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New research shows exercise lifts Multiple Sclerosis symptoms

Contradicting old research that says exercise is harmful for people with multiple sclerosis, the Multiple Sclerosis Society of Canada is now promoting exercise as a way of alleviating symptoms of the disease.

“One of the issues with MS is sensitivity to heat,” said Darrel Gregory, director of communications for the Alberta division of the MS Society of Canada. “When you exercise, of course your body temperature goes up and we used to think that was bad for people with MS.

“Now researchers have found out that any increase in your body temperature is just temporary. There’s no lasting damage.”

Gregory said researchers now say that exercise helps to alleviate some of the symptoms associated with MS.

MS is a disease that harms the central nervous symptoms with varying degrees of severity. Symptoms can include loss of balance, impaired speech, extreme fatigue, double-vision, loss of bladder control and paralysis.

Over 11,000 people in Alberta have MS and for reasons unknown women are three times as likely to be diagnosed with it. Three Canadians are diagnosed with the disease every day, according to the MS Society.

Exercise helps with primary symptoms such as fatigue, stiffness, numbness and pain. It also helps increase flexibility, enhance mood, improve bowel and bladder function and is also found to improve independent functioning.

“A person with MS, depending on the degree of mobility or impairment, can do the exercises that any able-bodied person can do,” said Dr. Garry Wheeler, vice president of the MS Society of Canada’s Alberta division. Though exercise is recommended, people with MS should consider several different factors when exercising, he said.

Because high temperatures can make symptoms of MS worse, he suggests exercising in a cool environment.

Wheeler also suggests exercising earlier in the day and doing so at an easy pace because fatigue is a factor among people with MS.

Balance and co-ordination is also a consideration for people with MS, Wheeler said.

“Running on a treadmill might be problematic for a person with balance problems so an exercise bike might be better.”

Because bladder control can be a problem “it’s important that a person empties their bladder before they exercise.”

People with MS should also drink a fair amount of water before they exercise to make sure they are well-hydrated.

Also be careful of the symptoms that any medications may cause such as dizziness.

“You don’t don’t want to be doing stressful exercise if you’re going to become dizzy and so on,” Wheeler said.

As MS progresses, memory and comprehension issues can affect the ability to follow instructions so its important to be in a safe environment and it’s a good idea to have a partner while exercising.

In case of a relapse, Wheeler said to slow down or take a break and he suggests consulting with a physician before beginning any exercise program.

Source: Fort Record © 2008 Fort Saskatchewan Record (14/05/08)

Role of exercise in mitigating effects of multiple sclerosis being studied

Of all the debilitating diseases, multiple sclerosis may be among the most cruel, University of Illinois researcher Robert Motl believes. That’s because it can literally stop people in their tracks in the prime of their lives.

“At the end of the day, MS is a disease that stops people from moving, that robs people of their ability to ambulate,” said Motl, a professor of kinesiology and community health. “It is chronic, progressive and unpredictable, and it occurs at the most devastating time of life for people – between the ages of 20 and 40. It strikes women most often.”

And it’s relatively common.

“Most people know someone with MS,” said Motl, who added that while certain drugs can be effective in treating various symptoms, there’s no cure for the disease. And as it progresses, so does the afflicted person’s overarching concern: “the fear of not walking.”

“People use walking as a primary way of understanding disease progression with MS,” he said. Progression goes from being fully ambulatory at the time of diagnosis to losing one’s balance, tripping easily or walking with an awkward gait to being unable to walk 500 yards, using a cane, holding onto walls or other people for balance, and using a walker or scooter for mobility.

While others work to find a cure – which Motl said is unlikely to materialize any time soon – he and colleagues at the U. of I. are focusing their research on “understanding the role of exercise as rehabilitation for MS, with the goal of slowing, mitigating or ending the devastating effects of the disease.”

That work, some of which has included collaboration with graduate student Erin Snook and kinesiology and community health professor Edward McAuley, includes examining the impact physical activity may have on symptoms, behaviour, disability progression and overall quality of life of individuals diagnosed with MS.

In a meta-analysis, the results of which appeared in a recent issue of the journal Multiple Sclerosis, Motl and another graduate, Jessica Gosney, reviewed published research conducted over the past four decades. They looked at studies that considered the effects of exercise training interventions on quality of life among people with MS, and found a positive connection.

“We used effects from each study to come up with an average effect across studies and found that exercise is associated with a small improvement,” Motl said. “But, that small improvement is clinically significant.”

Putting the finding in perspective, “disease-modifying drugs also reap what is considered to be a similarly sized and meaningful effect,” he said.

How and why physical exercise can translate to improved quality of life for an individual with MS is something Motl and McAuley are trying to pinpoint with support from a grant from the National Institutes of Health.

“What we’ve found are quite a few variables,” Motl said. Most notable among them is a relationship between exercise and self-efficacy, or the confidence that individuals will succeed at what they’re doing.

