no official reporting system for the disease, the majority of cases that are reported occurring between the ages of thirty and fifty. The exact cause of the disease remains unknown, although many theories have been proposed over time including; circulation issues, viral infection, allergies, migraine, autoimmune reaction and genetics. There is no known cure for the disease, and as such, treatment only exists to manage the symptoms. (3)

## Treatment

The use of drugs is primarily to reduce the severity of the symptoms; diuretics to remove fluid and limit the pressure on the inner ear and also anti-emetics to relieve the symptoms of nausea and suppress vomiting. Other areas of treatment include the adoption of a low-sodium diet, as the sodium causes the fluid build up in the ear a reduction in the amount of sodium present in the body would likely result in a reduction of the symptoms. (4)

#### Exercise

The introduction of exercise into the treatment process is a long term solution and seeks to have the patient essentially relearn balance at a base level. Any exercise should only be attempted to a point that it doesn't trigger the symptoms.(5) Working with an occupational therapist who specializes in vestibular rehabilitation can be helpful in creating an appropriate, individualized exercise program for patients.

##### Gentle

Meniere's sufferers have to adapt to a physical change within their own body, movement at a simple level is affected by the disruption to their balance. Exercises such as the Brandt and Daroff exercises work on regulating the build up of debris and sediment in the canals of the inner ear.(6) Stretching for the rest of the body is crucial for the next parts, allowing for full unrestricted movement.

##### Light

The ability to control the body through space is thought to switch on a connection between the brain and the body (kinaesthetic awareness) that is unseen in conventional weight bearing exercise.(7) This is of significance to those suffering from Meniere's as their connections have been reset due to the breakdown of their vestibular system. Simple calisthenics movements such as the push-up, pull-up, sit-up and bodyweight squat are the building blocks of bodyweight training. Performed correctly they are the key to the brain-body connection and the link to more advanced moves that can greatly increase proprioception and kinaesthetic awareness.

##### Heavy

Another variation of exercise would be to incorporate a weight (dumbbell, kettlebell) into the routine.(8) For the purposes of this process the kettlebell offers a greater level of stability and control. Using a single kettlebell for unilateral exercises can further enhance the foundation that the calisthenics put in place. The introduction of the weight throws up a new challenge for the brain-body pathway and allows for a stronger connection to be formed. A single-arm overhead press is a follow on from the push-up, a bent over row or high pull adds to the pull-up, the turkish get up adds to the foundation that the sit-up laid for the core, and the addition of the kettlebell to the bodyweight squat whether it be overhead, racked on the shoulder or performed as a goblet squat allows for reinforcement of the kinaesthetic awareness pathway.

## Recommendations
##### Coping

- basically coming to terms with the illness, acknowledging there is an issue and looking for the best course of action can limit the severity and allow for the best possible outcome.

##### Managing

- getting procedures in place to prevent episodes of Meniere's, and if they happen, having steps in place to deal with them.

##### Adjusting

- once all is said and done life must still go on. The changes that need to be made affect lifestyle, from diet (low sodium) to exercising, the change needs to be adopted wholly and followed through. (2) All of these steps are more easily attained and maintained with the help and support of family and friends. The more people there to help, the easier the 'new' life will be to live.

## References

* 1. http://www.menieres.org.au/menieres-disease.php
* 2. http://vestibular.org/menieres-disease
* 3. Brandt, T., & Daroff, R. B. (1980). Physical therapy for benign paroxysmal positional vertigo. Archives of Otolaryngology, 106(8), 484-485.
* 4. Santos, P. M., Hall, R. A., Snyder, J. M., Hughes, L. F., & Dobie, R. A. (1993). Diuretic and diet effect on Meniere's disease evaluated by the 1985 Committee on Hearing and Equilibrium guidelines. Otolaryngology—head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 109(4), 680-689.
* 5. Gottshall, K. R., Hoffer, M. E., Moore, R. J., & Balough, B. J. (2005). The role of vestibular rehabilitation in the treatment of Meniere's disease. Otolaryngology—Head and Neck Surgery, 133(3), 326-328.
* 6. Dix, M. R., & Hallpike, C. S. (1952). The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proceedings of the Royal Society of Medicine, 45(6), 341.
* 7. Garn, S. N., & Newton, R. A. (1988). Kinesthetic awareness in subjects with multiple ankle sprains. Physical Therapy, 68(11), 1667-1671.
* 8. Erbes, D. A. (2012). The Effect of Kettlebell Training on Body Composition, Flexibility, Balance, and Core Strength (Doctoral dissertation, University of Wisconsin—La Crosse).