MS

Multiple Sclerosis Overview

Learning Objectives

• Discuss the physiological changes that occur with a diagnosis of Multiple Sclerosis.

• Discuss the benefits of exercise.

• Outline appropriate exercise prescriptions and accommodations for progression of the disease.

Introduction to Multiple Sclerosis (MS)

• Definition: Multiple sclerosis is an autoimmune disease that damages the insulating myelin of the central nervous system.

• Mechanism: Inflammatory attacks on the nervous system occur randomly, leading to varied symptoms.

• Impact on Movement: Loss of myelin adversely affects the ability to make smooth, rapid, and coordinated movements.

• Demographics:

  • First diagnosed between ages 16 and 60.

  • Peak incidence at 30 years of age.

  • Affects women more than men, with a ratio of 3:1.

Symptoms of Multiple Sclerosis

• Common Symptoms:

  • Spasticity

  • Incoordination

  • Impaired balance

  • Fatigue

  • Muscle weakness

  • Sensory loss and numbness

  • Tremors

  • Heat sensitivity

  • Cardiovascular problems

Research on the Benefits of Exercise

• Physical Improvements: Exercise leads to improvements in short-term physical fitness and functional performance.

• Walking Improvements: There are small improvements in walking ability.

• Aerobic Training Benefits: Aerobic training improves:

  • Aerobic threshold

  • Health perception

  • Fatigue levels

  • Increased levels of activity

Medications for Multiple Sclerosis

• Disease Modifying Agents:

  • Interferons: Common side effects include flu-like symptoms.

  • Copaxone: Composed of four amino acids; potential side effects include chest pain.

  • Novantrone: Suppresses the immune system; side effects may include swelling of legs and shortness of breath.

  • Tysabri: Causes immune suppression; side effects can involve fatigue, joint pain, and depression.

• Symptom Management Medications:

  • Provigil: May reduce fatigue.

  • Zanaflex: A muscle relaxant that may cause muscle weakness.

  • Prozac: Used for depression management.

  • Prednisone: Used to decrease inflammation; may cause diabetes and osteoporosis.

Prednisone Overview

• Uses: Treats conditions like arthritis, blood disorders, breathing problems, severe allergies, skin diseases, cancer, eye problems, and immune system disorders.

• Mechanism: Prednisone is classified as a corticosteroid.

• Adrenal Suppression: Prolonged use (over seven days) can lead to adrenal suppression, causing dependency on prednisone.

• Withdrawal Consequences: Abruptly stopping the medication after prolonged use may lead to an Addison crisis.

Side Effects of Prednisone

• Adverse Effects:

  • Increased blood sugar for diabetics

  • Difficulty controlling emotions

  • Weight gain

  • Immunosuppression

  • Facial swelling

  • Depression and fatigue

  • Mental confusion

  • Blurred vision

  • Abdominal pain

  • Peptic ulcers

  • Painful hips and shoulders

  • Steroid-induced osteoporosis

  • Insomnia

  • Severe joint pain

  • Cataracts

  • Anxiety

  • Black stools

  • Stomach pain

  • Severe swelling

  • Mouth sores

  • Avascular necrosis

Exercise Testing in Multiple Sclerosis

• Challenges: Testing is complicated by factors like lower extremity sensory loss, foot drop, balance problems, muscle spasticity, and clonus, making treadmill testing highly difficult.

• Alternative Testing: Using arm or leg ergometers is limited since individuals often experience muscle fatigue before reaching true cardiopulmonary maximum.

• Maximal Heart Rate: Research indicates that most individuals with MS can achieve 85-90% of their age-predicted maximal heart rate.

Considerations for Exercise in MS

• Key Challenges:

  • Fatigue can greatly reduce exercise tolerance.

  • Balance issues need to be addressed.

  • Heat intolerance must be monitored.

  • Spasticity may require special adjustments like foot strapping.

  • Sensory loss increases the risk of falls.

  • Muscle paresis complicates exercise regimens.

Exercise Recommendations for Individuals with MS

• General Guidelines:

  • 30 minutes of moderate-intensity aerobic activity at least 2 times per week.

  • Moderate-intensity is rated as 5 or 6 on a scale of 10.

  • Engage in strength training exercises for major muscle groups at least 2 times per week, aiming for 10-15 repetitions per exercise (one set only).

  • Incorporate rest between exercises.

  • Following these guidelines may help reduce fatigue, improve mobility, and enhance health-related quality of life.

Symptoms Prevalence

• Common MS Symptoms and Their Prevalence:

  • 70.4% Numbness, tingling

  • 53.7% Headaches

  • 49% Cognitive dysfunction

  • 54% Depression

  • 35.7% Speech/swallowing problems

  • 13.8% Breathing problems

  • 89.6% Fatigue

  • 38.1% Sexual dysfunction

  • 60.8% Muscle spasms

  • 35.4% Itching

  • 41.6% Dizziness

  • 38.9% Vision problems

  • 53.9% Emotional changes

  • 15.2% Hearing loss

  • 63.2% Pain

  • 50.8% Bladder dysfunction

  • 26% Bowel dysfunction

  • 3.9% Seizures

  • 29.9% Tremor

  • 76.4% Walking difficulty

Managing Exacerbations

• Exercise Recommendations During Exacerbation:

  • Clients should not be encouraged to exercise until they return to remission.

  • Adapt exercises to include passive stretches, meditation, or range of motion (ROM) activities.

  • Establish a new baseline after an exacerbation.

  • Subtle changes might occur for slow-progressing MS patients while more aggressive forms could substantially affect mobility.

Important Considerations for Exercise

• Physiological Effects:

  • Absent sudomotor (sweating) response.

  • Issues with urinary incontinence.

Geographic Incidence of Multiple Sclerosis

• Increased Incidence in Canada:

  • According to the 2013 map produced by the Multiple Sclerosis International Federation, Canada ranks first with 291 cases per 100,000 people.

• Reflection on Causes:

  • Consider the incidence in Canada compared to other countries.

  • Various possible causes for MS rates in Canada should be explored, and the implications of these rates need to be understood.