Tweet
Recommendations
One of the difficulties repeatedly identified in the reviews and meta-analyses cited above is the heterogeneity of methodologies employed. A recent review suggests the following outcome measures for use in exercise studies in MS [Paul et al. 2014]:
Fatigue: Modified Fatigue Impact Scale (MFIS) [Fisk et al. 1994] or Fatigue Severity Scale (FSS) [Krupp et al. 1989].
Six Minute Walk Test (6MWT) for exercise tolerance [Goldman et al. 2008].
Timed Up and Go (TUG) for muscle function and mobility [Podsiadlo and Richardson, 1991].
MS Impact Scale 29 (MSIS-29) or MS Quality of Life 54 (MSQOL 54) [Vickrey et al. 1995] for QOL.
Body mass index (BMI) or waist hip ratio for assessment of health risks associated with obesity.
One study has reported that a change of approximately 800 steps/day is the minimal clinically important difference (MCID) in ambulatory persons with MS, suggesting that this may be a useful metric for studies looking at the effects of exercise on ambulation [Motl et al. 2013].
Because of the heterogeneity of methods in trials of exercise as a therapeutic modality, currently there are few standard guidelines for the optimal type of exercise that should be prescribed for persons with MS, although obviously there will be individual needs that must be taken in to account. These would include level of disability, cognitive status, fatigue, heat sensitivity or other subject-specific impairments.
The analyses of studies indicate that ideally both aerobic and resistance exercises may benefit persons with MS. Although Petajan and colleagues did not make formal recommendations per se in their publication, their protocol was 40 minutes of aerobic training 3 times per week. They noted that the social aspect of exercising in small groups, as opposed to training alone, appeared to be important in promoting adherence to exercise [Petajan et al. 1996]. Dalgas and colleagues suggested a regimen of 10–40 minutes/session of aerobic activity, performed at 60–80% of maximal heart rate. Suggestions for a combined regimen are 2 days/week each of aerobic and resistance training, with 24–48 hours rest between training sessions [Dalgas et al. 2008] (Table 1).
Similar recommendations for exercise for persons with MS are those of Latimer-Cheung and colleagues who published guidelines based on their review of published studies of different exercise regimens on various symptoms and impairments seen in persons with MS [Latimer-Cheung et al. 2013b]. Their recommendations are directed at adults with MS with 'mild to moderate' disability, and also suggest combined aerobic and resistance exercises [Latimer-Cheung et al. 2013a] (Table 1).
Persons with lower extremity weakness can concentrate on upper body exercises (arm ergometry, resistance) or aquatic exercise. Persons with marked fatigue or deconditioning may have to begin training at lower intensities and durations, and may take longer to reach maximal intensity and duration of exercise than someone who is more fit at baseline. All persons with MS should employ cooling strategies during exercise so as to mitigate increases in core body temperature which could temporarily aggravate symptoms.
An emerging concept is that lifestyle physical activity is an important and quantifiable adjunct to prescribed exercise training [Motl, 2014]. Persons with MS may increase physical activity though sports, household chores, occupation or transportation. Tracking may be accomplished by activity logs and inexpensive personal accelerometer devices.
Conclusion
Persons with MS are less physically active than the general population. In addition to preventing potential complications of being sedentary, such as deconditioning, osteoporosis, obesity or vascular comorbidities, physical exercise can play an important role in managing specific symptoms in persons with MS and may possibly be neuroprotective. Research in this area has suffered from heterogeneity of patient population, exercise regimen and outcome measures. Further information is needed to determine the optimal exercise regimen for persons with MS, and which specific exercise modalities may benefit specific symptoms and impairments. In the meantime, healthcare providers should encourage physical activity for their patients with MS, as it has been demonstrated to be safe and well tolerated.
One of the difficulties repeatedly identified in the reviews and meta-analyses cited above is the heterogeneity of methodologies employed. A recent review suggests the following outcome measures for use in exercise studies in MS [Paul et al. 2014]:
Fatigue: Modified Fatigue Impact Scale (MFIS) [Fisk et al. 1994] or Fatigue Severity Scale (FSS) [Krupp et al. 1989].
Six Minute Walk Test (6MWT) for exercise tolerance [Goldman et al. 2008].
Timed Up and Go (TUG) for muscle function and mobility [Podsiadlo and Richardson, 1991].
MS Impact Scale 29 (MSIS-29) or MS Quality of Life 54 (MSQOL 54) [Vickrey et al. 1995] for QOL.
Body mass index (BMI) or waist hip ratio for assessment of health risks associated with obesity.
One study has reported that a change of approximately 800 steps/day is the minimal clinically important difference (MCID) in ambulatory persons with MS, suggesting that this may be a useful metric for studies looking at the effects of exercise on ambulation [Motl et al. 2013].
Because of the heterogeneity of methods in trials of exercise as a therapeutic modality, currently there are few standard guidelines for the optimal type of exercise that should be prescribed for persons with MS, although obviously there will be individual needs that must be taken in to account. These would include level of disability, cognitive status, fatigue, heat sensitivity or other subject-specific impairments.
The analyses of studies indicate that ideally both aerobic and resistance exercises may benefit persons with MS. Although Petajan and colleagues did not make formal recommendations per se in their publication, their protocol was 40 minutes of aerobic training 3 times per week. They noted that the social aspect of exercising in small groups, as opposed to training alone, appeared to be important in promoting adherence to exercise [Petajan et al. 1996]. Dalgas and colleagues suggested a regimen of 10–40 minutes/session of aerobic activity, performed at 60–80% of maximal heart rate. Suggestions for a combined regimen are 2 days/week each of aerobic and resistance training, with 24–48 hours rest between training sessions [Dalgas et al. 2008] (Table 1).
Similar recommendations for exercise for persons with MS are those of Latimer-Cheung and colleagues who published guidelines based on their review of published studies of different exercise regimens on various symptoms and impairments seen in persons with MS [Latimer-Cheung et al. 2013b]. Their recommendations are directed at adults with MS with 'mild to moderate' disability, and also suggest combined aerobic and resistance exercises [Latimer-Cheung et al. 2013a] (Table 1).
Persons with lower extremity weakness can concentrate on upper body exercises (arm ergometry, resistance) or aquatic exercise. Persons with marked fatigue or deconditioning may have to begin training at lower intensities and durations, and may take longer to reach maximal intensity and duration of exercise than someone who is more fit at baseline. All persons with MS should employ cooling strategies during exercise so as to mitigate increases in core body temperature which could temporarily aggravate symptoms.
An emerging concept is that lifestyle physical activity is an important and quantifiable adjunct to prescribed exercise training [Motl, 2014]. Persons with MS may increase physical activity though sports, household chores, occupation or transportation. Tracking may be accomplished by activity logs and inexpensive personal accelerometer devices.
Conclusion
Persons with MS are less physically active than the general population. In addition to preventing potential complications of being sedentary, such as deconditioning, osteoporosis, obesity or vascular comorbidities, physical exercise can play an important role in managing specific symptoms in persons with MS and may possibly be neuroprotective. Research in this area has suffered from heterogeneity of patient population, exercise regimen and outcome measures. Further information is needed to determine the optimal exercise regimen for persons with MS, and which specific exercise modalities may benefit specific symptoms and impairments. In the meantime, healthcare providers should encourage physical activity for their patients with MS, as it has been demonstrated to be safe and well tolerated.