Multiple sclerosis (MS) is defined as an auto-immune disease which damages the insulating myelin of the central nervous system (CNS). This disease approaches the CNS in an ‘attacking’ manner which occurs randomly and varies widely in severity, frequency, and duration. Myelin is the fatty material that insulates nerves. Damage to the myelin affects the rapid, smooth conduction along the neural pathways in the CNS and thus affects the execution of smooth and coordinated movements.
The pathophysiology of multiple sclerosis (MS) is characterised by fatigue, motor weakness, spasticity, poor balance, heat sensitivity and mental depression. MS symptoms may lead to physical inactivity associated with the development of secondary diseases, such as diabetes, hypertension, obesity and coronary heart diseases. Functional impairment in MS such as abnormal walking mechanics, poor balance, muscle weakness and fatigue typically result from axonal degeneration and conduction block.
The disease process involves the activation and transport of inflammatory cells into the brain. There is an increased activation of natural killer cells to attack the myelin proteolipid protein. Demyelination comprises nerve fibre function by slowing axonal conduction velocity. Axonal injury or death can also occur. Altered conduction in demyelinated motor and sensory tracts within the CNS can disturb gait and balance, increase the risk of falls and reduce daily lifestyle activity. Balance and coordination are compromised when demyelination also affects the proprioceptive, visual and vestibular pathways. Vertigo, imbalance, incoordination, gait disturbances and spastic movements all contribute to mobility problems.
MS expresses itself in four clinical forms: relapsing remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive relapsing MD (PRMS), of which RRMS is the most common.
Individuals with MS face various physical and psychological adaptations when negotiating through the course of their disease.
The exact aetiology remains unknown, but a combination of factors such as genetic, infectious, environmental and autoimmune can contribute to the onset of the disease).
MS leads to a certain level of impairment, which will affect the individual’s response to exercise and the symptoms experienced. Symptoms may include the following:
The progression of MS as well as the prognosis is not affected by exercise training. Exercise training will only improve short-term physical fitness and functional performance, for example walking mobility. A greater improvement can be seen if programmes are supervised. Improvements such as increases in aerobic threshold, health perception, increased activity levels, increased strength, ambulation and decreased general fatigue can be observed.
Regular physical activity is associated with better bladder and bowel function, less fatigue and depression and a better quality life. Exercise reduces the risk for comorbidities such as diabetes mellitus, obesity, heart diseases and osteoporosis. Progressive resistance training improves muscle strength and the individual’s ability to perform activities of daily living.
Exercise sessions should be modified as necessary to accommodate any variations in the client’s symptoms and energy level. Participants who show signs/symptoms of worsening or physical activity intolerance should be referred to their physician. They should not resume their exercise program until their symptoms are under control and they have received medical clearance to do so.
