# Exercise as it relates to Disease/Aerobic or Resistance training for Multiple Sclerosis?
## What is Multiple Sclerosis?

Multiple Sclerosis is the demyelinating inflammatory disease of the CNS with subsequent destruction of myelin, oligodendrocytes and axons. The disease process involves the activation and transport of inflammation cells to brain. The exact cause and sequence that leads to this process are yet to be determined; however we do know increased activation of natural killer cells to attack myelin proteolipid protein characterizes the pathogenesis of MS. Myelin plays the role of speeding up nerve impulses. Demyelination compromises nerve fiber function by slowing axonal conduction velocity $^$. MS can cause axial injury or death. Altered conduction in motor and sensory tracts within the CNS can disturb gait and balance, increase the risk of falls and reduce daily lifestyle activity $^{[2]}$. MS symptoms include balance issues, lack of proprioception, visual problems, muscle weakness and fatigue, elimination dysfunction, depression and anxiety, and a higher risk of respiratory diseases, heart disease, and metabolic disorders$^$. Multiple Sclerosis affects 23,000 Australians, 73% of which are women. The mean age of diagnosis is 30years.

## What causes MS?

Although we understand the chemical process of MS the cause which starts the process has not yet been discovered.

## Treatment of MS

MS is an incurable disease however there are different avenues that can be taken to try to prevent or slow its progression. Not only does the actual disease need to be treated, but also the symptoms that can debilitate sufferers. MS is a disease that can affect sufferers constantly or in relapses$^{[3]}$.
Depending on the type of symptoms and their severity there are different types of drugs which doctors prescribe. Researchers are exploring the positive implications of physical exercise to improve functional capacity and quality of life in MS patients, this can include aerobic and resistance training but also other types of exercise including yoga and aqua aerobics.

## Benefits of Exercise

| Aerobic Exercise | Resistance Exercise |
| Increased: * Ability to undertake day-to-day activities * Aerobic work capacity * VO$_2$max$^{[1]}$ * Lung function (VC and FEV1)$^$ * Ventilatory muscle strength - increasing maximal inspiratory and expiratory pressures$^{[1]}$ * Weight loss * Improves exercise tolerance Other benefits: * Reduces incidences and severity of depression and anxiety * Improves general psychological well being$^$ | Increased: * Improved balance$^{[10]}$ * Motor performance and coordination$^{[10]}$ * Mobility and ROM$^{[1]}$ * Muscular Endurance$^{[1][8][10]}$ *Decreased: * Rate of bone density loss$^{[1]}$ * Reported levels of disability$^{[10]}$ * Sarcopenia through maintainence of lean muscle mass$^{[1]}$ |

## Exercise Recommendations

| Aerobic Exercise | Resistance Exercise |
| Frequency: *2-3 sessions/week Exercise Intensity * 65-75% HR max * RPE 11-14 (Borg Scale) Duration: * 20-30min/session or * 2x 10-15min/session * Aqua aerobics may help patients with low balance or excessive weakness | Frequency: *2-3 sessions/week Sets and Repetitions * 2-3 sets * 8-15repetitions * 60-120seconds rest between sets Weight Selection * Moderate weight increasing by 2-5% when can perform 15 repetitions correctly * Machines and free weights for high functioning patients * Variable resistance bands can also be used note: When weight training we must take into account the patients fatigue levels on the day as it will affect their training capacity $^{[1][10][11]}$ |

## Considerations and Barriers for Exercise

When undertaking exercise there are many things to consider: * Before beginning an exercise program graded exercise testing can provide information about an individuals limitations, aerobic fitness, strength, and functional capacity$^{[12]}$ * Time of day - Training in excessive heat and humidity can affect a patients work capacity, patients will tolerate exercise better earlier in the day in cooler temperatures$^{[12]}$ * Stretching before and for 10-15mins post exercise will aid in managing fatigue and avoiding muscle tightness$^{[1]}$ * Patients with exacerbated symptoms should only exercise under permission from a health professional$^{[9]}$
MS is a dibilitating disease and many patients report barriers stopping them from being able to exercise, these include: * Fatigue$^{[10]}$ * Lack of support * Lack of motivation or psychological stress$^{[7]}$ * Exacerbation of symptoms$^{[12]}$ * Sickness or injury$^{[10]}$

## Further reading

For more information please see the references below or: *http://www.msaustralia.org.au/ *http://www.msra.org.au/

## References

* ↑ Noseworthy, J,H., Lucchinetti, C., & Rodriguez, M. (2000) Multiple Sclerosis. New England Journal of Medicine. 343 (13). 938-952
* ↑ White, L,J., & Dressendorfer R.H. (2004) Exercise and Multiple Sclerosis. Journal of Sports Medicine. 34 (15). 1077-1100
* ↑ Owens, T. (2003) The enigma of multiple sclerosis: inflammation and neurodegeneration cause heterogeneous dysfunction and damage. Current opinion in neurology. 16 (3). 259-265
* ↑ Hartline, D,K,. (2008) What is Myelin? Neuron Gila Biology. 4 (2) 153-163
* ↑ Tsang, B, K-T., & Macdonnell, R. (2011). Multiple Sclerosis diagnosis, management, and prognosis. Australian Family Physician. 40(12)
* ↑ Hernandez-Reif, M., Field, T., & Theakston, H. (1998) Multiple sclerosis patients benefit from massage therapy. Journal of Body Work and Movement Therapies. 2(3).168-174
* ↑ Stroud, N., Minahan, C., & Sabapathy, S. (2009). The perceived benefits and barriers to exercise participation in persons with Multiple Sclerosis. Disability and Rehabilitation. 31(26). 2216-2222
* ↑ Kileff, J., & Ashburn, A. (2005) A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis. Clinical Rehabilitation. 19. 165-169
* ↑ Rampello, A., Franceschini, M., Piepoli, M., Antenucci, R., Lenti, G., Oliveri, D., & Chetta, A. (2007). Effect of aerobic training on walking capacity and maximal exercise tolerance in paients with Multiple Sclerosis: a randomised crossover controlled study. Journal of Physical Therapy. 87(5). 545-555
* ↑ Sabapathy, N, M., & Minahan, C, L. (2011). Comparing endurance and resistance exercise training in people with multiple sclerosis: a randomized pilot study. Journal of Clinical Rehailitation. 25. 14-24
* ↑ Collett, J., Dawes, H., Meaney, A., Sackley, C., Barker, K., Wade, D., Izardi, H., Bateman, J., Duda, J., & Buckinham, E. (2010). Exercise for Multiple Sclerosis: a single blind randomized trial comparing three exercise intensities. Multiple Sclerosis Journal. 17(5). 594-603
* ↑ White, A, T. (2001) Exercise for patients with Multiple Sclerosis. International journal of sports medicine. 2(3)