# Exercise as it relates to Disease/Resistance training for individuals living with multiple sclerosis
## What is MS?

Multiple Sclerosis (MS) is a neurodegenerative disorder of the central nervous system (CNS) caused by immune system imbalance. The principal consequence is damage and/or destruction to the myelin sheath, the protective coating that insulates nerve axons throughout the body. This causes axon damage and disruption to or loss of electrical signalling within CNS. While there are 4 principal types, relapsing-remitting is by far the most common (85% of cases). It is characterised by attacks of symptoms (‘relapses’) then a period of remission. Over time, there is usually progress into the other 3 more 'progressive' forms of the disease, characterised by a gradual worsening of symptoms. Eventually all forms of the disease lead to an accumulation of irreversible neurological deficits.

### Prevalence and risk factors associated.

An estimated 2.5 million individuals suffer from the disease worldwide and it at least twice as common in females than males. The exact cause of MS is not known, but some of the main risk factors identified include genetic predisposition (a range of different genes have been linked), vitamin D deficiency, and smoking.

### Common symptoms

The physiological changes caused by MS are illustrated by a range of symptoms common to those diagnosed with the disorder. These include but are not limited to:
* Loss of muscle strength and tone.
* Loss of balance and coordination .
* Numbness, tingling and tremors.
* Decreased functional ability.
* Increased fatigue.
* Sensory disturbance (often heightened).
* Bladder and bowel dysfunction.
* Loss of motivation and concern about being involved in social activities.
* Decrease in general quality of life.

### Recommended interventions

While there is no known cure, a range of pharmaceutical and non-pharamaceutical interventions are recommended. These will vary depending on the form or the disease and severity of the symptoms. However common treatment involves at least one or all of the following:
* Pharmaceuticals – Used to:
* Slow severity and frequency of relapses.
* Aid with inflammation.
* Diet – A balanced and healthy diet is recommended to increase energy levels.
* Exercise and lifestyle interventions – aerobic and resistance training to help prevent disability progression.

## Exercise recommendations

Resistance training is a form of exercise generally used to strengthen skeletal muscles. In MS patients, it has been shown to be effective in slowing disability progression of the disease and may be particularly useful in targeting specific symptoms, such as generalised muscle weakness.

##### What can it help with?

* Improving muscle strength.
* Improving balance/coordination.
* Increasing functional capacity.
* Decreasing fatigue.
* Encouraging social interaction.
* Improving mood, feelings of wellbeing and quality of life.

##### What are the recommendations?

* Train all major muscle groups at least 2 times per week.
* Slowly build up to 2 sets of 10-15 repetitions.
* Use weights heavy enough that repetitions can only just be completed.
* Rest for at least 1 day between sessions.
* Weight machines, free weights, cable pulleys, elastic resistance bands or bodyweight may all be used.
* Program should be individualised depending on severity of symptoms and disability.

##### What precautions should be taken?

* Exercise program should be designed by a qualified health professional and progress should be frequently reviewed.
* Potential interaction with medications should be considered.
* Exercise in an appropriate environment - due to decreased ability to thermoregulate, exercise should be undertaken at cooler parts of day and appropriate clothing/footware should be worn to encourage ventilation.

## Conclusion

While MS can be a physically and mentally debilitating disease, exercise, and in particular strength training, has been shown to drastically help improve some of the associated symptoms and help slow disability progression. As long as patients follow a properly designed program catered to their individual case, they should look forward to a range of positive benefits, including improved muscle strength, functional capacity, and decreased fatigue.

## Further reading

MS Society Australia: Strength training fact sheet.
MS Society of Canada: Multiple sclerosis and physical activity
MS Society UK: Exercise

## References

* 1 2 3 Multiple Sclerosis Australia (2012). Understanding MS: An introduction for people living with MS. Accessed online at: http://www.msaustralia.org.au/sites/default/files/files/Understanding-MS-Aug2012.pdf
* 1 2 3 White, L.J., et al. (2004). Resistance training improves strength and functional capacity in persons with multiple sclerosis. Multiple Sclerosis, 10: 668-674.
* ↑ Ascherio, A., Munger, K. L. and Simon, K. C. (2010). 'Vitamin D and multiple sclerosis'. Lancet Neurol, 9(6): 599-612.
* ↑ National Multiple Sclerosis Society (2014). MS Symptoms. Accessed online at: http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms
* 1 2 Kjolhede, T., Vissing, K., & Dalgas, U. (2012). Multiple sclerosis and progressive resistance training: a systematic review. Multiple Sclerosis Journal, 18 (9): 1215-1228.
* 1 2 3 Patterson, M.A. (2011). Strength Training and Multiple Sclerosis. ACSM’s Certified News. 21(1): 7-10.
* 1 2 Filipi, M.L., Kucera, D.L., Filipi, E.O., Ridpath, A.C. & Leuschen, M.P. (2011) Improvement in strength following resistance training in MS patients despite varied disability levels. NeuroRehabilitation, 28: 373-382.
* ↑ Dalgas, U., et al. (2009). Resistance Training Improves Muscle Strength and Functional Capacity in Multiple Sclerosis. Neurology, 73: 1478-1484.
* ↑ Canadian Society for Exercise Physiology (2014). Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis. Accessed online at: http://www.csep.ca/CMFiles/Guidelines/specialpops/CSEP_MS_PAGuidelines_adults_en.pdf