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    Exercise

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    Exercise and MSMore news can be found in New Pathways Magazine, our bi-monthly publication, and also check daily at MSRC: Latest MS News.

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  • Canadian researchers launch new MS mobility study

    Exercise and MS For people living with Multiple Sclerosis, some of the simple things many of us take for granted can be daunting. And, too often that leads to a withdrawal of activities for the person living with the disease. A group of local researchers is trying to change that by helping MS patients stay mobile one step at a time.

    With every step, Rob Loewen is fighting to keep his independence. He was diagnosed with Multiple Sclerosis in 1992 but says he's been living with the symptoms much longer-symptoms that have made life a challenge.

    "You plan a day and think here's a few things I want to achieve today. And at the end of the day, you say, I did nothing. That's pretty hard to live with," says Loewen.

    It's Loewen's determination to stay active that has led him to be screened for a new pilot project in Saskatoon. Researchers are working with MS patients to maintain their independence by engaging in exercises that promote mobility and help them with everyday activities.

    "In this particular case, regular mobility involves us doing things we take for granted, like getting across a crosswalk in time, getting up a flight of stairs without having to hold onto a handrail," says lead researcher with the project Larry Brawley.

    Brawley says those seemingly easy tasks can be daunting for MS patients. And, too often, that results in a loss of confidence and a withdrawal from activities all together. "Our motto here would be rather than run, our motto for this program would be we'd like to get people to walk before they run to make sure their mobility is preserved."

    Dr. Katherine Knox is the director of the Saskatoon Multiple Sclerosis Clinic. She says preserving that mobility is especially important as MS is a progressive disease.

    "People who maintain an active lifestyle and activity program that focuses on maintaining balance, range of motion and aerobic conditioning, they tend to live better with their disease," says Dr. Knox.

    People like Rob Loewen. Although he has good days and bad, he applauds any effort to help those in similar situations stay on their feet, and fight MS, every step of the way.

    "I'm always looking for the next challenge to enhance my quality of life and there's no shortage of those," says Loewen.

    Source CTV News © 2012 CTV Bell Media (09/05/12)


     Effects of 3 weeks’ whole body vibration training on MS

    Vibro-trainingAbstract

    Background: Exercise therapy in persons with multiple sclerosis (MS) is effective for improving muscle strength and functional mobility.

    Objective: To investigate, in MS patients attending an in-patient rehabilitation program, the additional effects of a 3-week exercise program, performed on a whole body vibration platform, on muscle strength and functionality.

    Methods: Median Expanded Disability Status Scale (EDSS) of participating patients was 5.5. This randomized controlled trial differentiated a MS control group (n = 17) and two exercise groups performing exercises on a vibration platform (WBV-full group, n = 20) and on the platform additionally covered by a damping mat (WBV-light group, n = 18). Exercise groups performed, during 10 training sessions, six static and dynamic exercises standing on a platform vibrating at high frequency and low amplitude. Isometric muscle strength of quadriceps, hamstrings, tibialis anterior and gluteus medius was measured with a hand-held dynamometer. Functional mobility was measured with Berg Balance Scale (BBS), 3-minute walk test and Timed Get up and Go test.

    Results: Eight drop-outs occurred in the exercise groups (WBV-full = 4, WBV-light = 4), but were unrelated to WBV as type of intervention. Across groups, significant time effects were found for all muscle groups. For maximal quadriceps and hamstrings muscle strength, interaction effects were found with post-hoc tests indicating exercise group-significant improvements in the WBV-full group only. Significant time effects were found for all functional tests. Improvements on the BBS and 3-minute walk test were larger in training than in control groups, but no significant interactions were found.

    Conclusions: A 3-week exercise program on a vibration plate significantly improved muscle strength, but not functionality, in persons with MS.

