Multiple Sclerosis and Exercise

By Nicole Picas

What is it?

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system, that is, the brain and spinal cord. All nerves are surrounded by a myelin sheath – a protective layer surrounding the nerves. This myelin sheath assists in the conduction of neural signals from the brain to the muscles, innervating the muscles and thereby creating muscular contractions. With MS, demyelination of these sheaths occurs, resulting in the neural conduction along the nerves being adversely affected. Speed of conduction is reduced and the result is a reduction in smooth, rapid and coordinated movement. The effects can range from little or no disability to severe disability.

http://omicsonline.org/blog/wp-content/uploads/2012/04/AX00011.jpg

Various types of MS exist

The National Multiple Sclerosis Society identifies 4 types of MS: relapsing remitting, secondary progressive, primary progressive and progressive relapsing. The most common form is relapsing remitting MS (RRMS). In this case, one has relapses, where symptoms are present, and then periods of remittance, where symptoms subside or disappear altogether. The more relapses a person has, the more severe the symptoms become. Stress, both physical and emotional, is the main contributing factor causing a relapse.

Causes

MS occurs as a result of the myelin sheath surrounding the nerves being damaged. This can be due to inflammation, when the body’s own immune cells attack the nervous system (autoimmune disease). The reason for this is unknown, but is thought to be due to a virus or genetic defect.

Who is at risk?

MS is more common in women. It is generally diagnosed between the ages of 20 and 40, but can occur at any age.

Symptoms

MS affects numerous body systems, including the eyes, bowel and bladder, sexual function, speech and swallowing and, most noticeably, the muscular system. In this blog, I will discuss the muscular system only. According to ACSM, the physical symptoms include the following:

• Spasticity
• Incoordination
• Impaired balance
• Fatigue
• Muscle weakness, paresis (partial paralysis) and paralysis
• Sensory loss and numbness
• Cardiovascular problems
• Tremors
• Heat sensitivity

The role of exercise in managing MS

The progression or prognosis of MS is not affected by exercise. However, a person with MS will still experience the short-term benefits of partaking in a regular exercise programme, such as improved cardiovascular fitness, increased strength and flexibility, and improved functional ability. People with MS often lose function in their legs, resulting in them being unable to walk. It is important to strengthen and stretch the leg muscles in order to prolong function. One should also focus on balance and stability exercises to reduce the risk of falling.

Important things to remember

People with MS do not have the same ability to regulate their body temperature as those without MS, so it is important to keep the room temperature in which you are exercising cool.

If muscles are overworked or overstretched, this can cause an acute inflammatory response, which may exacerbate symptoms. So, take it easy! Rather use lighter weights and do more repetitions to improve endurance and muscle tone.

Tips for staying healthy through Winter

With winter well on its way, many of us find it increasingly tempting to curl up under the blankets a little longer rather than braving the gym, and a hearty bowl of soup with warm fresh bread is much more appealing than a boring cold salad. However, in order to be able to enjoy the occasional winter treat, it’s important to persevere through the next couple of months to emerge fitter and healthier when spring eventually reappears.  Here are some tips to keep you motivated and healthy, instead of going into hibernation.

When to skip the gym

Although we always advocate exercise and could go on about the benefits of exercising forever, it’s just as important to know when NOT to exercise.

• If you have a fever: This means that your body temperature is already elevated and you are fighting an infection. Exercise imposes an additional stress on your body, and also further elevates your body temperature, which could cause severe damage. Also stressing your body in its already- stressed state, will worsen your infection and impede your body’s natural healing processes.

• The ‘above the neck rule’: This rule basically means that if your symptoms are above the neck (sore throat, runny nose, mild headache), then its ok to do so some light exercise, however, this is just a guideline, and you should still use your own discretion. If your symptoms are affecting your normal energy levels, hit the snooze button and have a couple of days break from exercise until your symptoms subside.

• Below the neck: If you are feeling lethargic, have muscle/body aches, a tight chest and cough, then listen to your body and rest until you are feeling better. Exercising when you are sick with flu can do permanent damage to your heart and can be fatal, so rather err on the side of caution, and wait until you are better and not taking any medication before you resume your normal exercise routine.

