# Exercise as it relates to Disease/Barriers to Exercise in Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system. Recurring episodes of MS can cause scarring in the central nervous system as a result of the breakdown of myelin, the insulating material that covers the nerve fibres. This can result in impairment of motor, sensory and cognitive functions.
The cause of MS is unknown and there is no known cure. The primary treatment for MS is pharmacological to help control exacerbation of the symptoms associated with the disease.

## Symptoms

The symptoms of MS are associated with the scarring of the central nervous system. The physical symptoms of MS usually present as a combination of:
   * Visual impairment
   * Loss of coordination and balance
   * Muscle spasms
   * Fatigue
   * Speech impediment

## Barriers to Exercise

Despite health promoting benefits, many MS patients are often hesitant to participate in physical activity for fear of increasing symptoms or worsening the condition
MS patients report several reasons for avoiding physical activity including:
   * Fatigue accentuating symptoms following exercise
   * Perceived inability to exercise
   * Perceived lack of physical activity benefits
   * Increased scarring exacerbation
There are only a few symptoms which are shown to present a barrier to physical activity in MS patients, such as:
   * Loss of coordination and balance during exercise resulting in injury
   * Physical impairment

## Benefits of Exercise

Physical activity has demonstrated many benefits to physical and mental health for sufferers of MS and shown that correct implementation of exercise programmes to be safe for MS patients. Exercise has been shown to have physical health benefits such as:
   * Reduce MS symptoms severity and prevalence
   * Slow degeneration of MS
   * Improve muscular strength
   * Improve balance and coordination
   * Reduce feelings of fatigue
   * Reduce other disease morbidities
Exercise has also been shown to have benefits to the mental health of MS patients such as:
   * Improve wellbeing
   * Reduce depression
   * Improve self-esteem
   * Improve social interactions and support networks

### Recommendations & Precautions

Exercise is beneficial to assist in reduction of symptoms for MS sufferers. Some types of training for MS patients include:
   * Aerobic exercise
   * Resistance exercise
   * Respiratory training
MS Specific Considerations for Exercise
   * Pre-cooling
   * Aquatic exercise
Prior to undertaking an exercise regime, individuals with MS should consult with a:
   * Doctor
   * Pharmacologist &
   * Exercise physiologist

## External Resources

Multiple Sclerosis Australia http://www.msaustralia.org.au/
Multiple Sclerosis USA http://www.nationalmssociety.org
Multiple Sclerosis Europe http://www.emsp.org/
Multiple Sclerosis UK http://www.mssociety.org.uk/
Multiple Sclerosis Forum for Doctors and Patients http://www.medhelp.org/forums/Multiple-Sclerosis/show/41

## References

* 1 2 3 "Multiple Sclerosis and Exercise - a review of the evidence" Author: H, Karpatkin. International Journal of MS care (2005)vol 7, 36-41
* ↑ "The perceived benefits and barriers to exercise participation in Persons with Multiple Sclerosis" Author: N, Stroud et al. Disability and Rehabilitation Journal. (2009); vol 31(26), pg 2216–2222
* ↑ "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
* ↑ "Recommendations for Physical Activity in Patients with Multiple sclerosis" Author: J, Petaja. Sports Medicine Journal. (1999); 27(3)
* ↑ "Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program" Author: Rodgers MM, Mulcare JA, King DL. Retrieved from http://www.rehab.research.va.gov/jour/99/36/3/rodgers.htm
* ↑ "Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity levels of subjects with multiple sclerosis" Author: Mostert S, Kesselring J. Retrieved from http://msj.sagepub.com/content/8/2/161.full.pdf+html
* ↑ "Impact of aerobic training on fitness and quality of life in multiple sclerosis" Author: Petajan JH, Gappmaier E, White AT. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/ana.410390405/pdf
* 1 2 "Resistance training improves strength and functional capacity in persons with multiple sclerosis" Author: LJ White, SC McCoy, V Castellano, G Gutierrez, JE Steven, GA Walter and K Vandenborne. Retrieved from http://msj.sagepub.com/content/10/6/668.full.pdf+html
* ↑ "Endurance training in patients with multiple sclerosis: five case studies" Author: Svensson B, Gerdle B, Elert J. Retrieved from http://physther.org/content/74/11/1017.full.pdf+html
* ↑ "Expiratory training in multiple sclerosis" Author: Smeltzer SC, Lavietes MH, Cook SD. Retrieved from http://www.sciencedirect.com/science/article/pii/S0003999396902816
* ↑ "Effects of an aquatics exercise program on quality of life measures for individuals with progressive multiple sclerosis" Author: T Roehrs, G Karst. Journal of neurological physical therapy. (2004); vol, 28(2)
* 1 2 "Effects of an aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis" Author: Gehlsen GM, Grigsby SA, Winant DM. Retrieved from http://www.physther.net/content/64/5/653.full.pdf+html.
* ↑ "Exercise in 94 Degree F Water for a Patient with Multiple Sclerosis" Author: Peterson C. Retrieved from http://ptjournal.apta.org/content/81/4/1049.full.pdf+html.