Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exercise

Skjerbæk, Anders Guldhammer; Møller, Andreas Buch; Jensen, Ellen; Vissing, Kristian; Sørensen, Henrik Toft; Nybo, Lars; Stenager, Egon; Dalgas, Ulrik

doi:10.1177/1352458512463765

Cited by 33 publications

(22 citation statements)

References 24 publications

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“…26 Most of these studies include both RRMS and progressive disease, so whether those with progressive multiple sclerosis, or severe disability, also benefit remains uncertain. Encouragingly, evidence from recent small-scale exercise studies of people with progressive multiple sclerosis, with moderate and severe disability, suggests that endurance training can improve aerobic capacity, 25,76 leading to an increase in walking distance. 25 Low dropout rates and good levels of adherence also provide cautious optimism that this intervention is feasible and acceptable in those with progressive disease.…”

Section: Reduced Cardiovascular Fitnessmentioning

confidence: 99%

Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Feinstein

Freeman

2015

The Lancet Neurology

235

168

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Disease-modifying drugs have mostly failed as treatments for progressive multiple sclerosis. Management of the disease therefore solely aims to minimise symptoms and, if possible, improve function. The degree to which this approach is based on empirical data derived from studies of progressive disease or whether treatment decisions are based on what is known about relapsing-remitting disease remains unclear. Symptoms rated as important by patients with multiple sclerosis include balance and mobility impairments, weakness, reduced cardiovascular fitness, ataxia, fatigue, bladder dysfunction, spasticity, pain, cognitive deficits, depression, and pseudobulbar affect; a comprehensive literature search shows a notable paucity of studies devoted solely to these symptoms in progressive multiple sclerosis, which translates to few proven therapeutic options in the clinic. A new strategy that can be used in future rehabilitation trials is therefore needed, with the adoption of approaches that look beyond single interventions to concurrent, potentially synergistic, treatments that maximise what remains of neural plasticity in patients with progressive multiple sclerosis.

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Section: Reduced Cardiovascular Fitnessmentioning

confidence: 99%

Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Feinstein

Freeman

2015

The Lancet Neurology

235

168

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“…Impaired regulation of body temperature is a major barrier to exercise for people living with MS [19,20]. In a cross sectional study, heat sensitive individuals with MS had simultaneous increase in core temperature and worsening of MS symptoms during aerobic exercise, when compared to resisted exercise [21]. Our previous research showed that cooling the exercise environment to 16°C, mitigated exercise-induced losses in central drive among people with MS who reported having heat sensitivity [22].…”

Section: Introductionmentioning

confidence: 94%

Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study

et al. 2020

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Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16°C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids.Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. Results: Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.

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“…Twelve patients with multiple sclerosis (MS) were selected to participate in this study. Sample size of the population was based on sample sizes of similar studies in patients with MS in which significant effects were found (Grahn et al, 2008;Reynolds et al, 2011;Skjerbaek et al, 2013;White et al, 2000). Patients were included regardless of age and gender.…”

Section: Participantsmentioning

confidence: 99%

Whole-body cooling does not compromise muscle oxidative capacity in subjects with multiple sclerosis

Eijnde

Keytsman

Wens

et al. 2014

NRE

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BACKGROUND: Whole-body cooling improves exercise tolerance in patients with multiple sclerosis (pwMS). To be able to exercise at greater intensities and/or for longer durations with whole-body cooling, it should be examined whether this compromises skeletal muscle oxidative capacity (assessed by exercise-onset VO 2 kinetics). OBJECTIVE: To study the impact of whole-body cooling on exercise-onset VO 2 kinetics in pwMS. METHODS: From 12 pwMS (EDSS 3.5 ± 1.5) and 12 healthy age, BMI, and gender-matched subjects exercise-onset VO 2 kinetics (mean response time [MRT]) and body temperature were determined under normothermic and hypothermic (pre-exercise 60-min whole-body cooling) conditions during submaximal exercise testing (two 6-min constant-load exercise bouts). Moreover, heart rate, blood lactate content, expiratory volume and ratings of perceived exertion (RPE) were assessed during exercise. RESULTS: Exercise heart rate (−7 ± 6 beats/min) and end-exercise body temperature (−0.9 ± 0.5 • C) was significantly lower in hypothermic vs. normothermic conditions in both populations (p < 0.05). In pwMS exercise RPE was lower in hypothermic vs. normothermic condition (p = 0.056). No significantly different MRT was found between normothermic vs. hypothermic conditions in both populations. CONCLUSIONS: Lowering body temperature prior to endurance exercise does not affect muscle oxidative capacity in pwMS, but lowers RPE, thus making it possible to prescribe exercises of greater intensity and/or longer duration.

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Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exercise

Abstract: An exercise-induced increase in C(temp) is associated with increased number and severity of perceived symptoms in HS persons with MS. Based on these findings it is expected that HS persons with MS do tolerate RE better than EE.

Cited by 33 publications

References 24 publications

Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study

Whole-body cooling does not compromise muscle oxidative capacity in subjects with multiple sclerosis

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