The effect of exercise on functional capacity and quality of life in patients with multiple sclerosis

Multiple sclerosis ( MS) is a chronic disease in which the immune system attacks the myelin sheath of axons of the central nervous system. Myelin sheath damage may result in spasticity, muscle weakness, impaired balance, ataxia and excessive muscle fatigue. Symptoms can include loss of bowel or bladder control, sexual dysfunction, pain, loss of function or feeling in the limbs, double vision, blindness, loss of cognitive functioning and emotional changes. During recent years it has become clear that MS patients benefit from physical exercise in the form of aerobic, strength and respiratory training. Intervention programs consisting of 30-minute treadmill training, twice a week at 55-85% of age-predicted maximum heart rate can improve cardiovascular function and physical fitness, decrease oxygen consumption at rest, diminish walking effort and improve walking speed. Other positive effects include improvement of learning capacity and mental performance, as well as attenuation of depressive feelings and fatigue. Moreover, this type of training has been shown to stimulate neurogenesis, and increase levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). Progressive resistance training can improve strength, mobility and balance without an increase in the symptoms of the disease. Supervised training consisting of 10-15 repetitions at 60-70% of one repetition maximum improves walking and functional ability in moderately disabled persons with MS. Respiratory training has a beneficial effect on respiratory muscle strength and aerobic capacity. A 12-week respiratory muscle training course with resistive loads (3 sets of 15 repetitions at 60% of maximum expiratory pressure twice a day) can increase inspiratory and expiratory muscle strength, and improve pulmonary function and exercise capacity, even in patients with advanced MS. Given the favorable effects of physical exercise on most components of the physical dimension and its positive impact on quality of life, physical exercise prescription is recommended as a complement to conventional therapy for patients with MS.