Sclerosis Society, USA,
cites (2008) a growing body of
that improvement in mobility, activities of
daily living, quality of life, prevention of complications, reduction in
healthcare utilization, and gains in safety and independence may be
realized by a carefully planned program of exercise, functional
training, and activities that address the specific needs of the
SOME RECENT EXAMPLES
On 22 July 2016 PubMed
reported on the influence of physical exercise as an important
non-pharmacological intervention for the
improvement of immune-mediated diseases such as MS.
the mouse model relating to experimental autoimmune encephalomyelitis
(EAE) it reported that both strength and endurance training protocols
consistently prevented clinical signs of EAE and decreased oxidative
stress. In addition, physical exercise inhibited the production of
pro-inflammatory cytokines in the spinal cord
Researchers said "Physical exercise,
especially strength and endurance training protocols, inhibits the
development and progression of disease
more about this research.
In June 2016 researchers
York University’s Langone Medical Center
reported that exercise seems to beneficially change how
certain genes work inside the brain through the production of a substance called brain-derived
neurotrophic factor (BDNF) which
helps neurons to grow and remain
vigorous. It also strengthens the
synapses that connect neurons, allowing
the brain to function better. Low levels
of BDNF have been associated with
cognitive decline in both people and
animals. Exercise increases levels of
BDNF in brain tissue
find out more.
2009 study at Massey University, NZ, demonstrated that not only is
vibration therapy safe, well tolerated by MS patients but it also
improved standing balance and walking speed. This is believed to be one
of the first studies to investigate vibration therapy as an exercise
training modality for people with multiple sclerosis -
find out more.
study conducted by the Division of Physiotherapy and Rehabilitation,
Istanbul University, Istanbul, Turkey demonstrated that supervised group
exercise training is effective in improving balance, functional status,
spasticity, fatigue and quality of life in moderately affected people
with multiple sclerosis, with no worsening of their clinical status.
study provided the first evidence whereby aerobic exercise
improves memory in multiple sclerosis by effecting improvements in hippocampal function. Researchers said “Aerobic exercise represents a
cost-effective, widely available, natural, and self-administered
treatment with no adverse side effects that may be the first effective
memory treatment for multiple sclerosis patients”.
In a more recent
study in March 2015 at the Sheba MS Centre in
Israel researchers said ''After
taking part in an intense rehabilitation programme there was a
significant improvement in walking performance for each of the groups.
Regardless of their level of walking disability at the start of the programme participants were able to walk further and faster after
completing the programme''
They went on to say ''The biggest improvements in walking were for those participants
who were in the moderate and severe groups, the mild group improved but
not as much as the other groups''.
The authors conclude that ''walking improvement can be achieved in
people with higher levels of walking disability and the results also
show that improvements can be safely and realistically achieved in the
space of three weeks''.
here to display a broad cross section of exercise related Healthy
Living abstracts from the
Network of Care's Horizon Scan database.
As Exercise is an important aspect of MS Rehabilitation
this summary should also be read in parallel with the document titled
Rehabilitation Issues and Expectations
UNDERLYING ISSUES - AEROBIC EXERCISE
AND DISTURBED BLOOD FLOW - IMPORTANCE OF HEALTHY ARTERIES AND
Research in 2010
that disturbances in the patterns of
blood flow in an artery determine where
atherosclerosis will later appear.
Atherosclerosis describes a process
where the arterial walls thicken and
harden, because of a gradual build-up of
white blood cells, lipids and
cholesterol. This process can eventually
heart attacks and strokes.
Researchers observed ''Endothelial
cells, which form the inner lining of
blood vessels, are equipped with sensors
that detect changes in fluid flow.
Disturbed flow is what causes the
endothelial cells to become inflamed and
cause white blood cells to accumulate
followed by buildup of cholesterol and
lipids and plaque formation'''
This research could provide insight into how aerobic
exercise, known to provide protection against atherosclerosis, improves
the patterns of blood flow and encourages protective genes to turn on in
blood vessels. Scientists have previously observed that atherosclerosis
occurs preferentially in branched or curved regions of arteries, because
of the "disturbed flow" branches and curves create. Constant,
regular flow of blood appears to promote healthy blood vessels, while
low or erratic flow can lead to disease.
