More on Exercise and Rehabilitation

It’s getting clearer that exercise and rehabilitation can help many levels of function and quality of life for people living with MS. This year, ECTRIMS is being held in conjunction with the 18th Annual Conference of Rehabilitation in MS, and I’ve been impressed by the extent to which researchers are applying creative strategies to study and maximize the potential benefits of rehab and exercise to address MS.
Some of these strategies were described by Dr. Dalgas (Aarhus, Denmark), who reminded the audience that for many years people with MS were advised against exercising because it seemed to make fatigue and other symptoms worse. Thanks to research, we now know that this worsening is usually temporary and outweighed by the benefits.
It seems like new benefits of exercise and rehab are being discovered every year. There have been hints that exercise can fight depression and improve cognition, and possibly even modify disease activity. The extent of these benefits and the optimal type of exercise for these benefits need further study.
One report by Dr. L. Prosperini and colleagues from Rome might be particularly motivating to keep active. They had already reported that an intensive home-based training program using the Nintendo Wii balance board improved standing balance and inhibited swaying in people with MS. Finding a way to improve balance can, for one thing, prevent falls. Falling, and the fear of falling, can dramatically impact a person’s quality of life.
To find out why it helped, they did advanced brain imaging in 21 people before and after a 12-week training period with the Wii board. After the training, differences in the imaging suggested that myelin in some parts of the brain had gotten thicker, particularly in the part of the brain that controls movement and balance (cerebellum). More work is needed, but it’s really exciting to think that we can take action to physically change our brains, and possibly to recover function.  
There were many other presentations related to benefits of specific rehab and exercise programs, such as Pilates to improve core stability, climbing to improve strength and balance, and tai chi for balance and other functions. One I was particularly interested in was a novel approach called kaatsu resistance training. It’s based on the idea that people who are already weak may have a hard time exercising with enough vigor to see positive changes in strength or growth in muscle mass.
Dr. Y. Learmonth and other rehabilitation researchers in Urbana, Illinois presented preliminary results of kaatsu training, in which blood flow to the muscles is partially blocked by a device similar to a blood pressure cuff, while performing lower limb exercises such as leg presses and curls. This may simulate extra resistance so that the exerciser needs to use less force to achieve gains. Eight people did these exercises 3 times a week for 6 weeks – 4 with the kaatsu cuff and 4 without. This was a small study, but they found it to be safe and also found hints that those using the cuff showed more signs of improved strength than the control group who didn’t use the cuff.  National MS Society has just committed to funding a small pilot study to further explore its potential, so we will keep you posted on progress in this area in the future.
Anyone who has ever tried to stick with an exercise routine knows that there are always things that can get in the way, making it challenging to maintain. As we continue to learn more about how exercise can really help people with MS, researchers are also looking at those barriers, too – what are they, and how can people best be motivated to stick with programs that can have such positive results.  
Tags Healthy Living, Research      3

Nicholas LaRocca, PhD

Dr. Nicholas LaRocca is a consultant to the National MS Society. He is a clinical psychologist who has worked in the field of MS for over 30 years. He was an associate professor at Albert Einstein College of Medicine and New York Medical College before joining the Society in 1997. Dr. LaRocca served as vice president of health care delivery and policy research in the research programs department of the Society. In this role, he was responsible for Society funding of research to address the symptoms of MS, and the rehabilitation, epidemiology and psychosocial aspects of MS, as well as health policy studies.