Wednesday, March 11, 2009

Keeping active with multiple sclerosis

Umer Physio
Putting Your Fitness First

Keeping active with multiple sclerosis
By Chris Sulway

A diagnosis of Multiple Sclerosis (MS) can be overwhelming, but it does not mean the end of physical activity: in fact, keeping strong and active can be key to maintaining a high quality of life. MS is a chronic, often disabling disease that attacks the central nervous system. With MS, the protective sheath known as myelin that surrounds the nerve fibres in the brain and spinal cord becomes damaged. The damaged areas become scarred, leaving multiple hardened sclerotic patches – hence the name.

Once the myelin is destroyed, the nerve is no longer able to send messages as efficiently, much the same way as the loss of insulation surrounding an electrical wire will interfere with its ability to transmit signals.
Despite a number of theories, the overall cause of MS remains unknown. It is generally accepted that MS is an autoimmune disorder; in other words, the body’s immune system attacks its own myelin. Genetic and environmental factors are believed to play a role.
The first symptoms of MS usually occur between the ages of 20 and 40 years. It is about twice as common in women as in men and it predominantly affects Caucasians living in temperate and northern climates. However, there is recent research indicating that it is becoming more common in the Gulf region.
MS is an unpredictable disease. Symptoms usually appear in episodes and there is no way of knowing in any particular individual how severe it will be and what part of the body will be affected. Symptoms can include fatigue, impaired vision, loss of balance and muscle coordination, tremors, bladder and bowel problems, and partial or complete paralysis. Just as the symptoms vary among individuals with MS, so does the course of the disease: some people can be minimally affected, while others suffer severe progressive disability.
As yet there is no cure for MS, but there are treatments available that can help slow the progression of the disease and provide relief for symptoms. A component of an effective treatment plan includes physiotherapy and exercise. Physiotherapy can address many issues associated with MS: decreased range of motion in the affected joints; spasticity; and inadequate trunk control.

Physiotherapists can also help with acquisition of assistive devices to help with daily activities; training on how to effectively transfer from lying, to sitting to standing; and fall prevention. A daily exercise program is an important part of an over all
treatment plan and has many benefits for people with MS. Research indicates that moderate daily exercise, geared to a person's abilities and limitations, improves cardiovascular fitness and strength, results in better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities.
Many people with MS can enjoy a variety of activities, but it is recommended that they consult a physiotherapist to provide guidance regarding types of activity and frequency. Issues that should be addressed include: target pulse and breathing rate, adapting routines when MS symptoms fluctuate, timing with medication, how to avoid overheating and dealing with symptoms that occur only on one side of the body. The exercise program should be designed to meet individual goals andlifestyle, and be enjoyable, too. Aquatics, exercise in water, is often recommended because it provides optimal exercise conditions for the person with MS. Being in chest-high water can provide support, and a sense of weightlessness. This enables people with weakened limbs to attain a greater range of motion in their joints and provides the ability to stand and maintain balance for exercises with less effort than on land. Water also provides resistance that can be used for muscle strengthening. Water temperature should be between 80° to 84° F to reduce body heat generated by exercise, this is important for MS, because overheating can often cause temporary worsening of symptoms.
Home exercise programs should be done daily and include components of stretching, strength training, aerobic exercise, and weight bearing activities. These can include activities such as yoga and Tai Chi, as well as weight lifting and ball exercises.
Even the most able-bodied person can’t expect to dive into exercise and achieve immediate dramatic change. Success is accomplished by meeting a series of small goals that fit individual strengths and needs. The less rigid the program, the greater the likelihood of success. Exercise may be so gratifying that it can lead to overexertion; with this comes fatigue and increased possibility of injury. Start slowly and exercise a little longer at each session. People with MS who work slowly at the beginning, and avoid exhaustion, will achieve greater positive results in the end. Living with the unpredictable nature of multiple sclerosis can be a challenge; exercise can be an effective tool to help reduce the impact the disease and bring a greater enjoyment to life.

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