EXERCISE PRESCRIPTION FOR MULTIPLE SCLEROSIS
Medical History:
Mrs
X, a 28 year -old Caucasian female, was diagnosed with MS 7 years ago. At that
time she had problems with ataxia and diplopia.
She
has had one or two exacerbation of MS per year since that time. An increase in
disease stability was noted after she started recombinant interferon 5 years
ago.
She
stopped the interferon therapy briefly during a pregnancy 4 years ago, and
after the pregnancy she had three exacerbations during the following year
despite being back on Betaseron.
With
each exacerbation, her symptoms of ataxia, vertigo, and diplopia worsened.
These symptoms involve primarily the left side of her body. These extremities
also cramp on occasion. After all, she functions reasonably well, taking care
of her children at home. She later quit working within a year after her
diagnosis because of problems with ataxia and fatigue.
An
MRI of her brain demonstrated multiple
white matter lesions consistent with MS. A spinal fluid examination
demonstrated elevated immunoglobulin G synthesis rate and oligoclonal bands
consistent with the diagnosis of MS.
She
is taking no other medication on a regular basis and has not been involved in a
regular exercise programme.
She
occasionally gets a urinary tract or upper respiratory infection that
necessitates antibiotics. Cramping in her extremities has not been bad enough
to warrant a muscle relaxant on a regular basis. She notes that when she walks
more than a couple of blocks, she feels weakness in her left leg and often
needs to rest for a few minutes before walking further.
She
also feels at times that her left leg may removed. On examination
there is mild in coordination and diffuse hyper-reflexia, which is more
pronounced in the left side extremities. She also has a few beats of nystagmus.
Diagnosis:
Her
diagnosis is relapsing -remitting multiple sclerosis, Grade 4.0 on the kurtzke
Expanded Disability Status Scale.Grade 4 means that the individual is fully
ambulatory without aid,is self sufficient, is up and about some 12 HR a day despite relatively severe disability,
and is able to walk without aid or rest for at least 500m and that the disease
affects one or more functional systems.
Exercise Evaluation:
An
exercise test was performed to assess functional ability and to rule out
cardiac origin of her arm weakness while walking. The patient performed a
bicycle protocol of 4 - min stages at 25,50,and
75 W.
There
was no sign of electrocardiographic abnormalities.
Exercise
was discontinued because of volitional fatigue.
Resting
values:
Heart
rate =93.
Blood
pressure =110/68.
Electrocardiogram:normal
sinus
rhythm and within normal limits.
Peak exercise values:
Heart
rate =189.
Blood
pressure =152/53.
Rating of perceived exertion =18.
Peak
Vo2 =17.6ml.kg.min.
peak
METs=5.0.
Exercise prescription
Because
the patient is just beginning an exercise programme, and because of the ataxia
and fatigue she experiences, she starts out at a low intensity and duration for
both aerobic and strength training. Limb strength is reduced on left side
because of increased MS-related symptoms.
Cardiovascular training:
She
started with light exercise and aerobic training on a cycle ergometer at 60% of
her heart rate reserve (150 beats per minute) for 30 min three times per week.
The
intensity was increased gradually, as tolerated, over a few weeks to a heart rate that is 84% of
heart rate reserve (172 beats per minute)
Strength
training :She performed resistance training two times per week at 40% of
1-repetition maximum (1RM) on her left side and 60% of 1 RM on her right side.
She
made use of dumb bells. resistance training machines, leg extensions, leg
curls, hand weights could also be used. The volume was increased gradually over
several weeks to two sets of eight repetitions and expand to other skeletal
muscle groups.
Muscle endurance training:
An
endurance skeletal muscle training programmes was administered on the days that
resistance exercise is performed.two times per week, at 40% to 50% of 1RM,
performing one set to muscular failure for the gastrocnemius, quadriceps,
hamstring, biceps and triceps brachii, chest, and abdominal muscles.
Flexibility training:
She
also performed stretching exercises before or after each exercise sessions focusing on the ankles, knee, Hip,
lower back, shoulder, wrist and neck. Static stretches was held for 10 to 20 s
and performed at least twice for each muscle group.
Multiple
sclerosis (MS) is characterized by random or sporadic patches of inflammation
of the central nervous system that result in demyelination.
The
demyelination, in turn, causes plaques, which can become permanent scars. Sclerosis
refers to the condition of demyelination and has many causes, and the term
multiple sclerosis refers to the multiple areas of demyelinated tissue of the
central nervous system.
Attempt this question.
List
Five (5) strength exercises for multiple sclerosis.
Stay
safe and stay healthy!!!
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