Skip to main content

Advertisement

SpringerLink
Log in

Recommendations for Physical Activity in Patients with Multiple Sclerosis

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

For many years, patients with multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, have been advised to avoid exercise. MS is believed to be autoimmune in origin, mediated by activated T cells which penetrate the blood-brain barrier and attack myelin. The pathophysiology, with respect to function is an impairment of saltatory conduction, specifically, slowing of conduction speed and/or conduction block. Symptoms can temporarily worsen on exposure to heat or during physical exercise.

Exercise programmes must be designed to activate working muscles but avoid overload that results in conduction block. Fatigue, often severe, affects about 85% of MS patients and, along with motor and sensory symptoms, results in decreased mobility and reduced quality of life. Physical activity and recreation are reduced in patients with MS. Before developing recommendations, physical activity patterns and the physical effects of MS should be assessed in individual patients. Patients may then be functionally classified. Physical activity can also be classified in a pyramid structure, with the most basic functions forming the base and the most integrated functions on top. The muscular fitness pyramid progresses through passive range of motion, active resistive, specific strengthening and integrated strength exercises. Overall physical activity may be increased according to functional level by performing activities of daily living, incorporating inefficiencies into daily living, pursuing more active recreation and eventually developing a structured exercise programme.

The importance of the proper exercise environment, balance and coordination issues and factors related to adherence are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gehlsen GM, Grigsby SA, Winant DM. Effects of an aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis. Phys Ther 1984; 64: 653–7

    PubMed  CAS  Google Scholar 

  2. Petajan JH, Gappmaier E, White AT, et al. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996; 39: 432–41

    Article  PubMed  CAS  Google Scholar 

  3. Schapiro RT, Petajan JH, Kosich D. Role of cardiovascular fitness in multiple sclerosis: a pilot study. J Neurol Rehabil 1988; 2: 43–9

    Google Scholar 

  4. Pender A, Csurhes PA, Houghten RA, et al. A study of human T-cell lines generated from multiple sclerosis patients and controls by stimulation with peptides of myelin basic protein. J Neuroimmunol 1996; 70 (l): 65–74

    Article  PubMed  CAS  Google Scholar 

  5. Wucherpfennig KW, Hafler DA. A review of T-cell receptors in multiple sclerosis clonal expansion and persistence of human T-cells specific for immunodominant myelin basic protein peptide. Ann N Y Acad Sci 1995; 756: 241–58

    Article  PubMed  CAS  Google Scholar 

  6. Bonetti B, Raines CS. Multiple sclerosis: oligodendrocytes display cell death-related molecules in situ but do not undergo apoptosis. Ann Neurol 1997; 42 (l): 74–84

    Article  PubMed  CAS  Google Scholar 

  7. Leppert D, Waubant E, Buck MR, et al. Interferon beta-lb inhibits gelatinase secretion and efficacy in multiple sclerosis. Ann Neurol 1996; 40 (6): 846–52

    Article  PubMed  CAS  Google Scholar 

  8. Briant L, Avonstin P, Clayton P, et al., French Group on Multiple Sclerosis. Multiple sclerosis susceptibility population and twin study of polymorphism in the T-cell receptor beta and gamma gene regions. Autoimmunity 1993; 15 (1): 67–73

    Article  PubMed  CAS  Google Scholar 

  9. Freedman MS, Bitar R, Antel JP. Relationship between heat shock protein expression and susceptibility to cytolysis. J Immunol 1997; 74 (12): 143–8

    CAS  Google Scholar 

  10. Usuka K, Joshi N, Hauser SL. T-cell receptors: germline polymorphism and patterns of usage in demyelinating disease. Crit Rev Immunol 1992; 1 (6): 381–93

    Google Scholar 

  11. Daugond F, Windhagen A, Groues CJ, et al. Constitutive expression of costimulatory molecules by human microglia and its relevance to CNS autoimmunity. J Neuroimmunol 1997; 76 (1–2): 132–8

    Article  Google Scholar 

  12. Weller RD, Engelhardt B, Phillips MJ. Lymphocyte targeting of the CNS: a review of afferent and efferent CNS-immune pathways. Brain Pathol 1996; 6 (3): 275–88

    Article  PubMed  CAS  Google Scholar 

  13. Levin MC, Krichavsky M, Berk J, et al. Neuronal molecular mimicry in immune-mediated neurologic disease. Ann Neurol 1998; 44 (1): 87–98

    Article  PubMed  CAS  Google Scholar 

  14. Compston A. Inflammation and the brain. Mol Chem Neuropathol 1993; 19 (1–2): 47–64

    Article  PubMed  CAS  Google Scholar 

  15. Brill MH, Waxman SG, Moore JW, et al. Conduction velocity and spike configuration in myelinated fibres: computed dependence on internode distance. J Neurol Neurosurg Psychiatry 1977; 40: 769–74

