Australasian Multiple Sclerosis Network of Care Multiple Sclerosis Network of Care Australia

A Voice for People Affected by MS


 
Exercise & Healthy Living  

CCSVI Australia

''Improving Blood Flow and Well Being'' TurnOnthe Tap
 
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Exercise Abstracts Rehabilitation News in Brief CCSVI Research Database
 
Research about the role of exercise is well highlighted by Australian Professor George Jelinek MD. Diagnosed with multiple sclerosis in 1999 Professor Jelinek is also a driving force in highlighting the importance of healthy living for those with MS. .  
The National Multiple Sclerosis Society, USA, cites (2008) a growing body of evidence 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 individual..
SOME RECENT EXAMPLES

In June 2016 researchers reported that

A 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.

 

A 2013 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.

An October 2013 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''.

Click 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
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UNDERLYING ISSUES - AEROBIC EXERCISE AND DISTURBED BLOOD  FLOW - IMPORTANCE OF HEALTHY ARTERIES AND VEINS
Blood flow Research in 2010 illustrated 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 lead to 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. 
IMPACT 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 - read more
RESTRICTED VEINS ALSO IMPEDE BLOOD FLOW FROM THE BRAIN
Emerging research also highlights a significant association between restricted blood flow from the brain (because of vein irregularities) and multiple sclerosis. Vein related endothelial 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 -  read more
GENETIC ASSOCIATIONS
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 progression''
EXERCISE IN PERSPECTIVE
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.  
Appropriate exercise, proper nutrition, and effective sleep readily spring to mind. In some situations it may also be necessary to address underlying chronic inflammatory issues. For example there is evidence for the respiratory pathogen Chlamydophila (Chlamydia) pneumoniae (cpn) 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 this.
IMPACT ON QUALITY OF LIFE PERCEPTIONS
Quality of Life is defined by the World Health Organisation as an 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 context of 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 strategies - read more about Quality of Life
GETTING STARTED WITH EXERCISE - SOME ISSUES and CHALLENGES
Challenges 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 needs
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. Read more about the four phases of care needs.
UNDERSTANDING MS POPULATIONS
MS 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 publication titled  '' Strength and cardiorespiratory exercise for people with multiple sclerosis (MS) - a guide for health care professionals."
COMMON BARRIERS
Barriers 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 believed their brain often can't generate enough neural input to cause muscles to contract and move in a fully co-ordinated way.
MS 'friendly' ACTIVITIES
Participating in ongoing physical activities that, by their nature, complement muscle movement can be a good starting point. For example, horse riding is 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. Hydrotherapy (aquatic 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
Sailability Australia are also reported as highly beneficial, Massage therapy addresses 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.
SIDE STEPPING THE BRAIN - VIBRATION THERAPY
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 contraction. 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 system.
Dr Stannard went on to say that 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.
BRAIN PLASTICITY
Plasticity 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. Read more about brain plasticity and MS.
The 2008 publication "'The Brain that Changes Itself - Norman Doidge MD"' is about 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 learn more from ongoing developments in this rapidly evolving field of medical research.
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RELATED TOPICS - SOME EXAMPLES
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.
Activity

Agency

Overview 

Contact

More 

Recreation, Sport, Tourism and the Arts NICAN is funded by Family and Community Services Nican is 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 1800 806 769 Visit
Exercise Groups Community Health Education Groups Grafton to Tweed CHEGS offers workshops on nutrition & weight management, exercise, Tai Chi, yoga and memory enhancing. A variety of exercise classes are available including gentle exercise, strengthening, stretch and back care. Mary Ward
CHEGS Coordinator
6620 7523

 

Visit
Sailing and Boating Sailability Australia Sailability Australia's key objective is to encourage and facilitate sailing and boating throughout Australia for people with disabilities in social, recreational and competitive activities. More about Sailability and MS Lynelle Boyd
6686 5469
Lake Ainsworth
Lennox Head

Other Localities

 
Visit
Horse Riding Riding for Disabled Association of NSW provides people with disabilities  opportunities to enjoy activities connected with horse riding.  Horse 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. Read more about these benefits Kerry Johnston
6687 8266
 

Other Localities
Visit
Vibration Therapy Massey University, New Zealand Vibration 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.    Visit
Aquatic Exercise Hydrotherapy National M.S.Society USA Guidelines Often 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 care professionals. Your local Physiotherapist or Exercise Physiologist Visit
Massage Therapy Regular remedial massage can help a person with MS to better manage muscle pain and reduce stress.  Massage also promotes a feeling of well being. For 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, reducing pain. Massage Australia

 

Visit
ASSOCIATED REFERENCES

       


 


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