Multiple Sclerosis - Ex Rx

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

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

Causes of Multiple Sclerosis

• Unknown

• Possible

  • Environment

  • Infections

  • Genetics

Pathophysiology of MS

• Autoreactive T-cells

• Myeline sheath deteriorates

• Plaques destroy axons

• Impairment of nerve conduction

Treatment/Management of MS

• No cure

• Medications

• Exercise

• Rehabilitation

Diagnostic Testing of MS

• Neurological Exam

• MRI

• Cerebrospinal Fluid

• Blood Test

  • No specific MS Blood Test

  • Test for other conditions

Exercise Testing for MS

• Determine current state of fitness

• Develop appropriate exercise prescription

Cardiorespiratory Testing for MS

• Careful consideration on mode

• Monitor temperature regulation

Physiological Responses During Exercise from MS

• Increased VO₂

• Steady or decreased BP

• Same or increased Body Temperature

• Earlier onset muscular fatigue

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

Musculoskeletal GXT

• Standard testing is typically okay

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

Flexibility GXT

• Use goniometers

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

GXT Considerations of MS

• Acute symptoms = postpone

• Mornings pererable (Less fatigue)

• Use RPE and HR

• A cycle ergometer is recommended

• Recumbent stepping

• Arm ergometer

• VO_{2 PEAK}: symptom limited, not capacity limited

• Muscle strength and endurance standard protocols

  • 8-10 RM

  • Functional testing

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

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

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