OF VASCULAR PROBLEMS ON MS PROGRESSION
In January 2010, the most highly read peer reviewed
neurology journal, Neurology, reported on the outcomes of
a study involving 8,983 pwMS, that concluded that vascular
comorbidity, whether present at MS symptom onset, diagnosis, or
later in the disease course, is associated with a substantially
increased risk of disability progression in MS and that the
impact of treating vascular comorbidities on disease progression
deserves investigation, The study demonstrated that the median
time between diagnosis and need for ambulatory assistance was
18.8 years in patients without vascular problems and 12.8 years
for those with vascular comorbidities -
VEINS ALSO IMPEDE BLOOD FLOW FROM THE BRAIN
research also highlights a
significant association between restricted blood flow from the brain
(because of vein irregularities) and
defects and associated
blood flow problems have been similarly associated
with this condition - referred to as chronic
cerebrospinal venous insufficiency (CCSVI). It is being
demonstrated that by correcting CCSVI conditions, often by a relatively
straight forward and established procedure, there can be
progressive, and at times significant, improvements in many of the
symptoms and issues associated with MS -
On a related
matter, on March 30, 2015 researchers
reported that while stroke,
epilepsy, multiple sclerosis,
amyotrophic lateral sclerosis (ALS) and
traumatic brain injury each affect the
central nervous system differently, they
all share common defects in blood-brain
barrier endothelial cells that can be
traced to a single set of genes. They
went on to say ''for these diseases, the
blood-brain barrier dysfunction is a
significant contributor to symptoms and
disease progression, so if we can stop
the endothelial cells from going down
this path, we could possibly limit such
For all of the foregoing reasons the role of regular exercise in
enhancing blood flow appears significant
in delaying MS progression - as well as
potentially partially ''winding back'' some damage
already occasioned. Given that
vascular irregularities are being shown
to contribute to
disease progression, it also makes good sense to also adopt lifestyle choices
that enhance vascular health - rather than place additional pressure on
what, for many, may already be a compromised vascular system.
sleep readily spring
to mind. In some situations it may also
be necessary to address underlying
inflammatory issues. For example there
for the respiratory pathogen
Chlamydophila (Chlamydia) pneumoniae
being a causal factor in some variants
of multiple sclerosis. Above all
is the importance of addressing the
chronic underlying conditions giving
rise to irregular blood flow -
more about what may be involved in doing
IMPACT ON QUALITY OF LIFE PERCEPTIONS
Quality of Life is defined by the World Health Organisation as
individual’s perception of their position in life in the context of the
culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns.
Arguably the rapidly emerging
knowledge that many of the most
disabling symptoms of MS are, for many, being shown to positively respond to
better management of vascular irregularities (across all levels of MS)
dramatically influences the
the ''culture and value systems'' in which multiple sclerosis has been
portrayed for generations. This may well provide an entirely new
frameworks for measuring
QoL perceptions and associated coping
about Quality of Life
WITH EXERCISE - SOME ISSUES
Collectively all of these seemingly
unrelated studies, point to
significant relationships between vascular health and MS. Exercise is an
important part of this equation.
Translating the research into programs
that are meaningful at an individual
level is the challenge. A useful
starting point is to broadly identify
individual care needs and to develop
exercise benchmarks sympathetic to those
The individual needs of
each person with MS must be considered, as each person's experience is
unique as are potential vascular irregularities. Four 'phases' of
MS care needs are regularly identified in research with each phase reflecting a
number of key issues and approaches to service provision. These phases do not
reflect an individual's disease progression. Rather, they provide a pragmatic
framework for discussion and a structure that enables the systematic
identification of a wide-ranging list of service needs. The timing of support
provided is therefore of major importance in delivering appropriate care.
more about the four phases of care needs.
Australia observes that people with MS experience specific problems that
may affect their performance of strength and cardiorespiratory exercises
and that an understanding of the MS population is required for the
successful implementation of such exercises. To assist with this it
provides a 2009 research based
titled '' Strength and cardiorespiratory exercise for people with
multiple sclerosis (MS) - a guide for health care professionals."
A common barrier impacting upon the ability of people with MS to engage in
conventional exercise is that they may be
unable to move their muscles normally due to damage caused in the central
nervous system. People with MS (pwMS) have a neural condition, whereby it is
brain often can't generate enough neural input to cause muscles to contract and
move in a fully co-ordinated way.
in ongoing physical activities that, by their nature, complement muscle movement
can be a good starting point. For example,
a unique form of exercise that has long been identified as of benefit to pwMS.
The complex movement of the horse helps to improve coordination,
balance, muscular development and fitness.
exercise) and swimming can also be highly beneficial as water helps people with MS move in
ways they otherwise may not be able to manage.
