Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course

Abstract

Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers: Healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS. Early evaluation by a physical or occupational therapist or exercise or sport scientist, experienced in MS (hereafter referred to as “specialists”), is recommended to establish an individualized exercise and/or lifestyle physical activity plan. Taking into account comorbidities and symptom fluctuations, healthcare providers should encourage ⩾150 min/week of exercise and/or ⩾150 min/week of lifestyle physical activity. Progress toward these targets should be gradual, based on the person’s abilities, preferences, and safety. If disability increases and exercise/physical activity becomes more challenging, referrals to specialists are essential to ensure safe and appropriate prescriptions. When physical mobility is very limited, exercise should be facilitated by a trained assistant.

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

“…Step 2: developing a logic model of change We produced a logic model of change (figure 2) which linked performance objectives to behavioural determinants that would lead to the proposed intervention outcomes over the short and medium term. Intrapersonal (for the PwPMS) performance objectives focused around three main areas-first, making a conscious decision to be more active; second, developing the skills and confidence to create a personal physical activity plan, which would include identifying suitable physical activities, 29 weighing up the risks and benefits of each activity in relation to health, and to be confident in trying new things and third-identifying solutions for perceived barriers through access to timely and appropriate support from physiotherapists. A key dependency was that the physiotherapists themselves recognised the importance of personalised and tailored self-management support for physical activity and that they had the knowledge, confidence and skills to do so.…”

Rehabilitation should be prescribed acutely in motor relapses – No

“…Medical treatment approaches in both acute relapses and everyday MS management have radically changed in the past couple of decades with increasing availability of effective disease-modifying therapies (DMTs) that have led to a reduction in frequency and severity of relapses, and reduced accrual of disability. 2 Along with DMTs, motor rehabilitation and physical activity are increasingly being recommended to augment functionality and even to act as anti-inflammatory agents during the lifespan of having MS. 3 Also, recent evidence-based recommendations from experts in MS rehabilitation include that healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS. 4 While the above indications are certainly valid over the lifespan of having MS, little research has been carried out regarding physical activity and the provision of rehabilitation for motor dysfunction during acute relapses in MS and in the early post relapse period. 5 In general, advice regarding physical activity during relapse is not to exercise until symptoms have leveled off and any steroids prescribed to help through the symptoms have finished; however, the NICE Guidelines clarify that it is necessary to "identify whether the person with MS having a relapse or exacerbation needs additional symptom management or rehabilitation."…”

“…Medical treatment approaches in both acute relapses and everyday MS management have radically changed in the past couple of decades with increasing availability of effective disease-modifying therapies (DMTs) that have led to a reduction in frequency and severity of relapses, and reduced accrual of disability. 2 Along with DMTs, motor rehabilitation and physical activity are increasingly being recommended to augment functionality and even to act as anti-inflammatory agents during the lifespan of having MS. 3 Also, recent evidence-based recommendations from experts in MS rehabilitation include that healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS. 4…”

COVID-19 Pandemisi Sürecinde Nörorehabilitasyonun Yönetimi

“…In MS, in combating spasticity, as well as depression and chronic fatigue, regular exercise is important. For the duration of the COVID-19 pandemic, patients should be encouraged to alternately perform cardiovascular and stretching exercises three times a week for 30 minutes (or every day, 10 minutes) at home (15). In addition, patients should be encouraged to learn effective exercises such as pilates for walking, balance, and posture from web based platforms.…”