    Effects of 3 weeks’ whole body vibration training on muscle strength and functional mobility in hospitalized persons with multiple sclerosis

    Marieke Claerbout, Department of Physical Medicine and Rehabilitation, AZ Sint-Blasius Dendermonde, Belgium; Benoit Gebara, National MS Center Melsbroek, University Hospitals Leuven, Belgium; Stefan Ilsbroukx, National MS Center Melsbroek, University Hospitals Leuven, Belgium; Sabine Verschueren, Department of Biomedical Kinesiology, K.U. Leuven, Belgium; Koen Peers, Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Belgium; Paul Van Asch, Fit Up, Fitness and Rehabilitation Center Kontich, Belgium; Peter Feys, Department of Rehabilitation Sciences, K.U. Leuven, Belgium; BIOMED, Hasselt University and REVAL Research Institute, PHL University College, Belgium

    Source: Sage Journals Online Copyright © 2011 by SAGE Publications (16/11/11)


    Study shows vibration therapy fails in MS patients

    Vibration TrainingWhole-body vibration is pitched as a solution to everything from low bone density in astronauts to a better golf swing for weekend duffers and as an aid to rehabilitating weakened muscles.

    But a small new study suggests that regular training using whole-body vibration does nothing to improve muscle strength or function in patients with multiple sclerosis (MS).

    The technology has been increasingly used as a treatment for muscle-related diseases such as MS because the vibration is thought to stimulate muscles to become more efficient and to build bone.

    In the U.S., an estimated 400,000 people have been diagnosed with MS, a condition affecting nerves and muscles that typically begins manifesting itself between the ages of 20 and 40. Characterized by progressive muscle weakness and loss of control, the course of the disease can vary widely between individuals but may eventually become debilitating.

    In the first long-term investigation of whole-body vibration in MS sufferers, Belgian researchers looked for an effect on various measures of muscle capacity in the upper legs, including strength, function, endurance and speed of motion in 11 men and women with mildly to moderately disabling disease.

    Volunteers performed leg exercises, such as squats and lunges, on the vibrating platform during five sessions every two weeks for 20 weeks. Meanwhile, another group of 14 MS patients was asked to go about their daily routines.

    The two groups began the study with similar levels of weakness in their legs, and after 10 and 20 weeks of follow-up that hadn't changed, according to the researchers. The lack of any effect of from the regular workouts was somewhat surprising, the scientists added, because studies have shown that MS patients benefit from regular exercise.

    "Under the conditions of the present study long-term probably does not improve upper leg muscle strength and functional capacity" in people with mildly or moderately disabling MS, the researchers wrote in the Journal of Rehabilitation Medicine.

    Although the results found no benefit from vibration therapy, the researchers said their study might have missed such an effect for several reasons. It's possible that the small number of patients prevented them from detecting improvements in muscle function. Similarly, every patient performed the same exercise routine, so it's impossible to say if a customized regimen would not be effective.

    Tom Broekmans, a doctoral student in physical therapy at Hasselt University in Diepenbeek, and leader of the study, added that the patients in the trial may not have been disabled enough to reap gains from the vibration treatment. However, patients who are too weak can't perform the exercises, he said, creating a tricky paradox for researchers hoping to study the issue.

    Dr. Nicholas LaRocca, vice president of health care delivery and policy research at the National Multiple Sclerosis Society, said his group does not endorse particular technologies but does stress the importance of exercise for people with the condition.

    "Exercise is really considered to be very beneficial for people with MS, particularly if they can avoid overheating," Dr. LaRocca said. Not only does aerobic exercise build strength, he said, but some evidence suggests that it may improve the immune system in MS patients.

    Few effective treatments exist for MS, and none can cure the condition.

    As for whole-body vibration and patients with MS, Dr. LaRocca said, "maybe additional research needs to take a closer look at who would be most likely to respond, if anyone," to the treatment.

    Source: Reuters (Health) © Copyright 2010 Thomson Reuters (08/10/10)


    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)

    © Multiple Sclerosis Resource Centre (MSRC)

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