    Article  PubMed  CAS  Google Scholar 

  16. Waxman SG. Membranes, myelin and the pathophysiology of multiple sclerosis. N Engl J Med 1982; 306: 1529–33

    Article  PubMed  CAS  Google Scholar 

  17. Petajan JH, White AT, Tang PZ, et al. Magnetic cortical stimulation and fatigue in MS [abstract]. Ann Neurol 1997; 42 (3): 452–3

    Google Scholar 

  18. Sheean GL, Murray NM, Rothwell JC, et al. An electrophysiological study of the mechanism of fatigue in MS. Brain 1997; 120 (Pt 2): 299–315

    Article  PubMed  Google Scholar 

  19. Valls-Sole J, Pascual-Leone A, Brasil-Neto JP, et al. Abnormal facilitation of the response to transcranial magnetic stimulation in patients with Parkinson’s disease. Neurology 1994; 44 (4): 735–41

    Article  PubMed  CAS  Google Scholar 

  20. Nielsen JF. Frequency-dependent conduction delay of motorevoked potentials in multiple sclerosis. Muscle Nerve 1997; 20: 1264–74

    Article  PubMed  CAS  Google Scholar 

  21. Ng AV, Miller RG, Kent-Braun J. Central motor drive is increased during voluntary muscle contractions in multiple sclerosis. Muscle Nerve 1997; 20: 1213–8

    Article  PubMed  CAS  Google Scholar 

  22. Kent-Braun JA, Sharma KR, Miller RG, et al. Postexercise phosphocreatine resynthesis is slowed in multiple sclerosis. Muscle Nerve 1994; 17 (8): 835–41

    Article  PubMed  CAS  Google Scholar 

  23. Sharma KR, Kent-Braun J, Mynhier MA, et al. Evidence of an abnormal intramuscular component of fatigue in MS. Muscle Nerve 1995; 18 (12): 1403–11

    Article  PubMed  CAS  Google Scholar 

  24. MacDougall JD, Ward GR, Sale DG, et al. Biochemical adaptation of human skeletal muscle to heavy resistance training and immobilization. J Appl Physiol 1977; 43: 700–3

    PubMed  CAS  Google Scholar 

  25. Coyle EF, Martin WH III, Sinacore DR, et al. Time course of loss of adaptations after stopping prolonged intense endurance training. J Appl Physiol 1984; 57: 1857–64

    PubMed  CAS  Google Scholar 

  26. Adams RD, Victor M. Principles of neurology. 6th ed. New York: McGraw-Hill, 1997

    Google Scholar 

  27. Krupp LB, Coyle PK, Doscher C, et al. Fatigue therapy in multiple sclerosis: results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology 1995; 45 (11): 1956–61

    Article  PubMed  CAS  Google Scholar 

  28. Dean G, Kurtzke JF. On the risk of multiple sclerosis according to age at immigration to South Africa. BMJ 1971; 3: 725

    Article  PubMed  CAS  Google Scholar 

  29. Riise T, Wolfson C. The epidemiologic study of exogenous factors in the etiology of multiple sclerosis. Neurology 1997; 49 Suppl. 2: S5–27

    Google Scholar 

  30. Rudick RA, Goodkin DE, Jacobs LD, et al. Impact of interferon beta-la on neurologic disability in relapsing multiple sclerosis. Neurology 1997; 49: 358–63

    Article  PubMed  CAS  Google Scholar 

  31. Johnson KP, Brooks BR, Cohen JA, et al., The Copolymer Study Group. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double blind placebo controlled trial. Neurology 1995; 45 (7): 1268–76

    Article  PubMed  CAS  Google Scholar 

  32. Krupp LB, Alvarez LA, La Rocca NG, et al. Fatigue in multiple sclerosis. Arch Neurol 1988; 45: 435–7

    Article  PubMed  CAS  Google Scholar 

  33. Guthrie TC, Nelson DA. Influence of temperature changes on multiple sclerosis: critical review of mechanisms and research potential. J Neurol Sci 1995; 129: 1–8

    Article  PubMed  CAS  Google Scholar 

  34. Rasminsky M. The effects of temperature on conduction in demyelinated single nerve fibers. Arch Neurol 1973; 28: 287–92

    Article  PubMed  CAS  Google Scholar 

  35. Schauf CL, Davis FA. Impulse conduction in multiple sclerosis: a theoretical basis for modification by temperature and pharmacological agents. J Neurol Neurosurg Psychiatry 1974; 37: 152–61

    Article  PubMed  CAS  Google Scholar 

  36. Miller RG, Green AT, Moussavi RS, et al. Excessive muscular fatigue in patients with spastic paraparesis. Neurology 1990; 40: 1271–4

