# Exercise as it relates to Disease/Resistance training for Motor Neuron Disease

The use of Resistance training on Motor Neuron Disease

## Brief Background

Motor Neuron Disease (MND), also known in most parts of the world as Amyotrophic Lateral Sclerosis (ALS) and in America as Lou Gehrigs Disease. MND is a progressive, terminal, neurodegenerative disease that effects the nerve cells of the central and peripheral motor neurones, there is no known cure or effective treatment. Neurons are highly excitable speciazlied cells that contain a nucleus and receive incoming nerve impulses, down the axon, which carry impulses or messages away from the cell body.The causes of MND are unknown at this present point in time, however current theories range from environmental chemicals and toxins to loss of growth factors and genetic susceptibility.

### Prevalence

The average number of MND patients within Australian is estimated to be 1900 with a average life expectancy of 27 months, every day in Australia two people die from MND. In the United States the average incidence of ALS is 2 per 100,000 every year.

### Signs and Symptoms

* Tripping due to weakness of the muscles in the legs
* Difficulty holding items due to weaknesses in the muscles of the arms
* Slurring of words and unable to swallow correctly due to the muscles of the throat cramping and twitching (fasciculation).
* Muscle atrophy
* Hyperreflexes (exaggerated reflexes)

### Testing

The following tests are usually carried out by a Neurologist to eliminate other medical conditions:
* Magnetic Resonance Imagery (MRI) used to show images of damaged structures of the body, MRI scans do not diagnose MND but help eliminate other conditions which can mimic MND symptoms.
* Conduction studies (NCS) analyse neural function by electrical stimulation of nerves and recording muscle activity.
* Electromyography (EMG) consists of inserting a electrode into different muscles of the body to measure their electrical activity.
* Blood tests look for an increase in creatine kinase, which is a by product of muscle break down.

## Explanation

Motor Function is controlled by the upper motor neurons that move into the spinal cord from the brain, where they stimulate the lower motor neurons. These neurons activate the nerves that control muscles that are used in speaking, vision, hearing and voluntary skeletal muscles whist the muscles of the digestive system and heart muscles are not effected by MND, even though the muscles used for breathing are involuntary your breathing pattens can change, effecting the progress of the disease. Muscles that are not being triggered, start to become weaker and break down (atrophy).

## Recommendations

Numerous health professionals specialising in MND/ALS have not concluded if resistance training can improve muscles that are affected with MND. With a decrease in use and atrophy taking place in the muscles, correct training and instruction could lead to a slowing down of the disease in muscles yet to be effected, keeping a level of independence to the person affected with MND so they don’t become reliant on others as quickly.
Training should be only undertaken with light weights that do not effect the muscles being attacked by the disease. The use of heavy resistance could cause unwanted fatigue on the body enabling it to repair as quickly and effectively as somebody without MND.
However, 2 small studies showed that resistance exercise had a greater effect on total body function, measured by ALS (MND) functional rating scale in both the upper and lower parts of the body, which relates to a better quality of life compared to the subjects that received usual care.
Current research relates to improving the quality of life of the person living with MND in the early stages as once the disease progresses there is not much that can be done to help slow down or stop the onset of muscle break down and eventually death.

## Further reading

* Motor Neurone Disease Australia
* Motor Neurones Disease NSW
* Amyotrophic Lateral sclerosis
* Muscular Dystrophy Association

## References

* ↑ Mndaust.asn.au, (2014). MND Australia - MND statistics in Australia. [online] Available at: http://www.mndaust.asn.au/Get-informed/What-is-MND/Facts-and-figures.aspx [Accessed 30 Sep. 2014].
* ↑ Lopes de Almeida, J, Silvestre, R, Pinto, A, & de Carvalho, M 2012, 'Exercise and amyotrophic lateral sclerosis', Neurological Science, Vol. 33, pp. 9-15.
* ↑ de Almeida, J., Silvestre, R., Pinto, A. and de Carvalho, M. (2012). Exercise and amyotrophic lateral sclerosis. Neurological Sciences, 33(1), pp.9--15.
* ↑ Drory, V., Goltsman, E., Goldman Reznik, J., Mosek, A. and Korczyn, A. (2001). The value of muscle exercise in patients with amyotrophic lateral sclerosis. Journal of the neurological sciences, 191(1), pp.133--137.
* ↑ Dal Bello-Haas, V., Florence, J., Kloos, A., Scheirbecker, J., Lopate, G., Hayes, S., Pioro, E. and Mitsumoto, H. (2007). A randomized controlled trial of resistance exercise in individuals with ALS. Neurology, 68(23), pp.2003--2007.
* ↑ de Almeida, J., Silvestre, R., Pinto, A. and de Carvalho, M. (2012). Exercise and amyotrophic lateral sclerosis. Neurological Sciences, 33(1), pp.9--15.
* ↑ Majmudar, S., Wu, J. and Paganoni, S. (2014). Rehabilitation in amyotrophic lateral sclerosis: Why it matters. Muscle \& nerve.