Multiple Sclerosis

Jarrod Wilson (Exercise Physiologist – Burnie)

What is Multiple Sclerosis (MS)?

Multiple Sclerosis, better known simply as MS, is a chronic disease of the central nervous system, where the immune system attacks myelin, the protective layer around nerve fibres. This occurs in the brain, spinal cord and optic nerves. As a result there can impaired coordination at some levels of the nervous system.

Common Findings with MS:

MS is the most common auto-immune condition that affects the central nervous system, with approximately 23,000 Australians living with the condition.

MS is considerably more common in females than males and is most commonly diagnosed in the 20-40 year old age demographic.

Interestingly MS affects Tasmanians at a higher rate than any other Australian state, possibly due to our higher rates of vitamin D deficiency due to less sun exposure.

MS is seldom seen in populations that live around the world’s equator.

Causes of MS:

• Researchers claim that there may be exposure to environmental triggers and/or viruses before puberty that can lead to the onset of MS.
• There may be an association with genetics, given that females are between two and three times more likely than males to be diagnosed with MS.
• Vitamin D has a protective effect on myelinated nerve fibres, raising the question that a deficiency in Vitamin D may be related to MS.

What are the Signs and Symptoms of MS?

The neurological signs and symptoms associated with MS differ significantly due to the varying degree of damage to the myelin of the nerve cells, and where the lesions or scarring is located. Generally the signs and symptoms of MS can be broken down into central changes, visual changes, sensation changes and bowel/urinary changes; all of which are elaborated on below. People with MS can also have difficulty swallowing and with their speech.

Visual Changes:

• Optic Neuritis (inflammation of the optic nerve)

Central Changes:

• Fatigue
• Cognitive impairment
• Depression or unstable mood

Sensation Changes:

• Pain
• Paresthesia (pins & needles, tingling, prickling, burning)
• Hypoesthesia (numbness)
• Heat sensitivity

Musculoskeletal Changes:

• Weakness
• Spasm
• Ataxia and loss of balance

Bowel/Urinary Changes:

• Bowel incontinence
• Diarrhea
• Constipation
• Urinary incontinence
• Urinary frequency
• Urinary retention

Types of MS:

A common misconception is that MS is all the same. There are however five main types of MS, and very rarely are two cases the same. Instead signs and symptoms can range from very mild to very severe. Let us now take a look at the different types of MS that an individual can be diagnosed with.

• Benign MS: If someone is diagnosed with Benign MS, they typically have very little-to-no disability and return to ‘normal’ between mild attacks. Unfortunately less than 5% of cases have this very mild form of MS.
• Relapsing-Remitting MS (RRMS): This is by far the most common form of MS with approximately 70% of MS cases having RRMS, and is characterised by unpredictable attacks of symptoms which may potentially leave permanent disability. These attacks (or relapses) are followed by periods of recovery (or remission). Females are three times more likely than males to develop RRMS.
• Primary-Progressive MS (PPMS): With this type of MS, individuals generally suffer with a steady increase in disability without attacks. PPMS accounts for approximately 20% of MS cases.
• Secondary-Progressive MS (SPMS): There is generally an initial ‘relapsing-remitting’ MS phase that suddenly begins to decline without periods of remission.
• Progressive-Relapsing MS (PRMS): There is a steady decline since disease onset with superimposed attacks. There is typically not a good recovery in between episodes, unlike other types of MS. Only 5% of the MS population suffer from this debilitating form of MS.

What About Exercise?

Regular exercise is useful as a treatment modality for people with MS, and research has shown that exercise is effective in managing the symptoms of MS.

Exercise can reduce symptoms in times of a mild exacerbation of MS.

Benefits of exercise include:

• Reduced fatigue levels
• Improved endurance
• Improved balance and coordination, leading to falls prevention
• Improved muscular strength and growth
• Improved neural activation
• Improved posture and flexibility
• Improved mental health and mood
• Improved concentration and focus

What Type of Exercise is Best?

• Aerobic exercise (e.g. exercise bike, elliptical, walking): Small bursts of regular exercise are best, rather than long periods of continuous exercise that can put strain on core temperature regulation.
• Resistance exercise (e.g. lifting weights, body weight, resistance bands): Compound over isolated exercises tend to work better for people with MS.
• Flexibility and balance exercise: can relieve muscle cramps and spasms associated with MS.

Exercise Considerations:

It is important to consider several factors when exercising. The main considerations are those that arise from the common signs and symptoms that present with MS. Given the large spectrum of signs and symptoms that the different types of MS can cause, one size does NOT fit all when it comes to exercise. However, these are some general considerations to take on board:

• If there are two or more cardiovascular risk factors (e.g. family history of heart disease, high blood pressure, etc.), then formal testing and medical assessment is recommended prior to engaging in exercise.
• If co-morbidities are present (e.g. heart disease, diabetes, etc.), these should be closely monitored when exercising.
• Due to the sensitivity to heat that is often reported from people who suffer MS, it is generally recommended that individuals exercise in a cool environment, or in cooler times in the day, where they can effectively regulate their core temperature.
• People with MS are much more likely to experience fatigue when exercising and more time is needed to recover. If weakness and fatigue are present after each bout of exercise, consider ceasing the activity, or speak with an Exercise Physiologist. The intensity and/or duration of exercise sessions may need to be modified to better manage fatigue.

Our Exercise Physiologists at Coastal Physiotherapy in Burnie have a great deal of experience working with MS clients. Given MS is a chronic condition, those with MS can receive a Medicare referral from their GP to see an Exercise Physiologist for up to 5 sessions with no out of pocket expense. For more information call our Burnie clinic today on 64314586!

References:

1. MS Australia, viewed 29 June 2015, <http://www.msaustralia.org.au
2. Berer, K & Krishnamoorthy, G 2014, ‘Microbial view of central nervous system autoimmunity’, FEBS Letters, vol. 588, no. 22, pp. 4207-4213.
3. MS Tasmania – MS Society of Tsmania, viewed 29 June 2015, http://mstas.org.au/about-us/>.
4. MS – MS National Multiple Sclerosis Society, viewed 29 June 2015, http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS>.
5. J. Cannell 2014, pers. Comm., 1 November.