Literature reviewPhysical training and multiple sclerosis
Introduction
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system that affects young people, especially women. The consecutive handicap varies depending on the locality and course of disease: relapsing, remitting or progressive. Motor disorders are frequent, with muscle weakness, balance problems and spasticity [9]. Fatigue is one of the symptoms most frequently reported by MS patients, sometimes isolated at the onset of MS or associated with other neurological disorders. The most likely causal mechanism, whether psychological and psychiatric disorders, sleep disorders, pain, comorbidities, medications, or deconditioning, has never been validated [3].
People with MS often limit their physical activity because of the risk of exacerbation of this chronic illness. In fact, decreased physical activity tends to increase deconditioning and alters fitness [17], [27], [35], [39]. Thus the benefit of physical activity for people with MS must be questioned.
We aimed to describe physiological responses to exercise in MS and then review published research to explore the efficacy of physical activity for people with MS. The response to disability depends on the level of handicap generally evaluated by the Expanded Disability Status Scale (EDSS), although it is probably not the best scale for patients with limited disability [19].
Section snippets
Physiological response to exercise in MS
The appropriateness of physical activity for people with MS largely depends on patients' physiological tolerance and response to exercise. Ponichtera-Mulcare [27], in a review of literature published between 1951 and 1993, found four main areas related to exercise: cardiorespiratory fitness, autonomic function, skeletal muscle function and the effect of exercise-induced temperature increase. This review stressed the importance of the level of neurological impairment, which influences physical
Physical training effects
Gehlsen et al. [11] found a real benefit in 10 patients with EDSS < 6 after a 10-week program of aerobic training in balneotherapy for 3 hours/week, with a heart rate under 65–70% of the theoretical maximal rate. Schapiro et al. [33] confirmed these results with an open study of the VO2 max without controls. Gappmaier et al. [10] studied 13 patients participating in three supervised sessions per week of combined leg and arm cycling for 15 weeks. Training consisted of 40 min of cycling per session
Exercise and temperature
Heat may induce an increase of symptoms in MS, and cold may improve symptoms. Little variations can result in a great change on neurological deficits. Namerow [22] and Davis et al. [5] reported spontaneous daily variations in clinical symptoms as a consequence of the circadian fluctuation of endogenous temperature, independent of physical exercise. In fact, the influence of temperature varies among patients with MS, as we noticed in a previous epidemiologic study [26].
Ponichtera-Mulcare et al.
Conclusion
For many years people with MS have limited their physical activity because of the fear of increased disability. In fact, lack of physical activity tends to increase muscle weakness and fatigue. Several studies have demonstrated that physical training can benefit people with MS with EDSS < 6, with improved muscular performance, exercise capacity, health-related quality of life and less impact on fatigue. Regular aerobic physical activity is necessary for maintaining the benefit of the physical
References (42)
Fatigue and multiple sclerosis
Ann. Readapt. Med. Phys.
(2006)- et al.
Évaluation préliminaire des effets de la rééducation sur les paramètres de force, d’équilibre et de marche dans la sclérose en plaques
Ann. Readapt. Med. Phys.
(2006) - et al.
Vesico urethral dysfunction and urodynamic findings in multiple sclerosis. A study of 149 cases
Arch Phys. Med. Rehabil.
(1998) - et al.
Sensory-motor and genito-sphincter dysfunctions in multiple sclerosis
Biomed. Pharmacother.
(1999) - et al.
Évaluation isocinétique de la flexion extension du genou chez les patients ambulatoires atteints de SEP
Ann. Readapt. Med. Phys.
(2000) - et al.
Activité sportive et sclérose en plaques
Ann. Readapt. Med. Phys.
(2006) - et al.
Health-related quality of life and depression in an Italian sample of multiple sclerosis patients
J. Neur. Sci.
(2003) - et al.
Influence des variations de la température sur la symptomatologie clinique dans la sclérose en plaques: étude épidémiologique
Ann. Readapt. Med. Phys.
(2004) - et al.
Renforcement musculaire isocinétique excentrique dans la rééducation du recurvatum de genou chez des patients atteints de sclérose en plaque: Résultats préliminaires à 3 mois
Ann. Readapt. Med. Phys.
(2005) - et al.
Exercise, functional limitations and quality of life: a longitudinal study of persons with multiple sclerosis
Arch. Phys. Med. Rehabil.
(2006)
Using isokinetic dynamometry to test ambulatory patients with multiple sclerosis
Phys. Ther.
Cardiovascular autonomic function in multiple sclerosis
J. Neurol. Sci.
Fluctuation of motor function in multiple sclerosis related to circadian temperature variations
Dis. Nerv. Syst.
Respiratory muscle function and exercise capacity in multiple sclerosis
Eur. Respir. J.
Les complications urinaires dans la sclérose en plaques : étude des facteurs de risque
Ann. Readapt. Med. Phys
Fifteen weeks of aerobic training improve fitness of multiple sclerosis
Med. Sci. Sports Exerc.
Effect of an aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis
Phys. Ther.
Respiratory muscle involvement in multiple sclerosis
Eur. Respire J.
Respiratory dysfunction in multiple sclerosis
Brain
Postexercise phosphocreatine resynthesis is slowed in multiple sclerosis
Muscle Nerve
Strength, skeletal muscle composition and enzyme activity in multiple sclerosis
J. Appl. Physiol.
Cited by (44)
Exercise in the management of multiple sclerosis
2022, Exercise to Prevent and Manage Chronic Disease Across the LifespanDosage and Effectiveness of Aerobic Training on Cardiorespiratory Fitness, Functional Capacity, Balance, and Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis
2021, Archives of Physical Medicine and RehabilitationCitation Excerpt :In most of the studies in this meta-analysis, the AT groups improved their cardiorespiratory fitness after the AT program, whereas control groups did not show changes or had decreased their levels.20,23,25,30,45,47,49-53 In general, individuals with MS exhibit lower V̇o2peak and V̇o2max compared with the general population.74 Previous studies suggest that these lower values are mainly due to the decreased level of daily activity75 and not necessarily caused by a problem at the physiological level.
The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis
2019, Archives of Physical Medicine and RehabilitationImpact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic review
2019, Multiple Sclerosis and Related DisordersCitation Excerpt :Exercise training may prevent or ameliorate these symptoms by preventing deconditioning and other comorbidities (Petajan and White, 1999; Sa, 2014). As some of the disabilities that MS patients experience e.g. muscle weakness and atrophy, could be considered as a consequence of inactivity and not a result of the disease per se (Dalgas, Stenager, & Ingemann-Hansen, 2008), it has been demonstrated that exercise can reduce inactivity-related impairments (Gallien et al., 2007). Therefore, it seems logical to speculate that exercise may induce clinically significant improvements in MS patients as well as benefits in their quality of life.