Multiple sclerosis, exercise, and cold How does exercise effect thermal regulatory responses in patients with multiple sclerosis (MS), and can pre-exercise cooling help mitigate any adverse reactions from exercise in these individuals? A: To answer this question, we performed a comprehensive search of the PubMed database (June 2012) for randomized, controlled trials and systematic reviews that addressed this specific research question. 1 Five studies met criteria for inclusion in review. One was written in 2009 as a review of literature on effects of cooling on both healthy individuals and individuals with MS,(2) and the other a review of literature focusing on nervous system effects with emphasis on individuals with MS. (1) Two studies(3,4) were studies which involved body immersion in cool water bath as means of cooling, with one study of healthy individuals(4) and the other on patients with MS.(5) Both studies used cycle ergometer as exercise of choice. One study was prospective trial without control measuring effect of cooling garment on various neurological and functional measures.(5) It is generally accepted that patients with MS are generally heat sensitive, whether heat is from external environmental source or from increase in body temperature as occurs with exercise. Most studies demonstrate improvement in person with MS (as well as with healthy subjects) in physical performance with some type of pre-cooling beforehand; this can last 70 mins to 2-3 hrs after cooling. Literature reviews identify several different methods of cooling including ingestion of ice water and application of ice packs, but two preferred methods in literature are immersion in 16-17°C bath (something MS patient could do at home if able to transfer in and out of tub by themselves or with limited help, or cooling garments, such as vest or vest/cap combination). More study is required comparing methods directly as well as vs control group. Various ideas as to the mechanism of how cooling works to improve function have been put forward, with earlier ideas such as hormonal mechanisms and changes in sweat production largely not confirmed by later research. Currently, effects on central (rather than peripheral) nervous system function have been found to occur in both normal and MS subjects with increased core temperature, such as depressed amplitude of compound muscle action potential and prolonged central motor conduction time. Cooling may work on these aspects of nervous system function to produce functional improvement for a time after cooling. Additionally, greater capacity to perform exercise with cooling would result in lessening of effects of fatigue and muscle disuse commonly seen as result of MS. Based on review, it can be concluded that inclusion of neck exercise improves outcomes for patients with chronic neck pain. Sample exercises from VHI PC-Kits have been provided based on examples from these studies.
Posted on: Mon, 10 Jun 2013 16:11:17 +0000
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