“Those who are more physically active have more confidence in their exercise performance, are more self-confident in general, and have more confidence in their ability to manage the disease,” Motl said.

Feeling in control of the disease means they’re more confident they can maintain their ability to walk, and that, he added, “translates to a better overall quality of life.”

Working from that knowledge, Motl said, rehabilitation efforts – especially for individuals who’ve recently been diagnosed with MS and have not yet developed severe disabilities – should focus on “trying to generate exercise programs that are designed in ways to maximize self-efficacy in order to manage quality of life.”

Designing such programs can be challenging he said, “since most exercise involves upright ambulatory movement,” which becomes more difficult as the disease progresses.

But given that Motl’s research also has indicated that exercise interventions can have “an overriding (positive) effect on walking ability,” including an outcome comparable to drug interventions – but over a much shorter period – he remains interested in exploring determinants for inactivity among this population.

In a paper just published online in the journal Research in Nursing & Health, Motl, Snook and co-author Randall T. Schapiro examined overall and specific symptoms to see if there were correlations between activity levels and physical symptoms. The 10 most common overall symptoms associated with MS range from fatigue, difficulty walking, stiffness and spasms to dizziness, problems with vision, memory and other cognitive functions.

“We initially examined the intensity of overall symptoms as a correlate of physical activity, and then examined the possibility that specific symptoms of fatigue, depression and pain would account for the association between overall symptoms and physical activity by way of difficulty walking,” the authors wrote.

Initial results indicated a statistically significant link between low exercise participation and higher levels of overall symptoms, fatigue and difficulty walking. Similar connections were not found, however, with respect to depression or pain.

Ultimately, the researchers determined that walking difficulty may explain the relationship between intensity of overall symptoms and decreased levels of physical activity.

These results reinforce Motl’s belief that in order to get people with MS to exercise, “we have to start by trying to manage their symptoms.”

“For instance, with fatigue, there are certain things you can do,” he said. “If people may get more tired by afternoon, they could make sure they get exercise in the morning.” Similarly effective, he said, is the concept of energy conservation: “Do only what you have to do, and do it efficiently.” Also key, he added, is “planning well.”

And if this approach to managing symptoms to increase participation and adherence in exercise programs can work for those with MS, he suspects it also can be effective for people suffering with depression, fibromyalgia and Chronic Fatigue Syndrome.

“This is about focusing on rehabilitation as opposed to medication,” he said. And that represents a significant paradigm shift since most past research has been “all about finding drugs that stop or slow the disease.”

A new, complementary approach is needed, he said, because “we’re not even close to curing it.”

Source: University of Illinois (29/02/08)

Multiple sclerosis and brief moderate exercise. A randomised study

This is a randomised control study, to determine the effect of aerobic and strength exercise on physical fitness and quality of life in patients with mild multiple sclerosis (MS). Sixteen outpatients with definitive MS, aged 18-50, with an Expanded Disability Status Scale (EDSS) <4, completed the study. Every patient was evaluated according to physical fitness with peak oxygen consumption (V'O2peak ), workload and anaerobic threshold; quality of life (SF-36); and degree of disability (EDSS). The patients were then randomised to an exercise group (EG) (n =6) or a control group (CG) (n = 10). The EG exercised three times a week for five weeks, and the CG did not change their habits regarding exercise.

In the EG, the mean change in workload was 0.34 W/kg (95% confidence interval (CI): 0.09-0.58), the mean change in V'O2peak was 4.54 mL/kg per minute (95% CI: 1.65-7.44), and the mean change in anaerobic threshold was 0.32 L/min (95% CI: 0.08-0.57). There was a tendency towards improved quality of life, and no change was detected in the degree of disability. This study confirms that brief, moderate, aerobic exercise improves physical fitness in individuals with mild MS. No evidence was found for worsening of MS symptoms in association with exercises.

O.H. Bjarnadottir, Reykjalundur Rehabilitation Center, 270 Mosfellsbaer, Iceland; A.D. Konradsdottir,Reykjalundur Rehabilitation Center, 270 Mosfellsbaer, Iceland; K. Reynisdottir, Reykjalundur Rehabilitation Center, 270 Mosfellsbaer, Iceland; E. Olafsson, Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland, School of Medicine, University of Iceland, Reykjavik, Iceland.

Source: Multiple Sclerosis 2007; 13: 776-782 (05/09/07)

fatigue and depression, which often results in a vicious cycle of reduced mobility and decreased physical activity. Reduced activity levels predisposes people with MS to be at increased risk for secondary diseases such as diabetes, osteoporosis and coronary artery disease (CAD).

Exercise Can Cut Coronary Artery Disease Risk For Some With Multiple Sclerosis.

Results of a new study suggest that people with mild to moderate multiple sclerosis (MS) are capable of improving their aerobic fitness levels similar to their non-MS counterparts. While physical inactivity may predispose MS patients to have increased coronary artery disease risk, MS-related symptoms don't preclude this group from potentially reducing their risk factors through exercise.

Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system of 400,000 Americans with 200 more diagnosed each week. The disease causes reduced nerve function and consequently a variety of symptoms. The most commonly reported symptoms include muscle weakness, spasticity, excess

In an effort to improve the health status of those with MS, a team of researchers worked with individuals diagnosed with mild to moderate disability in an eight week aerobic cycling regimen. The investigators found that people with MS improved their aerobic fitness and reduced their level of CAD risk.

The Study: Summary of Methodology

Eleven MS patients and 11 matched controls (age, sex, body mass index) participated in the study. MS patients were clinically stable and had mild to moderate disability. All volunteers (MS and control subjects) had physician clearance and met specific inclusion/exclusion criteria.

Once enrolled, subjects participated in an eight week supervised aerobic cycling exercise protocol wherein they exercised three days per week. Each exercise session consisted of a three minute warm up at a self-assessed comfortable speed followed by 30 minutes of cycle ergometry (continuous or intermitant) at 60 percent of VO2peak, consistent with the American College of Sports Medicine (ACSM) guidelines for improving health and fitness.

Subjects were assessed for CAD risk before and after the exercise intervention, according to the guidelines of the American Heart Association. Serum samples were obtained the morning after a 12-hour fast, 48 hours before the first and final exercise session of the training program. Enzymatic colorimetric methods were used to analyse serum total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides and glucose. Anthropometric (body weight, BMI, body fat percentage) measures and blood pressure were also taken at the same time.

Results

The researchers noted that following the intervention, aerobic fitness improved by 10 percent in MS subjects (Pre: 2.2 ± 0.4 L/min; Post: 2.5 ± 0.4) and 14 percent in controls (Pre: 2.4 ± 1.0 L/min; Post: 2.8 ± 1.0), respectively; baseline assessment of CAD risk factors showed that the MS subjects had significantly higher circulating levels of triglyceride (MS: 5.0 ± 2.2 mmol/L; Control: 1.2 ± 0.05) and total glucose (MS: 7.1 ± 1.1 mmol/L; Control: 6.6 ± 0.5) compared to the control group; after completion of 24 total cycling sessions, MS subjects showed significant reductions in percent body fat, triglycerides and resting diastolic blood pressure. Specifically, there was a 6 percent decrease in percent body fat (pre: 29.6 ± 5.8 percent; post: 27.9 ± 7.6), a 23 percent decrease in triglycerides (pre: 7.75 ± 2.2 mmol/L; post: 5.80 ± 1.8) while diastolic blood pressure dropped 5 mmHg (pre: 80.7 ± 11.1 mmHg; post: 75.0 ± 8.1). Relative improvements in the number of risk factors were observed in 7 of 11 MS participants; and the control subjects showed significant decrease in fasting glucose (pre: 6.6 ± 0.5 mmol/L; post: 5.9 ± 0.4). Additionally, four of 11 subjects reduced their relative CAD risk by at least one risk factor.

Discussion/Conclusions

The results of this study support earlier work done by this research team, which showed exercise was associated with reduced individual CAD risk factors among resistance trained MS subjects. The results suggest that people with mild to moderate MS are capable of improving their aerobic fitness to levels similar to their non-MS counterparts. Thus, while physical inactivity may predispose MS patients to have increased CAD risk, MS-related symptoms do not preclude this group from potentially reducing their risk factors through exercise.

Physiology is the study of how molecules, cells, tissues and organs function to create health or disease. The American Physiological Society (APS) has been an integral part of the scientific discovery process since it was established in 1887.

Reference: These findings are drawn from a study entitled Aerobic Exercise Influence on Coronary Artery Disease Risk Factors in Multiple Sclerosis. It was conducted by Darpan Patel, Vanessa Castellano, Sean McCoy, Ashley Blazina and Lesley White, all of the University of Florida, Department of Applied Physiology and Kinesiology, Gainesville, FL. Patel will present the team's findings at the 120th annual meeting of the American Physiological Society, being held as part of the Experimental Biology conference (EB '07).

Source: American Physiological Society.(01/05/07)

Exercise may be good for MS patients

A Calgary study shows that exercise can help people with multiple sclerosis.

The findings are the opposite of what people with the disease have been told for years.

It was believed that exercising would make their condition worse because fatigue is one of the most common symptoms of the disease.

But a small study by the University of Calgary found exercising actually gave people with MS more energy.

Kimberly Carcary is heading up the study. She says the women in her program all noticed significant changes in their day-to-day life and reported improvement in social, cognitive, and physical function.

Carcary says a temporary increase in symptoms is sometimes reported at the beginning of an exercise program but it is only temporary.

Her results found a decrease in the physical impact of fatigue from 21 to 33 percent.

Improvements in social and cognitive impact ranged from 21 to 42 percent.

Source: Calgary.ctv.ca © 2007 All Rights Reserved. (28/02/07)