• Medication: If you are on any medication, other than your normal medication and vitamins, then it’s wise not to exercise. Many flu medications can affect your heart rate, and from a diabetic point of view, can have an unpredictable effect on your blood glucose levels, so it’s best to avoid exercise until you are off the medication.

• Spreading germs: Aside from it being a danger to your own health, exercising when you are feeling sick poses a risk to those around you. If you come and exercise in a gym environment when you are sneezing and coughing, and blowing your nose constantly then touching gym equipment then it is not courteous to those around you and to your Trainer/Biokineticist. They will probably send you home to go and recuperate. 

Tips for staying healthy

So now that you know when you should avoid your exercise session, here is some advice on keeping yourself healthy and fit through winter.

• Have a Flu Vaccine: Although this is not 100% effective, it is a powerful barrier against the three most potent strains of flu from the previous season that are still circulating around the world. Having a flu vaccination can provide up to 70-90 % protection in healthy people.  The best time to have the flu vaccine is from mid-march to end of May, before the flu season starts, so if you haven’t had it yet, don’t despair, you still have two weeks to get it done- the sooner the better!

• Wash Hands: An obvious and simple task, yet it can cut the spread of flu symptoms by 75% and can reduce flu by 43%! Wash your hands before and after coming into contact with sick people.

• Boost your Diet:  Bear in mind that the worse your diet is, the poorer your body’s ability is to repair itself and recover from illness. Also you can add in some immune-boosting vitamin C (either in the form of seasonal citrus fruits, or with a supplement). Also add some extra Vitamin D to your diet (mushrooms, eggs and oily fish), which helps boost the immune response.

• Exercise regularly: studies have shown that exercising moderately for 30 minutes 5 times per week can do wonders for your immune system.  It has also been shown that people who are fit, regular exercisers recover more quickly from illness than their more inactive counterparts.

• Adapt your workout: This may be necessary if you find it difficult to maintain your routine through winter- maybe try changing your time to a bit later if you find it hard to wake up early. If you exercise outdoors, perhaps take your training to a gym environment for winter to avoid having to be exposed directly to the cold. You can even try adding some variety to your exercise routine to avoid boredom and keep you motivated, talk to your Biokineticist about adding in some new exercises where appropriate.

Here’s to a healthy, active winter ( with the odd hot chocolate and rusk thrown in now and then to maintain your sanity)!

By: Gill Scheepers

How does exercise benefit patients affected by strokes?

What is a stroke?

Stroke or medically referred to as cerebrovascular accident (CVA) occurs secondary to vascular inadequacy in the brain. Common causes include thrombosis, embolism or haemorrhage. This results in cell death and results in an impairment of central nervous system function.

The resulting neurological impairments depend on both the size and the area of the ischemic area (a decrease in the blood supply to an organ, tissue, or part caused by constriction or obstruction of the blood vessels) in the brain.

Who is at risk?

·         Hypertension

·         Diabetes mellitus

·         Smoking

·         Alcoholism

·         Coronary artery disease

·         Obesity

·         Cholesterol

Neurological impairments following a stroke vary between patients and this therefore impacts on their ability to perform certain exercises.

What neurological deficits may be present in a stroke patient?

·         Impaired motor and sensory function in upper and lower extremity e.g. walking

·         Visual field deficits

·         Expressive and receptive aphasia (impaired ability to communicate through speech)

·         Mental confusion

·         Apraxia (impaired sequencing of voluntary movements)

The ability to exercise as well as the type of exercise depends on the severity of the stroke as well as the existing of co-morbidities like orthopaedic, arthritic, cardiovascular.

These are some examples of potential neurological deficits that will determine the type of exercise that will be selected by the Biokineticist or Physiotherapist to be performed by the patient:

·         Muscle weakness e.g. bed rest and fear of moving leads to muscle atrophy.

·         Limited range of motion e.g the affected limbs maybe very rigid(hypertonic).

