Multiple sclerosis (MS) is a disease in which an abnormal response of the body’s immune system causes inflammation. This inflammation then destroys the myelin that surrounds and protects the nerve fibers along the central nervous system (CNS). The CNS controls much of the human body, it includes the brain and spinal cord. Both are involved in our thoughts and control over movement of the body. As one can expect, damage to the CNS creates a challenge for those affected.
The inflammation produced causes damage to the nerves, therefore creating scar tissue in the affected area. The inflammation and scar tissue alter the ability for nerves to communicate thus altering movement patterns. The damage causes a delay and prevents movement from occurring as they had in the past. Multiple sclerosis got its name from the diseases basic ‘function’. Multiple because it has the ability to affect multiple areas, and sclerosis because the scar is a hardened or stiffened piece of tissue that prevent the communication between nerves to occur.
Imagine yourself, a family member, or a friend living with a condition in which there is little to no typical course, and experts are unaware of the specific cause or the triggers. This is a reality for those living with MS. Experts do believe there is no single cause of MS, rather a combination of factors. Each with their own contribution including environmental factors such as, where you call home, vitamin D, smoking, and obesity. There is also supportive research pointing towards infectious disease, and genetic factors.
The first episode of neurological symptoms are due to inflammation and destruction of the myelin sheath within the CNS. By definition the episode must last for a full 24-hour period, and will exhibit symptoms of MS. However, not enough to clinically diagnosis MS. Those who experience said episode may not go on to develop MS altogether.
One of the ways in which neurologists are able to create a diagnosis is the through the use of MRI. Upon review, an episode accompanied with lesions within the brain means there is a greater chance in which a second episode will occur.
This is the most common disease course, more than 80% of those diagnosed with MS fall into this diagnosis. Relapsing-remitting MS is known for its clearly defined attacks accompanied with neurological symptoms. Following many attacks individuals go into remission. That is, there is a recovery period in which these attacks are partially or even fully repaired. Depending on the recovery, all of the symptoms may disappear, but some may linger as well.
Those who were previously diagnosis with RRMS may escalate into a more progressive course. Secondary progressive MS is a period of worsening neurological function and added physical disability. During secondary progressive there may be periods in which the condition is active or non-active. MS may also occur with and without progression.
Primary progressive is defined by the worsening of neurological functioning from the onset of symptoms. This is similar to secondary progressive in that it too can be characterized as active or non-active and with progression or without.
Multiple sclerosis is a chronic disease with debilitating symptoms, and for quite some time patients were advised to avoid exercise. Now accepted, exercise may be the most effective rehabilitation tool. Similar to healthy subjects exercise can improve muscular fitness, levels of fatigue, depressive symptoms, sleep quality, cognition, and CNS structure for those with MS. The positive outcomes associated with a well structured exercise program will help to maintain independence and quality of life for individuals living with MS.
Exercise has a very powerful affect, and scientists continue to examine aerobic versus resistance training. Resistance training is safe, well tolerated, and can help improve muscle strength and function when performed weekly. Resistance training will also help to minimize the effect of inactivity. Inactivity due to MS can lead to other conditions such as osteoporosis, which creates more of a challenge as progression occurs.
Aerobic exercise is also effective. Moderate intensity aerobic activity elicits improvement in cardiovascular fitness (heart health), mood and overall quality of life. Aerobic activity has also shown to reduce symptoms associated with fatigue.
Numerous studies show exercise to be a protective strategy for those living with MS. Exercise helps to protect against loss of independence, brain function, and fatigue. The relationship between physical activity and symptoms shows those who participated less in physical activity exhibited more symptoms. As the disease progresses and exercise is ignored symptoms worsen at a greater rate. Exercise may even have the power to slow progression of the disease all together. Studies continue to develop while providing greater and greater detail as to what effect exercise has on individuals with MS. As research progresses there will be more light shed on the power of exercise.
As mentioned MS comes in a number of shapes and forms. A one-size fits all exercise program will not do the trick. An exercise program for an individual living with MS focuses on the individual’s chief complaint. That may be improving gait (walking) patterns, rising from a chair, improving flexibility, etc. When designing an exercise program each movement should correlate to the goals at hand. Emphasis placed on lower extremity versus upper extremity movement will produce more beneficial outcomes.