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Exercise in people with MS: What recommendations can we give?
Learning objectives
This module was produced during the 2020 quarantine, where filming has been conducted remotely to adhere to social distancing guidelines. For this reason, please forgive a lower production quality than you are used to seeing from us.This module is intended to help you:
- Understand the principles of exercise therapy
- Understand the different practical exercise therapies that are relevant to patients with different forms of MS
- Appreciate the community and social impacts of exercise in patients with MS
Case study of an active patient with recently diagnosed clinically isolated syndrome
Anna
- Age: 29 years
- Occupation: Banker
Current medication
- No MS medication
Previous clinical history
- 2 months ago: Diagnosed with clinically isolated syndrome
Weekly exercise routine
- Two 30-minute slow-paced runs
Case study based on speaker’s clinical experience
Anna has taken an interest in exercise therapy.
What principles should she adhere to when exercise therapy is prescribed?
Select the correct answer(s)
* Progressive overload is recommended 1
† Regular and continuous moderate- to high-intensity efforts is recommended 1
Case study of an inactive patient with recently diagnosed relapsing–remitting MS
Oscar
- Age: 31 years
- Occupation: Dentist
Current medication
- Platform disease-modifying therapy
Previous clinical history
- 4 months ago: Diagnosed with mild relapsing–remitting MS
- 1 relapse — stated that he is feeling anxious about having his next relapse
Current clinical status
- Fatigue
- Visual disturbances
- EDSS score of 3.5
Weekly exercise routine
- No exercise routine currently
Case study based on speaker’s clinical experience
EDSS, Expanded Disability Status Scale
Oscar mentioned that he was feeling anxious about his next relapse. Within what range has exercise therapy been shown to reduce the relapse risk compared with the non-exercise group?
Select the correct answer(s)
* Exercise therapy was associated with 27% lower risk of relapse compared with the non-exercising cohort 1
- Dalgas U. Neurodegener Dis Manag. 2017;7:35–40
- Dalgas U, et al. Curr Neurol Neurosci Rep. 2019;19:88
- Hubbard EA, et al. Med Sci Sports Exerc. 2019;51:858–67
- Hass CJ, et al. Sports Med. 2001;31:953–64
- Riemenschneider M, et al. MSJ. 2018;24:886–894
- Souza PS, et al. Mol Neurobiol. 2017;54:4723–37
- Xie Y, et al. J Neuroimmunol. 2019;328:60–7
- Dalgas U. ECTRIMS 2019;281844
- Sandroff BM, et al. Neuropsychol Rev. 2016;26:271–94
- Kjølhede T, et al. MSJ. 2018;24:1356–65
- Pilutti LA, et al. J Neurol Sci. 2014;343:3–7
- Bahmani DS, et al. Front Psychiatry. 2019;10:265
- Heine M, et al. Cochrane Database Syst Rev. 2015;9:CD009956
- Latimer-Chung, et al. Arch Phys Med Rehabil. 2013;94:1829–36
- Learmonth YC, et al. Mult Scler. 2019;25;1031–72
- The National MS Society. Heat & Temperature Sensitivity. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Heat-Temperature-Sensitivity. Accessed: February 2020
- Chaseling GK, et al. Med Sci Sports Exerc. 2018;50:643–48
- Fakolade A, et al. Health Expectations. 2018;21:181–91
- Visser LA, et al. Mult Scler Rela Dis. 2020;39:101929
- Salem Y, et al. Disabil Rehabil. 2011;33:720–28
- Feys P, et al. Mult Scler. 2019;25:92–103
What are the key practical characteristics of aerobic/endurance training?
Select the correct answer(s)
* It is many, not few muscle contractions 1
† It is against low-resistance loads, not high-resistance loads 1
‡ It is many, not few muscle contractions and against low-resistance loads, not high-resistance loads 1
- Dalgas U, et al. Curr Neurol Neurosci Rep. 2019;19:88
In the current guidelines, which of these are the recommended types of aerobic activities?
Select the correct answer(s)
* Weight machines are recommended as a strength training activity 1
† Free weights are recommended as a strength training activity 1
- Latimer-Chung, et al. Arch Phys Med Rehabil. 2013;94:1829–36
Which of these are recommended by the National MS Society as coping strategies for overheating (e.g. during exercise)?
Select the correct answer(s)
* Staying in an air-conditioned environment and ingesting cold fluid are both
recommended for people with MS to cope with overheating 1
- The National MS Society. Heat & Temperature Sensitivity. Available at: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Heat-Temperature-Sensitivity Accessed: February 2020
Which factors can help the transition from a cycle of disengagement (less exercise) to a cycle of engagement (more exercise) in people with MS and their caregivers?
Select the correct answer(s)
* The presence of comorbidity and negative feedback can cause entrance into the cycle of
disengagement and not the transition from the cycle of disengagement to the cycle of engagement 1
- Fakolade A, et al. Health Expectations. 2018;21:181–91
Congratulations!
You have completed module 4
Links and downloadable elements
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Exercise in people with MS: What recommendations can we give?
There is emerging evidence that exercise therapy has a positive effect on multiple MS outcomes. This module discusses the effect of exercise therapy at different stages of the MS disease course and presents the guidelines for prescription of exercise therapy in people with MS.
Length
11 min course
Job code
NPS-TPE-NP-00164