Multiple Sclerosis (MS)

Overview of MS

MS is characterized by the development of sclerotic plaques in the central nervous system, which results in blocked or slowed neural transmissions. MS has episodes of increased symptoms followed by periods of recovery. There are four subtypes, based on the pattern of progression of the disease. Initial symptoms are sensory changes, visual deficits, muscle weakness, and balance impairments. Diagnosis of MS is based on the clinical presentation of symptoms and the identification of lesions on magnetic resonance imaging (MRI) of the central nervous system. Clients with MS have periods of increased fatigue and weakness, resulting in limited daily activities. Inactivity is linked to decreased aerobic capacity, reduced muscle strength, increased fatigue, and reduced maximum gait velocity.¹

Comorbidities to Consider

• Progression of the disease process results in sensory deficits, with poor coordination and balance with movements.

Client Examination

Keys to Examination of Clients

• MRI of the central nervous system will identify the location and extent of sclerotic plagues, which may assist in understanding the extent and progression of the disease.

• Determine fatigue levels before starting exercise and as an ongoing assessment for prescribing exercise intensities and durations.

• Determine the progression of the disease and the prognosis for improvement in function with the Kurtzke Expanded Disability Status Scale.²

Recommended Baseline Testing of Fitness Levels

• A 10-meter and a 6-minute walk have been used to assess mobility and endurance in clients.¹

• Isometric tests of muscle strength and functional assessments can be used to determine a baseline of strength measurements.^3,4 Clients' overall mobility and activities should be assessed to determine the quality and amount of their movement.

Exercise Prescription

Type: Walking, cycle ergometry, and aquatic exercise

Intensity: Start at 50%–70% of Vo₂ maximum or 60%–80% of maximum heart rate¹

Duration: 10–20 minutes

Frequency: Two to three sessions per week

Getting Started

A combination of endurance and resistive training is recommended. Endurance training is appropriate for clients with minimal to moderate disability levels.^1,5 Clients with no disability can participate in road running, bicycling, and recreational activities. The exercise environment must be controlled as many clients experience heat intolerance. Training should be increased in duration and frequency according to baseline testing and the client's control of fatigue level.

Resistive training, especially for the lower extremities, using weight training equipment is recommended for starting an exercise program.¹ A circuit of five to eight upper and lower extremity resistive exercises at an intensity allowing for 15 repetitions for one to three sets is recommended.^1,4 The emphasis should be on lower extremity exercises as ...