Physical Activity and Multiple Sclerosis

Abstract

Multiple Sclerosis (MS) is an autoimmune disease characterized by demyelination and axon degeneration of the central nervous system that is accompanied by a wide range of symptoms. It is well established that physical activity is associated with a wide variety of health benefits, including improving fitness, MS-related symptoms and function in the MS population. However, despite the potential benefits associated with physical activity participation, most people living with MS remain physically inactive. In 2012, new evidence-based physical activity guidelines (PAGs) for adults with MS were released. The PAGs suggest that for health benefits, adults aged 18-64 years with mild to moderate disability need at least 30 minutes of moderate intensity aerobic physical activity two days per week and strength training for major muscle groups two times per week. The purpose of this dissertation was to determine the association between physical activity and health and to explore physical activity as a potential disease-modifying therapy in the MS population. This was completed through a series of three projects focusing on the PAGs for adults with MS. The focus of the first study of this dissertation was on the implementation of the PAGs. The results from this study revealed that direct referral to physical activity from a physician is twice as effective as simply providing information about physical activity with respect to adhering to the PAG recommendations in people with MS (65.2 % vs. 32.8 % for direct referral and control groups, respectively). Further, the results revealed that a high self-efficacy for exercise at baseline may be an additional predictor to PAG adherence. The purpose of the second study of this dissertation was to validate the PAGs for people with MS within a community-based intervention, and to affirm that following the PAGs for 16 weeks would result in improvements in fitness, mobility, fatigue symptoms and quality of life. The results from the second study confirm the effectiveness of the PAGs for people with MS for improving health, as significant improvements were observed in VO2 peak (+32 %), strength (+8-20 %), mobility (+14 %), fatigue symptoms (-40 %) and quality of life (+10-24 %). The purpose of the third and final study was to determine the effect of exercise on brain function and cognition in a sample of adults living with MS. Following the PAGs for 16 weeks led to significant improvements in processing speed and memory in adults living with MS. Overall, the results from this dissertation are extremely promising and highlight the importance of physical activity with respect to improving aspects of health and the effect it can have on MS-related symptoms and cognition in the MS population. Novel findings in this dissertation present convincing evidence that physicians should refer patients with MS to participate in exercise to improve MS-related symptoms and overall well-being.