Exercise Benefits Mental, Physical Well-Being in Multiple Sclerosis

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Exercise Benefits Mental, Physical Well-Being in Multiple Sclerosis
Exercise Benefits Mental, Physical Well-Being in Multiple Sclerosis

The vast range of health benefits associated with physical activity is firmly established: It can reduce the risk of heart disease, some types of cancer, type 2 diabetes and metabolic disorder, while increasing muscle and bone strength, measures of mental health, and longevity.1 For people with multiple sclerosis (MS), exercise can also help to improve a variety of symptoms related to the neuromuscular disease.2

“There is a growing amount of scientific evidence that exercise can improve muscular strength and walking in people with MS, as well as reduce fatigue and increase emotional well-being,” and some data suggests that it can improve the cognitive abilities of MS patients, Jacob Sosnoff, PhD, a professor in the Department of Kinesiology and Community Health at the University of Illinois at Urbana-Champaign, and a founding member of the International MS Falls Prevention Research Network,3 told Neurology Advisor.

In a phase I randomized controlled trial reported in 2014 in Clinical Rehabilitation, Dr. Sosnoff and colleagues examined the impact of home-based exercise on fall risk in patients with MS.4 One group of participants performed exercises designed to improve balance and lower-body muscle strength three times weekly over a period of 12 weeks, while the wait-list control group continued their usual level of activity. At the end of the study period, the researchers found that fall risk had decreased among participants in the exercise group, while it actually increased in the control group.

“The data suggested that the decline in fall risk was mainly due to improvements in standing balance in the exercise group,” said Dr. Sosnoff. “Clinicians should inquire about falls and make appropriate referrals and encourage their patients to do balance exercises.”

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In a randomized controlled trial published in Multiple Sclerosis in 2013, researchers at the University of Limerick in Ireland investigated the effects of weekly community-based group exercise classes on patients with MS.5 The results show that, after 10 weeks, the exercise interventions led to significant improvements on the total and physical subscales of the Modified Fatigue Impact Scale (MFIS) and the Six-Minute Walk Test (6MWT), as well as the psychological and physical components of the Multiple Sclerosis Impact Scale (MSIS-29). The researchers believe that the group-based format may have facilitated the psychological improvements observed in participants. Results from another study published in Clinical Rehabilitation indicate that a 12-week group-exercise program supervised by a physical therapist was “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,” while some measures worsened among the control group.6

Benefits for Cognitive Function

Evidence regarding the mental and cognitive benefits of exercise for MS patients also continues to grow. Research published in the March 2014 issue of Multiple Sclerosis documented patients with progressive MS and moderate disability who participated in an aerobic exercise intervention for eight to 10 weeks.7 At the end of the study period, participants had improved on measures of aerobic fitness, walking ability, depression, fatigue, and multiple areas of cognitive function as assessed by neuropsychological tests. Additionally, findings reported in the Archives of Physical Medicine and Rehabilitation in July 20148 specifically suggest that improvements in the fitness level of MS patients are associated with improved executive functioning.

While support for the advantages of exercise for MS accumulates, there is little evidence of increased risk associated with such activity.

“There do not appear to be any abnormal risks of physical activity, and it has been associated with a lower rate of disease relapses,” Robert Motl, PhD, who is a professor in the Department of Kinesiology and Community Health at the University of Illinois at Urbana-Champaign, told Neurology Advisor. Motl co-authored a systematic review on the topic in the Journal of the Neurological Sciences,9 as well as the aforementioned July 2014 study.8

While Dr. Motl recognizes the importance of exercise for patients with MS, he believes that it may be more realistic to encourage increased movement in general, rather than formal exercise programs.

“Frankly, the focus on structured, supervised exercise is great, but many people with MS are not embracing that behavior,” he said. Despite the clear benefits of moderate-to-vigorous physical activity, approximately 80% of patients with MS do not engage in such activity.10 Accordingly, he advocates for an emphasis on “lifestyle physical activity” over structured workouts. 

“This is being physically active during every facet of daily life,” he said. “For example, walking and then talking with a co-worker or neighbor rather than sending an email, or perhaps parking a little further from a store entrance for extra steps, and if possible, walking up the stairs rather than an escalator or elevator.”

This focus on finding opportunities to increase physical activity throughout one's usual daily routine offers a broader set of options for MS patients who are interested in taking a more active role in managing their disease.

References

  1. Centers for Disease Control and Prevention: Division of Nutrition, Physical Activity and Obesity. The Benefits of Physical Activity. Accessed online on 10/06/15 at http://www.cdc.gov/physicalactivity/basics/pa-health
  2. National Multiple Sclerosis Society. Exercise. Accessed online on 10/06/15 at http://www.nationalmssociety.org/Living-Well-With-MS/Health-Wellness/Exercise
  3. Sosnoff JJ, Finlayson M. International MS Falls Prevention Research Network: Report from the Front Lines. International Journal of MS Care. 2014; 16(4): 161–162.
  4. Sosnoff JJ, Finlayson M, McAuley E, et al. Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial. Clinical Rehabilitation. 2014; 28(3):254-63.
  5. Garrett M, Hogan N, Larkin A, et al. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial. Multiple Sclerosis. 2013; 19(6):782-9.
  6. Tarakci E, Yeldan I, Huseyinsinoglu BE, et al. Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clinical Rehabilitation. 2013; 27(9):813-22.
  7. Briken S, Gold SM, Patra S, et al. Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial. Multiple Sclerosis. 2014; 20(3):382-90.
  8. Beier M, Bombardier CH, Hartoonian N, et al. Improved physical fitness correlates with improved cognition in multiple sclerosis. Archives of Physical Medicine and Rehabilitation. 2014; 95(7):1328-34.
  9. Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. Journal of the Neurological Sciences. 2014; 343(1-2):3-7.
  10. Motl RW. Lifestyle physical activity in persons with multiple sclerosis: the new kid on the MS block. Multiple Sclerosis. 2014; 20(8):1025-1029.
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