    Article  PubMed  CAS  Google Scholar 

  37. Freal JE, Kraft GH, Coryell JK. Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 1984; 65 (3): 135–8

    PubMed  CAS  Google Scholar 

  38. Waxman SG. Conduction in myelinated, unmyelinated, and demyelinated fibers. Arch Neurol 1977; 34: 585–90

    Article  PubMed  CAS  Google Scholar 

  39. Kent-Braun JA, Ng AV, Castro M, et al. Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol 1997; 83 (6): 1998–2004

    PubMed  CAS  Google Scholar 

  40. Ng AV, Kent-Braun J. Quantification of lower physical activity in persons with multiple sclerosis. Med Sci Sports Exerc 1997; 29 (4): 517–23

    Article  PubMed  CAS  Google Scholar 

  41. Stuifbergen AK. Physical activity and perceived health status in persons with multiple sclerosis. J Neurosci Nurs 1997; 29 (4): 238–43

    Article  PubMed  CAS  Google Scholar 

  42. Stuifbergen AK, Roberts GJ. Health promotion practices of women with multiple sclerosis. Arch Phys Med Rehabil 1997; 78 (12 Suppl. 5): S3-S9

    Article  Google Scholar 

  43. Joffe RT, Lippert GP, Gray TA, et al. Mood disorder and multiple sclerosis. Arch Neurol 1987; 44: 376–8

    Article  PubMed  CAS  Google Scholar 

  44. Moller A, Wiedemann G, Rhode U, et al. Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. Acta Psychiatr Scand 1994; 89: 117–21

    Article  PubMed  CAS  Google Scholar 

  45. Packer TL, Sauriol A, Brouwer B. Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome and multiple sclerosis. Arch Phys Med Rehabil 1994; 75 (10): 1122–6

    Article  PubMed  CAS  Google Scholar 

  46. Johnson JH, Searles LB, McNamara S. In-home geriatric rehabilitation: improving strength and function. Top Geriatr Rehabil 1993; 8 (3): 51–64

    Google Scholar 

  47. Kurland LT. Trauma and multiple sclerosis. Ann Neurol 1994; 36 Suppl.: S33–7

    Article  Google Scholar 

  48. Poser CM. The role of trauma in the pathogenesis of multiple sclerosis. Clin Neurol Neurosurg 1994; 96 (2): 103–10

    Article  PubMed  CAS  Google Scholar 

  49. Blair SN, Kohl HW III, Paffenbarger RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy males and females. JAMA 1989; 262: 2395–401

    Article  PubMed  CAS  Google Scholar 

  50. DiPietro L. The epidemiology of physical activity and physical function in older people. Med Sci Sports Exerc 1996; 28 (5): 596–600

    PubMed  CAS  Google Scholar 

  51. American College of Sports Medicine. Guidelines for exercise testing and prescription. 4th ed. Philadelphia (PA): Lea & Febiger, 1991

    Google Scholar 

  52. Olgiati R, Jacquet J, Di Prampero PE. Energy cost of walking and exertional dyspnea in multiple sclerosis. Am Rev Respir Dis 1986; 134: 1005–10

    PubMed  CAS  Google Scholar 

  53. Tantucci C, Massucci M, Piperno R, et al. Energy cost of exercise in multiple sclerosis patients with low degree of disability. Mult Scler 1996; 2 (3): 161–7

    PubMed  CAS  Google Scholar 

  54. Medical Research Council. Aid to the examination of peripheral nervous system [memorandum no. 45]. London: Her Majesty’s Stationery Office, 1976

    Google Scholar 

  55. Kriska AM, Caspersen CJ. Introduction to a collection of physical activity questionnaires. Med Sci Sports Exerc 1997; 29 (6 Suppl.): S5–9

    Google Scholar 

  56. DiPietro L, Caspersen CJ, Ostfeld AM, et al. A survey for assessing physical activity among older adults. Med Sci Sports Exerc 1993; 25: 628–42

    PubMed  CAS  Google Scholar 

  57. Fisk JD, Pontefract A, Ritvo PG, et al. The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 1994; 21: 9–14

    PubMed  CAS  Google Scholar 

  58. Krupp LB, LaRocca NG, Muir-Nash J, et al. The fatigue severity scale. Arch Neurol 1989; 46: 1121–3

    Article  PubMed  CAS  Google Scholar 

  59. National Multiple Sclerosis Society. Minimal record of disability for multiple sclerosis. New York: National Multiple Sclerosis Society, 1985

    Google Scholar 

  60. Vaney C, Blaurock H, Gattlen B, et al. Assessing mobility in multiple sclerosis using the Rivermeet Mobility Index and gait speed. Clin Rehabil 1996; 10: 216–26

    Article  Google Scholar 

  61. Gilson BS, Bergner M, Bobbit RA, et al. The sickness impact profile: final development and testing, 1975–78. Seattle: Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1979

