Recommendations for physical activity in patients with multiple sclerosis

For many years, patients with multiple sclerosis (MS), an inflammatory demy elinating disease of the central nervous system, have been advised to avoid exercise. MS is believed to be autoimmune in origin, mediated by activated T cells which penetrate the blood-brain barrier and attack myelin. The pat hophysiology, with respect to function is an impairment of saltatory conduc tion, specifically, slowing of conduction speed and/or conduction block. Sy mptoms can temporarily worsen on exposure to heat or during physical exerci se. Exercise programmes must be designed to activate working muscles but avoid overload that results in conduction block. Fatigue, often severe, affects a bout 85% of MS patients and, along with motor and sensory symptoms, results in decreased mobility and reduced quality of life. Physical activity and r ecreation are reduced in patients with MS. Before developing recommendation s, physical activity pat terns and the physical effects of MS should be ass essed in individual patients. Patients may then be functionally classified. Physical activity can also be classified in a pyramid structure, with the most basic functions forming the base and the most integrated functions on top. The muscular fitness pyramid progresses through passive range of motio n, active resistive, specific strengthening and integrated strength exercis es. Overall physical activity may be increased according to functional leve l by performing activities of daily living, incorporating inefficiencies in to daily living, pursuing more active recreation and eventually developing a structured exercise programme. The importance of the proper exercise environment, balance and coordination issues and factors related to adherence are discussed.