# Exercise as it relates to Disease/Effect of strength training in clients with multiple sclerosis

This is a criqtue of Enhanced neural drive after maximal strength training in multiple sclerosis patients

## What is the background to this research?

Multiple sclerosis (MS) is a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. It is a disease that effects the central nervous system, leading to destruction of myelin, oligodendrocytes and axons. MS affects over 25,600 in Australia and more than two million diagnosed worldwide. With females making up every 3 out of 4 people diagnosed with multiple sclerosis in Australia. Currently there is no known cure for MS, but are multiple treatments to alleviate the symptoms associated with MS through medication and other practical measures. There are certain risk factors that go into diagnosing Multiple Sclerosis such as genetics, sex, age, infections, and certain autoimmune diseases.
The published research article called " Enhanced neural drive after maximal strength training in multiple sclerosis patients" hypothesis stated that "maximal strength training (MST) using high loads and few repetitions would improve central neural drive and thus strength capacity of MS patients".

## Where is the research from?

The article was published in the European journal of applied physiology. Specifically, article volume 110 pages 435-443. The authors of the article are Marius S. Fimland, Jan Helgerud, Markus Gruber, Gunnar Leivseth and Jan Hoff. With the authors representing departments of Circulation and Medical Imaging, Physical Medicine and Rehabilitation, Training and Movement Science along with having connections to rehabilitation centres in Norway

## What kind of research was this?

The research conducted in the article questioning if strength training has any effect on clients with multiple sclerosis is a randomized controlled trail (RCT). With that being said a RCT is a study where participants are assigned into a controlled or experimental group. With only the outcome data being uncontrolled throughout the study. The RCT is considered a gold standard testing method.

## What did the research involve?

The research consisted of two groups, a MST group (maximal strength training) or an CG (controlled group) with seven subject in each group.The participants coming from the Multiple Sclerosis Center in Hakadal, Norway. Participants in both groups submitted informed consent along with were subject to the disability status scale (EDSS) to assess the severity of neurological impairment among the subjects before and after training. The MST group underwent a trained 4 x 4 repetitions of unilateral dynamic leg press and plantar flexion 5 days a week for 3 weeks.
Since it was such a small subject group the methodology was enough although the size is a limitation. Due to a small subject population the range of collected data does not allow for large scale application of the acquired data. Although drawing from a specific MS center provides with an instant source of participants with the downside of the population of MS patients in that center limiting the subject population.

## What were the basic results?

Results of the testing showed no differences between the MST group and the CG group in the pretest measurements. With no changes observed in the EDSS scores which remained unchanged in all subjects from pre- to post-test. The authors interpreted the results in a manner that stated that training increased the magnitude of efferent motor outflow from spinal motor neurons to the lower limb muscles in MS patients. Along with the increased soleus EMG activity and isometric strength gains of the plantar flexors
| | Maximal strength training group | | Control group | |
| | Pre | Post | Pre | Post |
| MVC (N m) | 88 ± 18 | 101 ± 18* | 88 ± 10 | 91 ± 12 |
| V-wave (�lV) | 1,051 ± 228 | 1,603 ± 124* | 978 ± 222 | 832 ± 195 |
| Msup (IlV) | 6,702 ± 1,167 | 6,997 ± 1,013 | 7,069 ± 1,168 | 6,820 ± 881 |
| Hsup (IlV) | 3,024 ± 729 | 3,327 ± 961 | 3,380 ± 599 | 3,325 ± 367 |
| TA EMGRMS (�lV) | 39 ± 10 | 35 ± 5 | 32 ± 6 | 25 ± 5 |
| VL EMGRMS (�tV) | 20 ± 9 | 18 ± 4 | 22 ± 5 | 25 ± 9 |
* Data are presented as mean ± SE
* MVC maximum voluntary isometric plantar flexor contraction, TA tibialis anterior, VL vastus lateralis
* p < 0.05, from pre- to post-test

## What conclusions can we take from this research?

Taking in the data and limitations of the randomized controlled trial study that was undertaken, a conclusion can be argued that the hypothesis was not incorrect nor was it correct. As in belief of that a larger scale subject group would have proved more beneficial and yielded more data to support the suggest hypothesis. The key limitation of this study is the subject population size, which was 14 people, which limits the size of possible collected data. Although the authors stated that the evidence shows that with strength training or normal repetitive rehabilitation seasons can be effective in helping alleviate some of the neuromuscular symptoms in patients.
Studies in other areas of MS yielded results. Such as a fifty-four participant study on how aerobic fitness can influence their quality of life while living with MS. The study concluded that exercise helped improve fitness, plus upper and lower extremity strength, along with improvements to quality of life. Another study published in 2009 stated that through "Moderate resistance training programs can improve muscle function and can be a promising therapy to delay the functional deterioration in multiple sclerosis patients.

## Practical advice

Recomendations on what type of intervention into helping repair or prevent the damage done by the immune system on the nervous system vary from patient to patient.Although it is to be stated that MS is a very variable disease, with each patient reacting differently to medication and having varied side effects thus contacting know organisations and practictionars to better help discuss and decide the best treatment is highly advised.
Practical advice can be given in taking to treatments by using certain medications that can help target specific symptoms of MS such as fatigue, neurological symptoms, continence along with the muscle problems such as spasm and paralysis requirign the recommended assistance of a physiotherapist.

## Futher information/resources

For more information regarding multiple sclerosis you can look up
* https://www.msaustralia.org.au/what-ms
* https://brainfoundation.org.au/disorders/multiple-sclerosis/
* https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
* https://msra.org.au/news/unravelling-causes-ms/

## References

* 1 2 3 4 5 6 7 8 Marius S. Fimland. 2010.Enhanced neural drive after maximal strength training in multiple sclerosis patients. European Journal of Applied Physiology. Volume 1. Page 435-436
* 1 2 https://www.msaustralia.org.au/what-ms
* 1 2 https://brainfoundation.org.au/disorders/multiple-sclerosis/
* 1 2 https://www.msaustralia.org.au/about-ms/medications-treatments
* ↑ https://msra.org.au/news/unravelling-causes-ms/
* ↑ mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
* 1 2 Dr Jack H. Petajan.1996.Impact of aerobic training on fitness and quality of life in multiple sclerosis.Annals of Neurology.Volume 39.Issue 4.pages 432-441
* ↑ S. Costilla.2009.International Journal Sports Med.Volume 30(4): 245-250