Multiple Sclerosis (MS) is a progressive autoimmune disease that affects the central nervous system, resulting in gradual neurological deficits. It is a demyelinating disease, meaning the “covers” around the nerve cells in the brain and spinal cord are damaged. Without this insulation, transmission of nerve signals is impaired, resulting in a range of symptoms. When the body repairs this damage to the cells, they heal as a hardened tissue, like scars or plaque. This is called sclerosis. MS is primarily diagnosed between 20-40 years of age, and is more prevalent in females. Unfortunately, there is no current cure for MS and the cause is not yet known.
Symptoms can vary from sensory to motor, behavioural and/or emotional disruptions. Where the sclerosis is located, will correlate with the functional impairments. Some examples of symptoms these people will experience are:
- Decrease in muscle strength – one side may be more affected than the other
- Gait (walking) impairments
- Coordination difficulty
- Memory impairment
- Decreased balance
- Altered sensations eg. numbness, tingling
- Fatigue – often that worsens with heat
- Bowel or bladder dysfunction
- Difficulty with speech
- Impaired vision
Types of Multiple Sclerosis:
There are 4 broad types of MS:
- Relapsing Remitting (approximately 60% of MS cases) – symptomatic episodes are separated by periods of remission. The severity of symptoms may or may not worsen between symptomatic episodes.
- Primary Progressive – constant progression of symptoms with no remission.
- Secondary Progressive – approximately one third of relapsing remitting progress to this type. Turns in to constant progression of symptoms.
- Progressive Relapsing – no remission periods, constant degeneration with more severe symptomatic episodes.
Individuals with MS will likely be on a/several medications to manage their symptoms. In addition, they may also utilise assistive devices such as a cane/walker, orthotics or functional electric stimulation. Cooling vests may also be used, as heat can exacerbate their symptoms.
There are many physical symptoms experienced with this disease, therefore, exercise is one of the main treatments recommended in managing this disease. Due to the progressive nature of MS, the main aim of exercise is to decrease the rate of decline, and maintain independent function for as long as possible. Some benefits of regular and tailored exercise participation include:
- Improving muscular power – eg. getting up out of a chair
- Maintaining or improving balance – important for going up/down stairs
- Improving mobility – which can increase walking speed and distance
- Improved gut motility
- Enhancing mood/mental health
- Overall, increased quality of life
But how does exercise actually achieve these things? Well, there are 3 main areas, specific to MS, that exercise targets:
- Reducing inflammation – there is inflammation in the central nervous system with those who have MS. This inflammation surrounds the nerves affected by MS and therefore can place pressure on the healthy/non-affected nerves. Thus, impacting the ability for these healthy nerves to conduct signals. Exercise has an anti-inflammatory response by stimulating the production of certain proteins and inhibiting the production of others.
- Re-myelination – exercise can promote re-myelination of damaged nerves. However, this re-myelination eventually becomes inadequate and there is too much damage to the nerves. These re-myelinated nerves will not conduct signals as quickly as previously healthy ones.
- Neuroplasticity – exercise promotes an increase in central nervous system activity which increases the number and frequency of neural connections. These neural connections are responsible for changing neuron structures, which can aid in enhancing the pathways of undamaged neurons taking over the role of damaged pathways.
Due to the symptoms experienced, the progressive nature of the disease, and the different types of MS, there are several considerations to be made when designing an exercise program. Some of these include:
- Starting with low intensity exercise that includes familiar activities
- Avoiding exercising when the circadian body temperature is at its highest (this is the afternoon, so exercising in the morning is best)
- Being mindful of the environment including the heat
- Trying multiple short bouts of exercise, rather than a long continuous bout to minimise fatigue and allow for adequate rest
- Progress exercise only as tolerated – will not be the same progression for everyone
It is evident that MS is a chronic, progressive disease that will vary greatly for each individual. Exercise is a primary mode of treatment in managing symptoms for these people, but should be tailored to the person’s needs and goals. An Accredited Exercise Physiologist is a tertiary qualified health professional for using exercise as medicine for those with chronic health diseases. Please reach out to an AEP when you are considering starting your exercise journey!