Multiple Sclerosis - Ex Rx

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17 Terms

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Multiple Sclerosis

  • Inflammatory autoimmune disease of CNS

  • Characterized by nerve demyelination

  • Plaque (sclerosis) in brain and spinal cord

    • Develops into permanent scars

    • Impaired neve transmission

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Symptoms of Multiple Sclerosis

  • Weakness

  • Fatigue

  • Impaired motor function

  • Numbness

  • Bowel Dysfunction

  • Cognitive Dysfunction

  • Optic neuritis

  • Nystagmus

  • Paresthesia

  • Spasticity

  • Heat Sensitivity/Impaired Temperature Regulation

  • Negative Cycle of De-conditioning

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Causes of Multiple Sclerosis

  • Unknown

  • Possible

    • Environment

    • Infections

    • Genetics

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Pathophysiology of MS

  • Autoreactive T-cells

  • Myeline sheath deteriorates

  • Plaques destroy axons

  • Impairment of nerve conduction

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Treatment/Management of MS

  • No cure

  • Medications

  • Exercise

  • Rehabilitation

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Diagnostic Testing of MS

  • Neurological Exam

  • MRI

  • Cerebrospinal Fluid

  • Blood Test

    • No specific MS Blood Test

    • Test for other conditions

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Exercise Testing for MS

  • Determine current state of fitness

  • Develop appropriate exercise prescription

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Cardiorespiratory Testing for MS

  • Careful consideration on mode

  • Monitor temperature regulation

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Physiological Responses During Exercise from MS

  • Increased VO2

  • Steady or decreased BP

  • Same or increased Body Temperature

  • Earlier onset muscular fatigue

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MS & GXT

  • Medical clearance needed prior to exercise testing is highly recommended

  • Include:

    • 6 MWT

    • Timed Up & Go

    • Waist-to-hip ratio or BMI

    • Berg Balance Scale

    • Functional Gait Assessment

    • 10-m walk test

    • Five times sit-to-stand

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Musculoskeletal GXT

  • Standard testing is typically okay

  • 1-RM can be used but modified if significant weakness exists

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Flexibility GXT

  • Use goniometers

  • Patients can be quite inflexibile because of disease progression and level of spasticity

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GXT Considerations of MS

  • Acute symptoms = postpone

  • Mornings pererable (Less fatigue)

  • Use RPE and HR

  • A cycle ergometer is recommended

  • Recumbent stepping

  • Arm ergometer

  • VO2 PEAK: symptom limited, not capacity limited

  • Muscle strength and endurance standard protocols

    • 8-10 RM

    • Functional testing

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Ex Rx Considerations of MS

  • Functional Activities

  • Acute symptoms = Decrease FITT to level of tolerance

  • Severe symptoms = Focus on maintaining functional mobility and on aerobic exercise and flexibility

  • Increased rest times between sets and exercises for full muscle recovery

  • Focus on large postural muscle groups and minimize total number of exercise performed

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Ex Rx Goals of MS

  • Maintain, re-achieve, or even improve general physical and mental health thus improving ADLs

  • Reduce symptoms

  • Improve QoL

  • Lower risk factors for cardiovascular and metabolic disease

  • Safe and do not exacerbate symptoms

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Additional Special Consideration of MS

  • Medication side effects

  • Awareness of difference between more general centered mediated MS fatigue and temporary peripheral exercise related fatigue

  • Cautious of possible dehydration

  • Cognitive effects