Sailing programs conducted by
are also reported as highly beneficial,
problems associated with muscle inactivity by activating the immune
system, assisting the venous flow of blood and encouraging lymphatic
flow. It also stimulates the sensory receptors in the skin and
stimulates endorphin production, reducing pain. What is common about these
sorts of activities is that muscle stimulation does not rely only on neural
input but is enhanced by some form of 'external' stimulation.
STEPPING THE BRAIN - VIBRATION THERAPY
In July 2009 Rachael Mason,
from the Institute of Food, Nutrition and Human Health at Massey
University, New Zealand, provided a presentation to the Australasian
Rehabilitation Conference in relation to a study at Massey that
addressed the issue of diminished neural input to facilitate muscle
The study supervisor Dr Steve Stannard said the trial was devised to see
whether side-to-side alternating vibration therapy was able to assist MS
sufferers, who often became unable to
move their muscles normally due to
damage caused in the central nervous
Dr Stannard went on to say
the vibration stimulus is thought to cause a reflex contraction of
muscle so in MS patients this might be therapeutic - it's a way of
side-stepping the brain and making the muscles contract. It was shown that not only is
vibration therapy safe, well tolerated by MS patients but it also improved
standing balance and walking speed. This is believed
to be one of the first studies to investigate vibration therapy as an exercise training
modality for people with multiple sclerosis -
find out more.
In the frontiers of Brian Science there
are a growing number of reports about
how neural pathways can be side-stepped
by alternate stimuli with the aim of
improving functionality. Many of these
reports also observe a capability of the
brain (termed brain plasticity), over
time, to develop new pathways that
recognise this improved functionality.
about brain plasticity and MS.
The 2008 publication "'The Brain that Changes Itself - Norman Doidge MD"'
the discovery that the human brain can change
itself, as told through the stories of the scientists, doctors, and patients who
have together brought about the transformations documented in the book.
Watch a brain plasticity
video featuring Dr Doidge - a range of videos are available.
AN ABSOLUTE MUST READ
In February 2015 the Wall Street Journal referenced Dr Doidge's latest
research regarding brain plasticity as adapted from his
latest book “The Brain’s Way of Healing”..Dr. Doidge
teaches in the University of Toronto’s department of psychiatry and is
on the research faculty at Columbia University’s Center for
Psychoanalytic Training and Research.
This overview of the importance of
exercise for PwMs would be
lacking if readers were not also encouraged to
more from ongoing developments in this rapidly evolving field of
RELATED TOPICS - SOME
Following are some examples of exercise
based programs, services and support identified by people with MS.
While some of these examples may relate to services in a specific locality
they typify the types of support more broadly available.
Check with your regional MS Australia
representative to find out about the availability of these or
comparable services in your locality.
Sport, Tourism and the Arts
is funded by Family and Community Services
an information service on recreation, tourism, sport and the arts for
people with disAbilities and supports an Australian society where any
recreational opportunity values diversity, supports freedom and choice
and strengthens inclusive communities
Health Education Groups
Grafton to Tweed
offers workshops on nutrition & weight management, exercise,
Chi, yoga and memory enhancing. A variety of
exercise classes are
available including gentle exercise, strengthening, stretch and back
key objective is to encourage and facilitate sailing and boating
throughout Australia for
people with disabilities in social, recreational and competitive
Sailability and MS
for Disabled Association of NSW provides people with disabilities opportunities to enjoy
activities connected with horse riding.
riding is an unique form of exercise and rehabilitation. The complex
movement of the horse helps to improve coordination, balance, muscular
development and fitness. Also assists in the development of personal
confidence and self esteem.
more about these benefits
University, New Zealand
exercise therapy is well suited as an effective exercise solution
especially for those having difficulty engaging in a conventional
exercise program due to physical limitations.
M.S.Society USA Guidelines
recommended because it provides optimal exercise conditions for the
person with MS. MS Australia provides an overview of MS and hydrotherapy
related issues in a research based
publication titled 'Aquatic Exercise for people with MS' - a guide for health
local Physiotherapist or Exercise Physiologist
remedial massage can help a person with MS to better manage muscle pain
and reduce stress. Massage also promotes a feeling of well being.
people with MS, massage activates the immune system, assists the venous
flow of blood and encourages the lymphatic flow. It also stimulates the
sensory receptors in the skin and stimulates endorphin production,