# Exercise as it relates to Disease/Effects of exercise on Multiple Sclerosis
## What is Multiple Sclerosis?

Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system. Multiple Sclerosis affects the brain and the spinal cord due to the damage of the myelin, axon and oligodendrocytes. There is a higher activation of the body's natural killer cells and these attack the myelin proteolipid protein.$^{(1)}$ The process of the demyelination of the axon slows down the conduction velocity of the axon. The slowing of conduction in the demyelinated motor and sensory tracts can cause problems in balance and gait (walking). This can also occur in the proprioceptive and visual pathways causing imbalance, in coordination and spastic movements.

## Problems Associated with Multiple sclerosis.

Multiple Sclerosis effects those between the ages of 20–50 years old. Majority of the MS population are physically inactive, due to symptoms such as fatigue than can make it very difficult to do so. This can lead to secondary diseases such as obesity and Coronary heart disease. Multiple Sclerosis causes many problems for sufferers in the areas of muscle, sensation, coordination and balance. These symptoms can make it hard for sufferers to lead normal lives as it can restrict their social interaction, lose their occupation, effect mental health and stops them from performing normal day to day tasks.

## Prevalence and Incidence

* In 2009 there was approximately 23,700 Australians living with Multiple Sclerosis. Of these it was found 48% had a severe core activity problem.
* Caucasians are more affected by Multiple Sclerosis than any other racial group.
* Women more likely to be diagnosed than men, with a 2:1 ratio of women to men being diagnosed.

## Symptoms of Multiple Sclerosis

| Symptoms | Effect on Patient. |
| Fatigue | Fatigue is one of the major symptoms associated with MS. 65% of individuals who suffer from MS reported some sort of fatigue limitations. 40% found it was the most debilitating symptom. MS fatigue is most frequently felt as tiredness or as muscle fatigue without any exercise Fatigue can also become progressively worse throughout the day, and can be affected by heat and humidity. |
| Muscle Weakness | By having muscle weakness or diminished muscle strength individuals with MS are limited to the activities in which they can perform and makes it especially hard to perform daily living tasks. The muscle weakness that patients experience could be down to two possible problems. The deterioration of the central nervous system and it's inability to activate the actual muscle. Being Physically inactive due to the disabling symptoms of MS. |
| Spastic Paresis | Motor neuron impairment in the upper body and causes over emphasized reflexes of the tendons (hyperflexia) and muscle weakness. An increase in temperature or the humidity can cause Spastic Paresis to increase. For MS patients high temperature's should be avoided in attempt to minimise the chances of spasticity. |
| Poor Balance | Multiple Sclerosis patients have diminished muscle strength and therefore their motor control is affected. To maintain balance, somatosensory and vestibular input needs to be unimpaired. In MS patients falls are a lot more prevalent, 2-3.4 times higher due to their balance being impaired because of poor judgment with is effected by diminished muscle strength. |

## Recommendations for Exercise.

At this point in time Multiple Sclerosis has no cure and so therefore the supportive interventions used to try and improve the daily lives of MS patients is important. One strategy that is considered important in the intervention and the slowing of the disease is Exercise. Exercise can help individuals suffering with MS to increase their fitness, help reduce fatigue and most importantly improve their quality of life. There are many different types of exercise which can be used to help patients with Multiple Sclerosis have the best quality of life and help manage some of the symptoms associated with MS,
| Type of Exercise | How it can help the MS patient. |
| Aquatic Exercise | Aquatic exercise is good for individuals with physical weakness's such as poor muscle strength, as the buoyancy of the water supports them. Also beneficial for patients who are sensitive to heat, the cooler water allows for the dissipation of heat at a far quicker rate. |
| Aerobic Activity | Recommended by the physical activity guidelines for adults with Multiple Sclerosis 30 minutes of moderate intensity, 2 times per week. This will give individuals with MS positive fitness benefits. |
| Strength Training | Needs to be individual so it can allow for increases in muscle tone, muscle strength, it will also aid individuals with balance. Different types of resistance can be used in able to load the muscle such as: Free Weights Weight Machines Elastic Bands What type of resistance used will largely be effected by the disability level of the individual. |
| Flexibility Exercise | Multiple Sclerosis patients have decreased muscle strength, muscle tone and regularly have some sort of reduced range of motion. Flexibility training can help to develop joint mobility and muscle length. Both of these factors can help with effects of spasticicity and also with balance. |

## Research Support on effects of exercise on Multiple Sclerosis.

* A study found that a 5 week Respiratory Muscle Training(RMT)program mixed with progressive resistance patients who suffered mild to moderate MS had improved inspiratory and expiratory muscle strength and also decreased fatigue.
* A study undertaken by Motl et al showed that individuals who participate in more exercise reported lower levels of fatigue.
* An 8 week aquatic exxercise program was undertaken and showed that individuals improved their level of fatigue and also their health related quality of life.

## Further reading

* Exercise and Multiple Sclerosis: http://web.ebscohost.com.ezproxy1.canberra.edu.au/ehost/pdfviewer/pdfviewer?sid=fa3cad26-1e2d-4301-b6f2-ff611257958e%40sessionmgr14&vid=7&hid=24.
* Multiple Sclerosis Australia Website: http://www.msaustralia.org.au/index.asp

## References.

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 White,L.,Dressendorfer, R.,Exercise and Multiple Sclerosis. Sports Medicine 2004 34: 1077-1100.
* 1 2 3 4 5 6 7 8 Horton, S.,MacDonald,D., Erickson.,K, MS, exercise, and the potential for older adults. European Review of Ageing and Physical Activity 2010 7: 49-57.
* 1 2 3 4 5 6 7 , Kargarfard et al, Effect of Aquatic Exercise training on fatigue and health related quality of life in patients with multiple sclerosis.Physical Medicane and Rehabilitation 2012 93: 1701-1708.
* 1 2 Kuspiner, A, Anderson, RE, Teng, SY, Asano, M, Mayo, NE, Predicting exercise capacity through submaximal fitness tests in persons with Multiple Sclerosis. Physical Medicane and Rehabilitation 2010 91: 1410-1417.
* 1 2 3 Latimer-Cheung et al, Development of Evidence- informed physical activity guidelines for adults with Multiple Sclerosis. Physical Medicane and Rehabilitation 2013 94: 1829-1836.
* 1 2 The Australian Bureau of Statistics, Multiple Sclerosis, viewed 22nd October,http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4429.0Main+Features100182009
* ↑ Multiple Sclerosis Australia, viewed 22nd October, http://www.msaustralia.org.au/aboutms/livingwithms-exercise.asp
* ↑ Ray, AD, Udhoji, S, Mashtare, TL, Fisher, NM., A combined Inspiratory and Expiratory muscle training program improves respiratory muscle strength and fatigue in Multiple Sclerosis. Physical Medicine and Rehabilitation 2013 94: 1964-1970.