Cooling Therapy Before Exercise Can Increase Physical Activity in MS Patients

Lowering body temperature helps to improve exercise and functional capability in multiple sclerosis (MS) patients by preventing disease worsening, researchers in  Greece report.

The study with that finding, “Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic review,” was published in the journal Multiple Sclerosis And Related Disorders.

Exercise is known to help prevent and manage MS symptoms and complications. However, due to an inefficient regulation of body temperature reported by many MS patients, exercise-induced excessive increase in body temperature (hyperthermia) can worsen the disease symptoms. So, it becomes difficult for patients to participate in physical activity.

Pre-cooling treatment before an exercise regimen could be helpful. However, according to the team, the available information about pre-cooling therapy and functional improvement in MS patients has not been throughly analyzed.

Now, researchers reviewed previously published studies on the use of cooling treatments and their effect on MS patients’ ability to be physical active.

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Until September 2018, only six studies described the use of a cooling intervention and its effect on functionality. The number of participants in these six studies ranged between six and 84 MS patients.

Different cooling techniques were used in these studies. Three studies used “active cooling” to lower body temperature. Active cooling refers to a liquid cooling method in which cold liquid was circulated in multiple tubes through the patient’s clothing or other material.

One study implemented the “passive cooling” technique of using ice or cold gel packs to absorb heat. Direct skin contact with cold liquid or cold solid surface were used in the other two studies.

Most studies tested patients’ functional and exercise capability before and after cooling therapy to alleviate exercise-induced hyperthermia.

In general, results showed that the core temperature was reduced by 0.37 to one degree Celsius. Any cooling method used lowered the patient’s core temperature within 30 minutes to one hour of treatment.

Overall, patients in all six studies experienced moderate improvement in their ability to exercise. Pre-cooling appeared to improve both arms’ (upper limb), and legs’ (lower limb) functionality. In all studies, some form of timed walk-test was used to assess the functional capacity of patients, in addition to other tests. Hand grip strength was assessed for upper limb functionality.

In particular, the study using pre-cooling through direct contact via solid surface reported a 33% increase in exercise duration in patients. In one of the “passive cooling” studies, 50% of patients experienced the beneficial effects of the cooling intervention for two to eight hours after the treatment.

Head and neck cooling for an hour by wearing a cold liquid-containing hood served as a supporting method to improve daily functions and physical performance in one of the studies. No adverse side effects were reported, confirming the safety of the technique.

Although pre-cooling therapy showed a positive effect in the functional capacity of MS patients, the researchers noted several limitations in the six studies analyzed. Factors such as cooling regulation, clothing fit, body size and shape, among others, can influence the cooling efficiency, and none of these parameters were considered in these six studies. Also, the studies included a small number of participants, and lacked a robust study design.

“Therefore, more studies with strong experimental design should be conducted in order to clarify the acute and long-term effects of pre-cooling therapy on functional capacity in MS patients,” the researchers wrote.

Nonetheless, the team concluded that, overall, “the results of all the studies analysed in this review demonstrated that pre-cooling therapy can prevent the symptom worsening due to increased body temperature in multiple sclerosis patients without causing adverse effects. Therefore, such strategies could serve as a complimentary therapeutic approach in multiple sclerosis patients.”