    Google Scholar 

  62. Ponichtera-Mulcare JA. Exercise and multiple sclerosis. Med Sci Sports Exerc 1993; 25 (4): 451–65

    PubMed  CAS  Google Scholar 

  63. Judge JO. Resistance training. Top Geriatr Rehabil 1993; 8 (3): 38–50

    Google Scholar 

  64. Svensson B, Gerdle B, Elert J. Endurance training in patients with multiple sclerosis: five case studies. Phys Ther 1994; 74 (11): 1017–26

    PubMed  CAS  Google Scholar 

  65. Fisher NM, Pendergast DR, Gresham GE, et al. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil 1991; 72: 367–74

    PubMed  CAS  Google Scholar 

  66. Kriendler H, Lewis CB, Rush S, et al. Effects of three exercise protocols on strength of persons with osteoarthritis of the knee. Top Geriatr Rehabil 1989; 4 (3): 32–9

    Google Scholar 

  67. Judge JO, Underwood M, Gennosa T. Exercise to improve gait velocity in older persons. Arch Phys Med Rehabil 1993; 74 (4): 400–6

    PubMed  CAS  Google Scholar 

  68. Fiatarone MA, Marks EC, Ryan ND, et al. High intensity strength training in nonagenarians: effects on skeletal muscle. JAMA 1990; 263: 3029–34

    Article  PubMed  CAS  Google Scholar 

  69. Dishman RK, Buckworth J. Increasing physical activity: a quantitative synthesis. Med Sci Sports Exerc 1996; 28: 706–19

    Article  PubMed  CAS  Google Scholar 

  70. White AT, Wilson TE, Petajan JH. Effect of pre-exercise cooling on physical function and fatigue in multiple sclerosis patients. Med Sci Sports Exerc 1997; 29 Suppl. 5: S83

    Google Scholar 

  71. Ponichtera-Mulcare JA, Mathews T, Glaser RM, et al. Maximal aerobic exercise of individuals with multiple sclerosis using three modes of ergometry. Clin Kinesiol 1995; 49 (1): 4–13

    Google Scholar 

  72. Gehlsen G, Beekman K, Assmann N, et al. Multiple sclerosis gait characteristics: progressive gait changes and effects of exercise on gait parameters. Arch Phys Med Rehabil 1986; 67: 536–9

    PubMed  CAS  Google Scholar 

  73. Tourtellotte WW, Baumhefner RW, Potvin JH, et al. Comprehensive management of MS. In: Hallpike JF, Adams CWM, Tourtellotte WW, editors. Multiple sclerosis. Cambridge: Cambridge University Press, 1983

    Google Scholar 

  74. Noronha MJ, Vas CJ, Aziz H. Autonomic dysfunction (sweating responses) in multiple sclerosis. J Neurosurg Psychiatry 1968; 31: 19–22

    Article  CAS  Google Scholar 

  75. Cartlidge NEF. Autonomic function in multiple sclerosis. Brain 1972; 95: 661–4

    Article  PubMed  CAS  Google Scholar 

  76. Heider W, Gottlob I. A differential diagnostic test for optic neuritis. Klin Monatsbl Augenheilkd 1987; 190: 420–3

    Article  PubMed  CAS  Google Scholar 

  77. Van Diemen HAM, Van Dongen MMMM, Dammers JWHH, et al. Increased visual impairment after exercise (Uhthoff’s phenomenon) in multiple sclerosis: therapeutic possibilities. Eur Neurol 1992; 32: 231–4

    Article  PubMed  Google Scholar 

  78. Capello E, Gardella M, Leandri M, et al. Lowering body temperature with a cooling suit as symptomatic treatment for thermosensitive multiple sclerosis patients. Ital J Neurol Sci 1995; 16 (8): 533–9

    Article  PubMed  CAS  Google Scholar 

  79. Woyciechowska J, Israel DJ, Hoffman RG, et al. Application of cooling techniques during exercise in MS patients. MS Management 1995; 2 (2): 25–9

    Google Scholar 

  80. Davidoff RA. Antispasticity drugs: mechanism of action. Neurology 1985; 17: 1107–16

    Google Scholar 

  81. Nance PW, Bagaresti J, Shellenberger K, et al. Efficacy and safety of tizanidine in the treatment of spasticity. Neurology 1994; 44 Suppl. 19: 544–52

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, 50 North Medical Drive, University of Utah, Salt Lake City, Utah, 84112, USA

    Jack H. Petajan

  2. Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah, USA

    Andrea T. White

Authors
  1. Jack H. Petajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea T. White
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jack H. Petajan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petajan, J.H., White, A.T. Recommendations for Physical Activity in Patients with Multiple Sclerosis. Sports Med 27, 179–191 (1999). https://doi.org/10.2165/00007256-199927030-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199927030-00004

Keywords

Search

Navigation