Skip to main content Skip to navigation

Exercise literature review

TiMS research group

Way Ahead 2006;10(4):11

More information on TiMS, a group for therapists with an interest in MS

As part of the TiMS Research Group, Margaret Hewett, Clinical Lead in Neurology and Neurorehabilitation, Conquest Hospital, St Leonards on Sea, carried out a review of the literature on exercise for people with MS. A summary of this review is detailed below along with the supportive references.

History and current thinking

Originally it was believed that exercise for people with MS should not be encouraged[1,2] due to negative effects on central fatigue, muscle fatigue, spasticity and exacerbations. Although studies of the effects of physical activity in MS are limited[3], it is now recognised that people with mild to moderate MS can obtain positive results by exercising at an appropriate intensity, without experiencing excessive fatigue or exacerbations[1,2,4]. However, exercising during the administration of steroid therapy is not recommended[2]. Thermosensitivity is no longer a reason for not exercising[5].

Content and setting of exercise programmes

The literature describes a variety of programmes, but the main emphasis is on aerobic conditioning and strength training[1,4,6-9]. Some also include balance work[8,10]. The environment needs to motivate the individual to exercise[5], if this is a home setting, the content must be home and user friendly[4]. Supervised exercise in a healthcare setting may improve motivation and allows adjustment to programmes as an individual progresses[10]. Group exercise may be preferable due to increased motivation through peer support and social interaction. Increasing physical activity levels through leisure is more effective[2].

Fatigue, deconditioning and cooling

Fatigue may be due to deconditioning, increased body temperature, increased tone, or time of day. It was previously thought to be linked to depression, but has been shown to be distinct[1]. It is important to have a balance between physical activity and rest[2]. Declining fitness levels and disuse atrophy can result from a less active lifestyle, leading to lower physical performance, but this can be minimised with regular fitness training[5]. Employing methods of cooling before, during and after exercise may be beneficial[1,2].

Maximal v submaximal exercise and type of exercise

People with minimal impairment exercising at submaximal levels may benefit most from exercise programmes[1], but maximal effort has been shown to increase strength and ambulatory levels without increasing fatigue[3]. Strength training needs to be specific to muscle groups[7]. Hydrotherapy may be beneficial for some people due to improvements in flexibility, posture, muscle tone and coordination[2].

Summary of the benefits of increased physical activity

  • Reduces deconditioning and helps maintain optimum levels of function[4]
  • Aerobic exercise increases fitness, decreases depression and anxiety, and improves the sense of wellbeing[2], as well as reducing fatigue[11]
  • Has positive effects on long-term management[8,12]
  • Leads to reduced morbidity due to vascular disease and other illnesses linked to immobility[2]
  • Motor fatigue can be decreased[7]
  • Strength training can improve ambulation and reduce fatigue[9] and enhance transfers[6]

References

  1. Costello E, Curtis CL, Sandel IB, Bassile CC.
    Exercise prescription for individuals with multiple sclerosis.
    Neurol Report 1996;20(2):24-30.
  2. Petajan JH, White AT.
    Recommendations for physical activity in patients with multiple sclerosis.
    Sports Med 1999;27(3):179-191.
  3. Yates HA, Vardy TC, Kuchera ML, et al.
    Effects of osteopathic manipulative treatment and concentric and eccentric maximal-effort on women with multiple sclerosis: a pilot study.
    J Am Osteopath Ass 2002;102(5):267-275.
  4. Hale L, Schou E, Piggot J, et al.
    The effect of a combined exercise programme for people with multiple sclerosis: a case series.
    NZ J Physiother 2003;31(3):130-138.
  5. Mostert S, Kesselring J.
    Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis.
    Mult Scler 2002;8(2):161-168.
  6. Harvey L, Davies-Smith A, Jones R.
    The effect of weighted leg raises on quadriceps strength, EMG parameters and functional activities in people with multiple sclerosis.
    Physiotherapy 1999;85(3):154-161.
  7. Surakka J, Romberg A, Ruutiainen J, et al.
    Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis: a randomised controlled trial.
    Clin Rehabil 2004;18(7):737-746.
  8. van Sint Annaland E, Lord S.
    Vigorous exercise for multiple sclerosis: a case report.
    NZ J Physiother 1999;27(3):42-45.
  9. White LJ, McCoy SC, Castelano V, et al.
    Resistance training improves strength and functional capacity in persons with multiple sclerosis.
    Mult Scler 2004;10(6):668-674.
  10. Kirsch NR, Mylinski MJ.
    The effect of a personally designed fitness program on the aerobic capacity and function for two individuals with multiple sclerosis.
    Phys Ther Case Reports 1999;2(1):19-26.
  11. Oken BS, Kishiyama S, Sajdel D, et al.
    Randomised controlled trial of yoga and exercise in multiple sclerosis.
    Neurology 2004;62(11):2058-2064.
  12. Johnson KB.
    Exercise, drug treatment and the optimal care of multiple sclerosis patients.
    Ann Neurol 1996;39(4):42-43.

Return