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!!!