Exercise as it relates to Disease/A Comparison of Aerobic and Resistance Training on Multiple Sclerosis

Multiple Sclerosis (MS) is a neurological degenerative disease that is observed frequently in young adult populations. Typically nerves within the central nervous system (CNS) have signals occurring regularly and travelling uninterrupted throughout the body, via axons surrounded by a myelin sheath, which offers protection and insulation, while promoting fast transmission of nerve impulses. MS affects the CNS by demyelinating the nerve fibres, leaving behind plaques that interfere with signal transmission. Symptoms include heat sensitivity, fatigue, motor weakness, poor balance, and spasticity. MS has no known cause or cure, so treating it requires a multidisciplinary treatment plan, undertaking rehabilitation programs, implementing some lifestyle changes using additional medications to help with pain relief or other symptoms such as depression or anxiety can all be put into practice to complement the use of Disease Modifying Agents which is the most common practice for treating MS. Due to the demyelination of nerves mobility can be impaired causing sufferers of MS to be less physically active and physically weaker than other adults. This decrease in physical activity results in all the health issues that are associated with a sedentary lifestyle in a healthy individual; however they are exacerbated in a MS patient. Although there is no evidence for exercise reversing the progression of MS there is strong evidence to support both aerobic exercise and resistance training in improving the quality of life and mobility, as well as reducing co-morbidities associated with sedentary behaviour, such as osteoporosis and cardiovascular disease, in MS patients. Recent research has indicated that both aerobic exercise and resistance training provide their own benefits and can aid in improving the health of MS patients, without causing injury or exacerbating MS symptoms.

Benefits of Aerobic Training
Recommendations include:
 * Increased endurance
 * Increased oxidative capacity of muscles
 * Increased respiratory function (increased FVC, FEV1 and VO2 max)
 * Decreased fatigue
 * Increased social interaction
 * Increase in general muscle strength
 * Should include a light warm-up
 * Small increases in workload until steady intensity for that session is reached
 * Short intervals of training with rest periods interspersed is best for building endurance and minimising fatigue
 * Cycle ergometry, swimming, and aquatic exercises are most beneficial

Benefits of Resistance Training
Recommendations include:
 * Improved muscle strength
 * Improved mobility
 * Improved balance
 * Improved walking speed
 * Decreased perception fatigue and disability
 * Improved gait kinematics
 * Using training machines or home based training (e.g. resistance bands) as opposed to free weights.
 * Intensity: 60-80% repetition maximum (RM)
 * Sets: 1-3 of 8-15 repetitions and 2-4 min rest intervals
 * Frequency: 2–3 days/week
 * Program: whole body 8-10 exercises

Considerations and Precautions

 * Before undertaking an exercise program a health care professional should be consulted
 * Exercise should be performed under supervision with heart rate and blood pressure monitoring
 * Exercise programs should be tailored to an individual's level of mobility and disability
 * Exercise programs should minimise the risk of falls resulting from poor balance in MS balance
 * Programs should be performed at appropriate times of day to consider the impact of environmental temperatures on patient heat sensitivity
 * Participant fatigue should be assessed prior to and assessed during exercise

Summary
While aerobic exercise and resistance training are different, they complement each other with gains in muscle strength, balance and mobility further enabling increases in cardiovascular and respiratory function and decreased fatigue from aerobic exercise. Therefore a combination of the two leads to the greatest increase in quality of life and overall health in MS patients.