Study Supports High Intensity Exercise to Improve Muscle Condition in MS Patients

Study Supports High Intensity Exercise to Improve Muscle Condition in MS Patients

A new study recently published in the journal PLOS ONE revealed that high intensity exercise is safe and offers clinical benefits for patients with multiple sclerosis (MS). The study is entitled “High Intensity Exercise in Multiple Sclerosis: Effects on Muscle Contractile Characteristics and Exercise Capacity, a Randomised Controlled Trial,” and was conducted by researchers at Hasselt University in Belgium and Aarhus University in Denmark.

MS is a chronic, progressive neurodegenerative autoimmune disorder that results from an attack to the central nervous system (brain, spinal cord and optical nerves) by the body’s own immune system, ultimately causing motor function impairment, irreversible neurological disability and paralysis. It is estimated that more than 2.3 million people in the world suffer from the disease.

Due to the symptoms caused by MS, patients often have a more sedentary lifestyle that may promote the loss of muscle strength and exercise capacity, which can further affect the patient’s quality of life.

Studies have shown that low-to-moderate intensity cardiovascular or resistance training exercise can improve muscle contractile properties, strength, functional ability and the endurance capacity in MS patients, aiding symptom management and making a positive impact in patients’ quality of life. The effects of high intensity exercise combining cardiovascular and resistance training are, however, not clear in this patient population.

The goal of the study was to assess the impact of high intensity exercise in MS patients. The team enrolled 34 MS patients in a clinical trial (NCT01845896), and randomly divided them into a sedentary control group (11 patients), and two exercise groups that performed a 12-week program of either high intensity interval (HITR, 12 patients) or high intensity continuous cardiovascular training (HCTR, 11 patients). Both programs were combined with resistance training. The physical condition and body features of all participants were assessed prior and after 12 weeks.


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Researchers found that, in comparison to patients in the sedentary group, the 12-week high-intensity exercise period led to an increase in mean muscle fiber cross-sectional area (CSA), an important measure of skeletal muscle plasticity. Furthermore, patients under high intensity exercise also experienced an improvement in muscle strength (of 13 to 45%), and a decrease in body fat percentage. Only MS patients using the HITR program were found to have an increase in endurance capacity, time to exhaustion, and lean tissue mass.

Based on the results, the research team concluded that 12 weeks of high intensity cardiovascular exercise combined with resistance training is well-tolerated by MS patients, and most importantly, it can lead to an improvement in muscle plasticity, strength and endurance capacity. Interval training seemed to be superior to continuous training. The authors believe that exercise and rehabilitation programs can offer clinical benefits for patients living with MS.

10 comments

  1. Susan says:

    I will try interval training if these are proven benefits.
    I currently do mat Pilates, foam roll and swim laps.
    Previous attempts to high intensity training left me with increased spasticity, pain and eventual increased weakness.

  2. Theo says:

    It would be interesting to get some information on; 1 – how high ‘high-intensity’ is in this context, &
    2 – what temperatures the patients did their exercises in.

    • Patricia Silva, PhD says:

      Dear Theo,
      The study does not mention the temperature at which the exercises were performed, but they do provide a detailed description of the exercise program. Please find below such information taken directly out of the article:

      “Exercise intervention program

      After the baseline measurements, the subjects were enrolled in a well-controlled and supervised training program, to increase cardiorespiratory fitness, as well as strength of the major peripheral muscle groups. Subjects participated in 5 sessions per 2 weeks. Training sessions were interspersed by at least one day of rest, to ensure adequate recovery. Each session started with endurance training, followed by resistance training, interspersed by a short resting period.

      HITR program: Each session started with a 5min warm-up on a cycle ergometer. Hereafter, high intensity cycle interval training was performed. During the first 6 weeks exercise duration gradually increased from 5x1min interspersed by 1min rest intervals to 5x2min and 1min rest intervals. Exercise intensity was defined as the heart rate, corresponding to 100% of the maximal workload (which was comparable to approximately 80–90% of the maximal heart rate). During the second 6 weeks, duration remained stable at 5x2min and the heart rate increased to reach a level corresponding to 100–120% of the maximal work load (which was comparable to approximately 90–100% of the initial maximal heart rate). The second part consisted of moderate-to-high intensity resistance training (leg press, leg curl, leg extension, vertical traction, arm curl and chest press, Technogym). In order to exercise at similar relative workload, resistance training of the lower limb was performed unilaterally, due to the frequent bilateral strength differences seen between the legs of MS patients.[25] Training intensity and volume were adjusted from 1×10 repetitions to 2×20 repetitions at maximal attainable load. Maximal attainable load was expressed as the maximal load that the subject was able to manage, under guidance and consequent encouragement. By applying the same standardised encouragements in all groups, subjects were stimulated to perform at their personal maximal ability.

