# Exercise as it relates to Disease/Exercise prescription for multiple sclerosis patients
#### What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a autoimmune disorder of the central nervous system. MS is characterised by the deterioration of the myelin that covers cell fibers in the brain and spinal cord with subsequent destruction of oligodendrocytes and axons. The demyelination of nerve fibres causes axon conduction velocity to slow and consequently results in functional impairments such as reduced mobility, muscle weakness, fatigue, poor balance, abnormal gait mechanics and cognitive and autonomic dysfunctions. An estimated 23,700 Australians suffer from MS (0.1% of the population) and of those affected, an estimated 75% are female.

#### What is the cause of MS?

The cause of MS is still unknown. It is thought that a combination of genetic and environmental factors may contribute to MS, but the distinct trigger has not yet been discovered.

#### Symptoms

There are many possible symptoms of MS. Symptoms will vary from person to person, depending on the severity of their disorder. The most common notable symptoms are:
* Vision Problems
* Dizziness and Vertigo
* Fatigue & Weakness
* Numbness & Tingling
* Walking (Gait), Balance and Coordination problems
* Bladder, Bowel & Sexual Dysfunction
* Chronic Pain & Involuntary Spasms
* Emotional Changes
* Depression
* Cognitive Dysfunction

## Exercise Prescription
#### Barriers to Exercise

The acceptance of exercise as a positive treatment for MS patients is continually growing. Despite this there are still a number of individual barriers that prevent MS sufferers from participating in exercise these include;
* Lack of self belief in successfully participating
* Fear of increasing fatigue symptoms after exercise
* Perceived lack of benefits
* Safety concerns
* Lack of enjoyment

#### Benefits of Exercise

| Aerobic Exercise | Resistance Exercise |
| Improved cardiovascular function Improved respiratory function Improved aerobic capacity / endurance Improved social interactions and support network Weight loss Daily tasks become easier Improved self esteem Reduced depression and anxiety Improved quality of life | Improved muscular strength Improved balance and coordination Decreased perception of fatigue Improved mobility and ROM Improved walking speed Daily tasks become easier Improved self esteem Reduced depression and anxiety Improved quality of life |

#### Exercise Recommendations

Exercise is not a cure for MS. However, it has been found to have beneficial affects on reducing MS symptoms severity and subsequently restoring quality of life to sufferers. Beneficial training types and their individual recommendations are as follows
| Type of Exercise | Recommendations |
| Aerobic Exercise | Frequency: Patients are to perform 2–3 sessions per week. Duration: The exercise session should go for 20–30 minutes and can be broken down into 2 x 10-15 minute sessions, if the patient requires. Intensity: The exercise session should be performed at moderate intensity (65–75% HRpeak or 50–70%V ̇O2peak). RPE on the borg scale should stay between 11 and 14. Type: common prescribed exercises are; stationary cycling with legs and/ or arms, swimming and treadmills for higher functioning MS patients. |
| Resistance Training | Frequency: Patients are to perform 2-3 sessions per week. Sets and Repetitions: 1-3 sets of 8-15 repetitions of each major muscle group. Rest: 2–3 minutes between sets. Type: Patients should us elastic bands, machine weights, pulley systems and free weights (depending on their capability). Target areas: MS patients should target their legs, back, chest, shoulders and arms when resistance training. Note:Weight lifting in the seated position minimises the potential risk of falls and subsequent injuries when using free weights. |
| Aquatic Exercise | Water temperature: Temperatures of 27–29 °C are recommended for MS patients, particularly those who are heat sensitive. Note: The buoyancy of water helps MS patients with weakened limbs achieve greater ranges of motion. Chest high water provides support to the body and allows MS patients to stand and maintain balance with less effort than on the ground. |
| Flexibility Exercise | Frequency: Patients are to stretch daily. Duration: 10 – 15 minutes. Hold length: Stretches should be held for 20–60 seconds for maximum benefit. Target ares: Both upper and lower body. Note: Stretching should not be painful. |

#### Exercise Considerations

Exercise considerations for MS patients should be assessed before, during and after exercise;
* Before commencing an exercise program a doctor or appropriate physician should be consulted for preliminary testing
* The exercise program should be designed specifically for the patient, dependent on physical limitations and current fitness level (determined by preliminary testing)
* Appropriate goals should be set and assessed; before, during and after the program
* Patient fatigue should be recorded; before, during and after exercise (exercise should be avoided if fatigue is reported on that day)
* The patient should be observed during exercise for signs of fatigue and loss of coordination
* Heart rate, blood pressure and patients perceived exertion should be monitored during exercise
* Patients should not exercise on hot days (unless in water)

## Further reading

* http://www.msaustralia.org.au
* http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Multiple_sclerosis_explained
* http://www.msra.org.au

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Horton, S., MacDonald, D. J., & Erickson, K. (2010). MS, exercise, and the potential for older adults. European Reviews Of Aging & Physical Activity, 7(1), 49-57
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 White, L. J., & Dressendorfer, R. H. (2004). Exercise and Multiple Sclerosis. Sports Medicine, 34(15), 1077-1100
* ↑ Australian Bureau of Statistics. (2012, 06 27). 4429.0 – Profiles of Disability in Australia, 2009. Retrieved 21/10/13: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4429.0Main+Features100182009
* ↑ MS Australia.(2013) About MS. Retrieved 21/10/13: http://www.msaustralia.org.au/aboutms/causes.asp
* 1 2 3 4 5 6 7 8 9 10 11 "National Multiple Sclerosis Society." Symptoms : National MS Society. N.p., n.d. Web. 21 Oct. 2013. <http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/index.aspx>.
* 1 2 3 4 5 6 7 8 Tarakci, E., Yeldan, I., Huseyinsinoglu, B., Zenginler, Y., & Eraksoy, M. (2013). Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clinical Rehabilitation, 27(9), 813-822.
* 1 2 3 "What makes it so hard? Barriers to health promotion Experienced by people with Multiple sclerosis and polio" Author: H, Becker et al. . Family and community health Journal. (2003); vol 27(1) pg 75–85
* 1 2 3 4 5 6 7 8 9 Stroud, N., Minahan, C., & Sabapathy, S. (2009). The perceived benefits and barriers to exercise participation in persons with multiple sclerosis. Disability & Rehabilitation, 31(26), 2216-2222.
* 1 2 3 4 5 6 Sabapathy, N., Minahan, C., Turner, G., & Broadley, S. (2011). Comparing endurance- and resistance-exercise training in people with multiple sclerosis: a randomized pilot study. Clinical Rehabilitation, 25(1), 14-24.
* 1 2 3 4 5 McCullagh, R., Fitzgerald, A. P., Murphy, R. P., & Mater, G. (2008). Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study. Clinical Rehabilitation, 22(3), 206-214.