Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion
Abstract
:1. Introduction
2. What We Know about Exercise in MS, Including a History of Benefits and Safety
2.1. Early Cases of Exercise in MS
“A gentleman aged 34, of a slender make and very active habits, was affected in the summer of 1815 with numbness and diminished sensibility of all extremities…along with diminution of muscular power. He could walk a considerable distance, though he did so with a feeling of insecurity and unsteadiness; but he could not …perform running leaping or very quick walking. He was in other respects in good health. Various remedies were employed, without benefit. He became determined to try the effect of violent exercise. For this purpose, he walked as hard as he was able, 5 or 6 miles in a warm evening, and returned home fatigued. Next morning he had severe pains in the calves of his legs, but his other complaints were much diminished, and in a few days disappeared. He has ever since enjoyed very good health”.
“(Hammond employed) the same therapies as others used. His approach was to give repeated courses of chloride of barium, iron, hyoscyamus, strychnine, nitrate of silver, and cod liver oil, in addition to recommending two glasses of wine daily and moderate exercise.”
“Patients with neurological disease were often treated with water therapy, spas, baths and douching. Commonly used physical measures for MS were galvanic and faradic stimulation, (physical treatments were) used throughout the 19th century.”
2.2. Dawn of the Randomised Controlled Exercise Trials
2.3. Growth of Clinical Trials and Expanding Knowledge of Benefits
2.4. Exercise Safety
3. What We Recommend Neurologists and MS Healthcare Providers Prescribe for Exercise Based on Recent Guidelines
3.1. Current Recommendation Guidelines
3.2. Understanding Theory to Overcome Exercise Barriers
4. Recommendations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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General Aerobic Activity | Advanced Aerobic Activity * | Strength Training | |
---|---|---|---|
How often? | 2/3 times per week | 5 times per week | 2/3 times per week |
How much? | Gradually increase your activity towards being able to complete 30 min of aerobic activity during each workout session | Increase your activity towards being able to complete 40 min of aerobic activity during each workout session | Repetitions are the number of times you lift and lower a weight Try to do 10–15 repetitions of each exercise. This counts as 1 set Gradually work up to doing 2 sets of 10–15 repetitions of each exercise |
How hard? | The activities should be performed at a moderate intensity. Moderate intensity physical activity is usually between 11 and 13 on the 20-point RPE scale, and it causes your heart rate to go up. Another rule of thumb, if you are doing moderate-intensity activity you can talk, but not sing a song, during the activity An alternative way of measuring moderate intensity of exercise is 40–60% VO2peak or HRpeak | The activities should be performed at a moderate to vigorous intensity. Intensity of exercise can approach 15 on the 20-point RPE scale. Another rule of thumb, if you are doing vigorous-intensity activity you can only say a few words while doing your activity. An alternative way of measuring moderate intensity of exercise is 70–80% VO2peak or HRpeak | Choose a resistance (using free weights, cable pulleys, bands etc) heavy enough that you can barely, but safely, finish 10–15 repetitions of each exercise You should rest for 1–2 min between each set and exercise, or alternate with a different resistance exercise (e.g., upper body then lower body) |
How to? | Options should be feasible and sustainable, and might include | ||
Some options for general aerobic activities include
| Some options for advanced aerobic activities include
| Strength training activities
| |
Other types of exercise that may bring benefits
| |||
Special considerations |
|
Actions and Resource Development | Target Audience |
---|---|
Service Training (i.e., sharing of knowledge between exercise- specialist healthcare providers with non-exercise specialist healthcare providers or behaviour change specialist healthcare providers with non-behaviour change specialist providers) to deliver evidenced guideline-based exercise promotion to patients/clients, ideally for use at initial consultations and review consultations thereafter | Neurologists and the multidisciplinary healthcare team, and healthcare team systems |
Professional Training (i.e., theory based education) to deliver evidenced guideline-based exercise promotion to patients/clients, ideally undertaken at graduate level and post-graduate continual education | Neurologists and the multidisciplinary healthcare team, educational establishments and national MS advocacy organisations |
Evidenced guideline-based resources or protocols to apply exercise health benefits and knowledge to design, or refer for design (by appropriate exercise specialist healthcare provider), patient/client specific programmes | Neurologists and the multidisciplinary healthcare team |
Initial and ongoing consultations where exercise outcome expectations and goal discussion are salient and where knowledge can be shared in client-accessible print and electronic materials (with consideration of health-literacy and language capacity) | Neurologists and the multidisciplinary healthcare team, persons with MS, carers. |
Cross-referral pathways between exercise-specialist healthcare providers/behaviour change specialist healthcare providers with non-exercise/non-behaviour change specialist healthcare providers should be developed to ensure appropriate and comprehensive content and acknowledgement ofMS symptoms (e.g., fatigue, mobility-disability, depression and cognitive impairment), personal circumstances and community circumstances which may prevent engagement in exercise. | MS healthcare providers Neurologists and the multidisciplinary healthcare team systems and national MS advocacy organisations |
Exercise and behaviour change preparation through appropriate provision of exercise programme explanations, equipment and faciliries, and use of evidenced behavioral strategies, goal discussion, sequestering of barriers and mastery of life-long exercise behaviours | MS Exercise specialist providers and MS Behavioural specialist providers |
Monitoring of exercise behaviour performance ideally at initial consultation and review consultations thereafter. Inclusive of monitoring functional progress, client accountability toward exercise behaviour, exercise behavioural (un) achievement and goal discussion updates. | Neurologists and the multidisciplinary healthcare team |
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Learmonth, Y.C.; Motl, R.W. Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion. Int. J. Environ. Res. Public Health 2021, 18, 13245. https://doi.org/10.3390/ijerph182413245
Learmonth YC, Motl RW. Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion. International Journal of Environmental Research and Public Health. 2021; 18(24):13245. https://doi.org/10.3390/ijerph182413245
Chicago/Turabian StyleLearmonth, Yvonne Charlotte, and Robert Wayne Motl. 2021. "Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion" International Journal of Environmental Research and Public Health 18, no. 24: 13245. https://doi.org/10.3390/ijerph182413245