      HCTR program: Each session started with a cardiovascular part, consisting of cycling and treadmill walking/running (Technogym). Session duration and exercise intensity increased as the intervention progressed, starting from 1x6min/session to 2x10min/session, at a high workload, corresponding to 80–90% of maximal heart rate and according to individual capabilities. The second part of the training session comprised similar resistance training, as described in the HITR program.

      All exercises were performed at a high workload corresponding to 14–16 ratings of perceived exertion on 20-point Borg scale (RPE) and were adjusted to individual disability level. The Borg Rating of Perceiver Exertion Scale measures perceived exertion and is used to document the person’s exertion during a test or to assess the intensity of training and rehabilitation. The scale ranges from 6 to 20, where 6 means “no exertion at all” and 20 means “maximal exertion”. Continuous encouragement by the instructors led to a systematic increase of the training load over the 12-week training period. All sessions were ended by stretching of the extremities, and RPE-level was recorded.”

    • Steve says:

      Deborah, I’ve been doing walkers an wheelchairs, but have had good results on a “Gazelle” (kind of a simple ski machine). At first, I could barely do 5 minutes. But now up to two 30 minute sessions a day, (morning and evening) watching TV and pouring on the speed during commercials. My overall energy and arm / leg muscle has increased. Also been taking LDN nightly.

        • Steve says:

          4.5mg. Definitely lessens fatigue. Seem to awaken earlier, with an overall feeling of wellbeing, hopefully through most of the day. Spasticity? Not sure. My neuro Rx’d Baclofin (muscle relaxer) for the stiff right leg but I won’t take it. Exercise or physical therapy sound better to me.

  3. Sally says:

    High intensity interval training has a psychological benefit for me, in addition to the benefits referred to in the study:
    – the endorphin release acts as an analgesic helping me manage limb discomfort;
    – helps reduce stress and anxiety;
    – improves sleep;
    – and boosts self esteem, which has taken a nose dive since my diagnosis.

    Would welcome formal studies of HITR and psychological benefits in MS patients to sit along side this emerging evidence about the physical benefits; and research about the merit of more moderate exercise ( treadmill walking) on cognitive function ( ref: Ailsa Woods, April15 MSNewsToday), as to date advise has steered MS patients away from high impact adrenalin generating exercise

  4. wayne fenton says:

    You tell us that high intensity exercise is good that’s all fine and dandy ,but if you have a problem walking or even less luck getting off the floor and you have the luxury of an assistant to help, what have you than all your advice is geared toward the person who is very lightly affected by this horrible disease or are practically not affected at all, we all are not fortunate enough to have access to a personal therapist or private therapy in a high tech establishment,we only have access to therapists whos first and only objective is to drive you to disability because its easier or focus on the fact your progressing as if we didn’t know we live with it 24 hours a day we don’t need you shoving it in our faces , exercise is very beneficial but when your only help is telling you how you are getting worse not what you are or can do to improve , I need help bad but am in a dire situation.

  5. wayne fenton says:

    You tell us that high intensity exercise is good that’s all fine and dandy ,but if you have a problem walking or even less luck getting off the floor and you have the luxury of an assistant to help, what have you than all your advice is geared toward the person who is very lightly affected by this horrible disease or are practically not affected at all, we all are not fortunate enough to have access to a personal therapist or private therapy in a high tech establishment,we only have access to therapists whos first and only objective is to drive you to disability because its easier or focus on the fact your progressing as if we didn’t know we live with it 24 hours a day we don’t need you shoving it in our faces , exercise is very beneficial but when your only help is telling you how you are getting worse not what you are or can do to improve , I need help bad but am in a dire situation.
    Reply

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