Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review

Abstract

In the treatment of multiple sclerosis (MS), exercise training is now considered a cornerstone. However, most clinicians tend to focus on neurologic deficits only, and thus prefer to prescribe rehabilitation programs specifically to counteract these deficits. However, the present comprehensive review shows that patients with MS (pwMS) also experience significant muscular, cardiac, ventilatory and metabolic dysfunction, which significantly contribute, next to neurologic deficits, to exercise intolerance. In addition, these anomalies also might increase the risk for frequent hospitalization and morbidity and can reduce life expectancy. Unfortunately, the impact of exercise intervention on these anomalies in pwMS are mostly unknown. Therefore, it is suggested that pwMS should be screened systematically for muscular, cardiac, ventilatory and metabolic function during exercise testing. The detection of such anomalies should lead to adaptations and optimisation of exercise training prescription and clinical care/medical treatment of pwMS. In addition, future studies should focus on the impact of exercise intervention on muscular, cardiac, ventilatory and metabolic (dys)function in pwMS, to contribute to improved treatment and care.

Simplified indices of exercise tolerance in patients with multiple sclerosis and healthy subjects: A case‐control study

“…These findings point out to an actual cardiorespiratory deconditioning of these patients, independently from other factors affecting maximal exercise testing such as lack of motivation or familiarity with exercise, fatigue, and muscle weakness. This has been partially explained by muscle, cardiac, and respiratory impairments, resulting directly either from the pathophysiology of the disease or from physical deconditioning secondary to sedentary behavior 14,43 …”

“…Low VO 2max is associated with negative outcomes at different levels of patient functioning, including body structures and functions, activities, and participation 13 . Even though these limitations in pwMS are not fully understood from a physiologic point of view, evidence points to muscular cell abnormalities, enzyme abnormalities, HR and stroke volume impairments, and ventilatory function impairments 14 . However, in a recent study, only 37.5% of pwMS with low‐to‐moderate disability actually reached the VO 2 “plateau” during exercise testing 15 .…”

Respiratory impairment in persons with multiple sclerosis: A cross-sectional study

“…The spirometry was performed to all patients before the HSCT treatment, with the purpose of evaluating the pulmonary function before the administration of the different drugs required and also as a part of the pre-surgical evaluation before the Mahurkar catheter placement. All subjects were recommended to avoid smoking, recent alcohol consumption, or consuming large meals before the test, according to international guidelines [7][8][9][10] . The volumes reported in this study included: forced vital capacity (FVC) and forced expiratory volume of the 1 st s (FEV1) in liters (L) and predicted (%) values and FEV1/FVC ratio.…”

Promotion of physical activity and exercise in multiple sclerosis: Importance of behavioral science and theory

“…hippocampus), 13 sleep quality, 14 and cardiovascular/metabolic cormorbidity. 15 Exercise has been associated with reduced rates of MS relapses 16 and slowed disability progression. 17 The evidence base has yielded guidelines for prescribing exercise behavior in patients with MS who have mild or moderate neurological disability 18 that can be implemented within comprehensive MS care.…”