# Exercise as it relates to Disease/Benefits of moderate aerobic exercise on Amyotrophic lateral Sclerosis
## Benefits of moderate aerobic exercise on Amyotrophic lateral Sclerosis
### Background

Amyotrophic lateral Sclerosis (ALS) also known as Lou Gehrig’s disease is a degenerative disorder of specific nerve cells of the spinal cord, brain stem and the brain itself that affects the upper and lower parts of the body. Amyotrophic lateral Sclerosis is the most common disease in a group of diseases known as Motor Neuron Disease (MND). It is a neurological disease that selectively affects the nerves of the body which are specifically known as motor neurons. Motor neurons are cells that control voluntary muscle action and help us perform everyday actions such as walking, speaking, breathing, swallowing and general movement of the body. Being a neuron muscular disease, once Amyotrophic Lateral Sclerosis reaches the majority of neurons there is nothing exercise can do as the patient is completely bed ridden through partial or complete paralysation.

### Risk and symptoms of Amyotrophic lateral Sclerosis

ALS generally strikes patients of middle age (25 to 55) and is more often found in men than women. In the initial stages of ALS symptoms can be so slight that they are often overlooked. The earliest symptoms are weakness and/or muscle atrophy. Yet this can often be disguised if a person does physical activity as they perceive it as just natural fatigue. Other initial symptoms include muscle fasciculation (twitching), cramping or muscle stiffness and slurred or nasal speech. These symptoms can come in any particular order and will depend on which motor neurons in the body are damaged first. As symptoms progress each part of the body beginnings slowing down and eventually reaches a parasitic state. From this stage death is inevitable. In recent years more and more neurologists are stating that “Physical inactivity could expose people with ALS to even greater health risks, and exercise in moderation can bring the benefits of exercise while minimizing the risk of worsening their conditions”. When you look into it, there is no stone cold evidence that exercise can actually do damage to patients yet there is evidence for the benefits.

### Aerobic exercise benefits for Amyotrophic lateral Sclerosis

Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation. In relationship to Amyotrophic Lateral Sclerosis, moderate aerobic exercise is vital in two important ways. The first way is for prolonging the symptoms from multiplying and the second is for the prevention of the disease all together. Between the years of 1992 and 2011 five major studies were done, suggesting that Aerobic exercise played a major role in prolonging of ALS symptoms and the increased quality of life. These studies are as followed:
* 1992: scientist discovered that short moderate aerobic exercise boosted the levels of neurotrophins in the brain. Neurotrophin are a substance of the brain that protects motor neurons and triggers growth of new motor neurons.
* 1995: studies were done, in which rats did moderate running exercise each day for one week. It was found that these rats had doubled levels of BDNF (brain derived neurotrophic factor)
* 2000: researchers found that increase levels of neurotrophin following moderate aerobic exercise actually helped protect the brain in rats from injury or neuron diseases.
* 2003-2005: two groups of rats with ALS were tested. The first group did moderate running exercise over the space of several weeks while the second group did moderate swimming over the same amount of time. Both sets of groups came back with positive results. In the first group it was reported that moderate running actually increased the lifespan of rats with ALS. While in the second group it was found that swimming significantly delayed clinical onset and dropped losses of motor neurons in the spinal cord by almost 50%.
* 2011: researchers found that aerobic exercise not only increased neurotrophins but had the potential to keep the power on in the motor nerves by increasing the amount of oligodendrocytes in the brain and spinal cord. Oligodendrocytes are cells of the brain and spinal cord that supply critical energy to mitochondria keeping the energy flowing in distal axon and nerve terminals. They do this by making up the myelin sheath which extends and speeds up the functioning of the neurons.This meant that symptoms decreased and the quality of life increased.
These tests showed that through moderate aerobic exercise both neurotrophins and Oligodendrocytes are increased or maintained allowing for a decrease in the rate of destruction of motor neurons. This meaning that the onset of the diseases was a lot less severe and allows patients to live longer and healthier lives. It is important to note that aerobic exercise does not reverse the disease but only delays the onset.

### Moderate aerobic exercise activities suited for Amyotrophic lateral Sclerosis

Moderate aerobic exercise activities are vital when attempting to prolong the onset of ALS, recommended exercises are:
* walking
* swimming
* stationary cycling
It is important that these exercises are all done at 60 to 65% of a persons oxygen output, last no longer than 30 minutes and are partaken at least 3 times a week. This intensity allowed weakened muscles to preform exercise without overworking or damaging them and promotes the increase of protective substances in the brain and spinal cord. By doing this exercise it keeps fast twitch muscles active and oxidates them slowing down the process of atrophy. It also found that patients had significant signs of reduced functional decline and increased post rehabilitation survival. While swimming significantly delayed clinical onset and dropped losses of motor neurons in the spinal cord by almost 50%.

### Further research

Further research is being done to find out more about the effects of aerobic exercise in ALS patients. Testing still needs to be done on how different intensities may affect the disease and if resistance exercise can play a role. But what we are sure of is that any form of moderate aerobic exercise weather it is swimming, running or cycling can have a positive result rather than no exercise at all. It can increase the neurotrophins and oligodendrocytes in the brain and spinal cord allowing for a reduced functional decline and increased survival rate. If suffering from ALS support can be found at the ALS help forum

## Reference list

* ↑ Lui, A.J. and Byl, N.N. (2009) A systematic review of the effect of moderate intensity exercise on function and disease progression in amyotrophic lateral sclerosis. Journal of Neurological Physical Therapy 33, 68-87
* ↑ Lopes de Almeida, J. P., Silvestre, R., Pinto A. C., and de Carvalho, M. (2012) Exercise and amyotrophic lateral sclerosis. Neurological Sciences 33, 9-15.
* ↑ Itoh, H, Ohkuwa, T, Yamamoto, T, Sato, Y, Miyamura, M, and Naoi, M. (1998) Effects of endurance physical training on hydroxyl radical generation in rat tissues, Life Sciences 63, 1921-1929
* ↑ Itoh, H, Ohkuwa, T, Yamamoto, T, Sato, Y, Miyamura, M, and Naoi, M. (1998) Effects of endurance physical training on hydroxyl radical generation in rat tissues, Life Sciences 63, 1921-1929
* ↑ Kirkinezos, I.G, Hernandez, D., Bradley, W.G. and Moraes, C.T (2003) Regular exercise is beneficial to a mouse model of amyotrophic lateral sclerosis. Annals of Neurology 53, 804-807
* ↑ Nave, K.A. (2010) Myelination and the trophic support of long axons. Nature Reviews Neuroscience 11. 275-283
* ↑ Neeper, S.A., Goauctemez-Pinilla, F., Choi, J. and cotman, C. (1995) Exercise and neurotrophins. Nature 373, 109