# Exercise as it relates to Disease/Can exercise be beneficial to people suffering from multiple sclerosis?/Can exercise be beneficial to people suffering from multiple sclerosis?

This paper looks at a study of aerobic training as it relates to Multiple Sclerosis patients and the effects it has. This critic has been written as a university assignment for the subject of health disease and exercise.
The study: Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis S Mostert and J Kesselring* Department of Neurology, Rehabilitation Centre, CH-7317 Valens, Switzerland

## What is Multiple Sclerosis?

Multiple Sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system. The immune system attacks the myelin sheath, which is a fatty substance that surrounds and insulates the nerve fibers within the central nervous system. The damaged myelin forms scars and with any part of the myelin sheath or nerve fibers damaged or destroyed the nerve impulses travelling to and from the brain get distorted/ interrupted during their path which can cause a variety of symptoms. The severity differs in forms of either mild, moderate or severe.

## Prevalence

It is estimated that about 2.5 million people worldwide have MS. MS rates have been seen to be higher the farther north of the equator. It’s estimated that in southern states the rate of MS is 57-78/100 000 and farther north of the equator is estimated to be between 110 – 140/ 100 000.

## Symptoms and treatment

MS varies greatly in its array of symptoms, no two people will have the same symptoms. An individual’s symptoms are even subject to change over time. Common symptoms are:
| Fatigue | Walking gait difficulty |
| Numbness/ tingling | Weakness |
| Dizziness/ vertigo | Sexual problems |
| Pain | Emotional changes |
| Depression | Cognitive changes |
| Bowel problems | Bladder problems |
| Vision problems | Spasticity |
There is no cure for multiple sclerosis. The focus of treatment is to hasten the recovery from attacks, slowing the progression of the disease and management of the various symptoms of the disease over time.

## Where is the research from?

The research was conducted by S Mostert and J Kesselring at the department of neurology rehabilitation centre in Valens Switzerland and published through the Multiple Sclerosis Journal.

## What kind of research was this?

The study was of a Randomised Control Trial (RCT) where patients were assigned to either the MS exercise training group or the MS non-intervention group also in the study was a healthy mostly sedentary control group who were also split into the exercise and non-intervention group.
| Advantages | Disadvantages |
| Gives distinct results between control and test groups | Study sample size was very small |
| RCT gives quantitative data easily graphed, recorded and compared | Study could have lasted longer than 4 weeks to see greater results |
| Having the intervention group chosen at random keeps the results from being bias | Due to such a small study sample size the whole population has not been accurately represented |

## What did the research involve?

The research involved 37 MS patients who took part in an inpatient rehabilitation program in the Rehabilitation Centre of Valens, Switzerland, these patients were recruited for the investigation and randomly assigned to the exercise training group (MS-ET) or no intervention group (MS-NI) with 11 patients pulling out or being unable to complete the study reducing the number to 26. All MS participants had confirmed diagnosis of clinical definite MS. The study was conducted over four weeks with aerobic training being the focus. To test the before and after effects, a graded maximal exercise test with measurement of gas exchange and a lung function test were undertaken by all participants, followed by questionnaires to measure the change in activity level, fatigue and health perception. The training itself comprised of 5 x 30 min bicycle training sessions a week that were individualized in regards to training intensity.

## What were the basic results?

The results concluded that a rightward shift occurred for the MS training group when compared to the baseline results for the aerobic threshold. There was a 13% increase in VO2, 11% increase in work rate, an improvement in health perception by 46% for vitality and 36% for social interaction. An increase of 17% was also seen for activity level and a tendency to be less fatigued.

## What conclusions can be taken away from this study and what are the implications of this research?

We can conclude from the study that a four week aerobic training program can be beneficial to MS patients in the case of improving aerobic fitness, fatigue and health perceptions. However further research is needed in this specific field and the sample sizes need to be larger to gain greater and more accurate results. However the study provided helpful information showing that MS patients can safely perform a GET and aerobic training with low incidence of symptoms worsening. This result was lower than what was normally expected from MS patients therefore, the avoidance of MS patients participating in aerobic training activities needs to be reconsidered when looking at this studies results.

## Further reading

* Effects of a 6-month exercise program on patients with multiple sclerosis A randomized study A. Romberg, PT; A. Virtanen, MSocSc; J. Ruutiainen, MD; S. Aunola, PhD; S.-L. Karppi, MSc; M. Vaara, MSc; J. Surakka, MSc; T. Pohjolainen, MD; and A. Seppänen, MD
http://www.direct-ms.org/pdf/GeneralInfoMS/ExerciseMSStudy.pdf
* Endurance exercise improves walking distance in MS patients with fatigue: Dettmers C, Sulzmann M, Ruchay-Plo¨ssl A, Gu¨tler R, Vieten M. Endurance exercise improves walking distance in MS patients with fatigue. Acta Neurol Scand 2009: 120: 251–257. 2009 The Authors Journal compilation 2009 Blackwell Munksgaard.
http://zh9bf5sp6t.scholar.serialssolutions.com/?sid=google&auinit=C&aulast=Dettmers&atitle=Endurance+exercise+improves+walking+distance+in+MS+patients+with+fatigue&id=doi:10.1111/j.1600-0404.2008.01152.x&title=Acta+neurologica+Scandinavica&volume=120&issue=4&date=2009&spage=251&issn=0001-6314

## References

* ↑ National Multiple Sclerosis Society: http://www.nationalmssociety.org/What-is-MS/Definition-of-MS
* ↑ Health Line, Multiple Sclerosis by the numbers http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic
* ↑ Mayo Clinic; Diagnosis and treatment http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/treatment/txc-20131903
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