·         Lack of adequate balance.

·         Impaired sensation may affect independent ambulation.

·         Receptive aphasia, mental confusion and/or apraxia may affect ability to understand and follow directions. This may affect execution of exercises.

Benefits of Exercise for stroke patients

·         Increase aerobic capacity and endurance e.g. walking distance and speed

·         Decrease dependence on walking aids for ambulation (walking)

·         Improve balance

·         Improve activities of daily living (ADLS)e.g. getting dressed, standing up from a chair, putting shoes on unassisted.

·         Increase independence in ADLS

However it depends on the severity of the neurological involvement and existing co-morbidities experienced by the person who has had the stroke.

Other benefits:

·         Exercise also reduces the patient’s risk factors that may have lead to the stroke occurring e.g. hypertension.

·         Reports show that patients who have experienced strokes and who exercise regularly are less likely to feel depressed.

NB: Goals must be decided on by the patient with his or her Physiotherapist and/or Biokineticist!

·         Examples: Standing up from a chair, walking without a walker, increasing aerobic capacity or walking speed, going to the toilet by yourself.

·        Goals must be individualised, realistic and attainable.

Exercises must be kept functional and fun!

The choices of exercises depend on neurological deficits. Here are some examples.

·        Increase aerobic capacity by choosing either an arm bike or upright leg stationary bike or treadmill.  Choice of aerobic exercises is determined by the patient’s ability to balance and ambulate.

·        Stretching – very important as one of the neurological deficits is a decrease in a range of motion and stiffness from lack of mobility.

·        Exercise to music that has a good beat will assist with rhythmic movements like walking.

·        Chair stands in order to sit on toilet or on chair.

·        Marching on the spot assist with balance and walking. Stand near a secure object.

·        Lifting one leg up and holding while holding on to asecure object. This assist with walking and balance.

NB! No exercise regime should commence without clearance from your doctor, especially cardiologist. These exercises should not be performed without supervision.  Please contact us for further information.

Exercise of any kind will make one feel better about one’s self and will empower you to reach for one’s goals. The sooner one starts exercise rehabilitation post stroke the better the outcome.

By
Tanya Bellon
Biokineticist

Adhesive Capsulitis ("Frozen Shoulder") & Diabetes

by: Lauren Williamson

Adhesive capsulitis, also known as "frozen shoulder" is a condition where the shoulder joint gradually loses mobility over a period of time, until the joint becomes immobile or "frozen." It is often very painful at first. Eventually the condition can reverse itself but it can take 2 or 3 years for that to happen. Adhesive capsulitis is more prevalent in people who have diabetes.

Often the first symptom is pain when moving the arm and shoulder. Eventually there is a gradual loss of range of motion in one or both shoulders.

The shoulder joint capsule actually adheres (or sticks) to the head of the humerus bone. The humerus is the long bone that extends from your shoulder to your elbow. The joint capsule is a protective sleeve of connective tissue that surrounds the joint.

Diabetes & Frozen Shoulder:

According to the National Institute of Health (NIH), people with diabetes have an increased risk of developing adhesive capsulitis. Excess glucose can adhere to the cells, damaging the connective tissue which makes up the joints. Other conditions that can put you at risk include autoimmune or endocrine disorders, open heart surgery or upper spine disc diseases.

The stages/progression of adhesive capsulitis includes:

·                        Pain in one or both shoulders

·                        Inability to fully move shoulder joint through it’s full range of motion

·                        Gradual improvement of joint mobility. Usually adhesive capsulitis resolves on its own within 1 to 3 years.

Treatment methods include:

·                        NSAIDS – non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen

·                        Injected corticosteroids into affected shoulder joints

·                        Physical therapy e.g. Biokinetics

·                        Surgery is sometimes used to free the joint

Since people with diabetes are at higher risk of adhesive capsulitis, they can help prevent the condition by making sure that blood glucose levels are as close to normal as possible. Regular exercise provides motion for the shoulder joints and keeps the joints strong and flexible.