Introduction
Multiple sclerosis (MS), which affects more than 2 million people globally, is an immune-mediated demyelinating disease that affects the Central Nervous System (CNS) causing some physical impairments. Even though there are many theories regarding its cause, Multiple Sclerosis (MS) is shown to be caused by both ecological and genetic elements. Genetic factors that can contribute to getting the disease are ethnicity and sex (since women are two times more likely than men are in getting it). The environmental factors like geography and vitamin D levels mean that the closer an individual is to the equator, the lower the chances of acquisition. This study sets to evaluate new research and exercise as it pertains to MS patients and to study new recommendations for the same.
Diagnosis.
For diagnosis, the fundamental practice has been to disseminate CNS lesions in space and time. The most prevalent method of testing is the McDonald’s criteria. For the latest revision model of the same (2010 model), a clinicians’ objective was to show lesions in space and time with the help of magnetic resonance imaging (MRI). Dissemination in space entails a medical demonstration of attacks including two areas of the CNS. Alternatively, it requires presence of more than one lesions in multiple regions of the CNS. MS is divided into four phenotypes, the most recent (in 2013) being clinically isolated syndrome. It is the first attack and it has not fulfilled the McDonald’s criteria, that is, it has not displayed lesions in space and time. The relapsing-remitting MS is the second phenotype, and which happens to be the most common MS case. It is defined by attacks and relapses over a definite interval, where the patient’s return to complete baseline is uncertain. The final phenotype is the primary progressive MS where the disease progresses from relapsing remitting type and deteriorates without remissions, except for occasional plateaus.
Delegate your assignment to our experts and they will do the rest.
Treatment
The options for management of MS is between acute attacks and disease modifying agents, each having different pharmacotherapy. Acute attacks therapy is a 3-7- day course of intravenous (IV) methylprednisone or oral prednisone and an optional prednisone. While acute attacks focus on relapses on relapse-remitting MS, disease modifying agent-treatment focuses on decreasing the threat of long term disease progression and controlling relapses. A patient and their doctor have alternatives for disease modifying agents, varying with effectiveness, safety and convenience. For patients who prefer effective and safe over convenience, injectable medication is the best alternative, since these are the most studied. Infusion therapy may also be taken by patients who value efficiency. Alternatively, those who value convenience opt for daily oral agents (dimethyl fumarate).
Exercising in MS
Previously, MS patients were advised against exercising for the fear that it may worsen their disease progression. Studies where patients took 8-12-week progressive resistance training programs have been conducted. Contrary to the fears, the research has shown that resistance training may improve their balance and functional ability, though improvement in balance was not experienced if the patient had no instructor. No injuries were recorded, meaning nothing but safety and higher life quality for the patients was at stake for the patients.
With regard to aerobic exercise, fatigue and improvement in balance were recorded, although patients with severe disability did not respond to the exercise. Rottoli et al. noted this improvement in fatigue, which is significant given 80% of MS patients report fatigue, and the most devastating at that (Rottoli M, La Gioia S, Frigeni B, et al., 2017).
Finally, aquatic exercise received particular interest due to its advantages over land exercise, like buoyancy (which reduces stress on joints), viscosity (equal resistance) and thermodynamics which was the most importance. Thermoregulatory properties of water tackle the Uhthoff phenomenon, which is the deteriorating of MS symptoms when temperature is raised. With regard to aquatic aerobics, one study showed an improvement in fatigue and quality of life while another found the overall impact of these exercises similar to land based Pilates (Castro-Sánchez et al., 2012). In general, exercises show great benefits for the patients, though research favors aquatic exercise, due to water’s thermoregulatory benefits.
Conclusion
Exercise in MS patients shows no adverse effects and, in fact, it has positive impacts especially pertaining to fatigue and balance. It, however, has not shown any consequence as far as reducing the frequency of relapses, though this has not been conclusively established through studies. A study conducted by Kerling et al. suggests that there is no significant difference between individuals who take aerobics and those who take aerobics and resistance training, so none is superior to the other (Kerling et al., 2015). Aqua therapy has, however, been the most preferred exercise for MS patients since it reduces instances of temperature flair ups. The evidence shown thus recommends that MS patients take appropriate pharmacotherapy with a siding of exercise for best therapy results.
References
Castro-Sánchez AM, Matarán-Peñarrocha GA, Lara-Palomo I, et al. Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial. Evid Based Complement Alternat Med. 2012; 2012:473963.
Kerling A, Keweloh K, Tegtbur U, et al. Effects of a short physical exercise intervention on patients with multiple sclerosis. Int. J. Mol. Sci. 2015; 16:15761–75.
Rottoli M, La Gioia S, Frigeni B, et al. Pathophysiology, assessment and management of multiple sclerosis fatigue: an update. Expert Rev. Neurother. 2017; 17:373–9.
