This document discusses multiple sclerosis (MS) and the role of exercise therapy. It contains the following key points: 1) MS is a chronic progressive disease despite disease-modifying drugs. Studies show disability worsening over time with the duration of the disease. 2) Early studies were skeptical about treating MS, but more recent evidence and reviews find moderate to strong evidence that exercise therapy can improve muscle power, exercise tolerance, mobility and mood in people with MS with no evidence of harmful effects. 3) Specific exercise therapy programs may be as effective as other exercise treatments in improving activities and participation for people with MS. Exercise training can result in improved fitness and quality of life. 4) Temporary increases

1. Workshop D
sightseeing
That’s the question

2. Berner Klinik
Montana
Klinik
Valens

3. 0
2.5
5
7.5
10
0 5 10 15 20 25 30
disease duration in years
E
D
S
S
town
house
In spite of the disease modifying drugs
MS is a chronic progressive disease
(Roxborough RH et al. Neurology 2005)
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4. avec le temps la maladie progresseeeee
irrémédiablement
y = 2.5118x + 1.4394
R2
= 0.9358
0.0
5.0
10.0
15.0
20.0
25.0
30.0
0.0 2.0 4.0 6.0 8.0 10.0
annéesdemaladie
Avec le temps la maladie progresse irrémédiablement
(n= 1875 patients vus à la clinique depuis 2000)
EDSS
C.Vaney 2013 ; unpublished data

5. “le temps n’est pas venu pour sérieusement envisagé un
traitement de la sclérose disséminée…”
Jean Martin Charcot 1867
La Salpétrière 1853

6. Der Jungbrunnen 1546 J.Cranach
Nationalgalerie - Berlin

7. « Ruhe, Vermeidung von Anstrengung aller Art und von
Übermüdung werden in akuten Stadien der Multiplen
Sklerose automatisch verordnet und gewöhnlich von den
Ärzten auch während Remissionen und chronischen Stadien
der Krankheiten angeraten… »
Robert B.Aird
Deutsche Medizinische Wochenschrift 1957;82:111123-1126

8. View from the window may influence recovery
Ulrich R . Science (1984);224 :420-421

9. “…. strong evidence in favour of exercise therapy
compared to no exercise therapy in terms of
muscle power function, exercise tolerance
functions and mobility-related activities.”
Rietberg MB et al. Exercise therapy MS.
Cochrane Database of Systematic Reviews 2005


10. Effect
Size:
0.3

11. “Moderate evidence was
found for improving mood.”
and
“No evidence of deleterious
effects of exercise therapy
was described
in included studies.”
Rietberg MB et al. Exercise therapy MS.
Cochrane Database of Systematic Reviews 2005

12. Smith et al. Arch Phys Med Rehab, 87, 723-27, 2005
Background
Temporary increase in symptoms
Normalised in 85% of the patients within
30min after exercise cessation

13. Relapses in RCT exercise studies
N Control
(No. of relapses)
Exercise
(No. of relapses)
Duration
Romberg et al. 95 6 5 24 weeks
Bjarnadottier et al. 16 1 1 5 weeks
Petajan et al. 54 3 4 15 weeks

14. Særlige problemstillinger
Tallner et al. Mult Scler, 2011
…Our data suggest that physical activity has no
significant influence on disease activity

15. Rietberg MB et al. Exercise therapy MS.
Cochrane Database of Systematic Reviews 2005
“ Finally, no evidence was found that
specific exercise therapy programmes
were more successful in improving
activities and participation than other
exercise treatments.”

16. Petajan et al. 1996 Annals Neurology
Exercise training resulted in improved fitness
and had a positive impact on factors related to
quality of life


17. Særlige problemstillinger
Int J MS Care, 12, 1, 6-12, 2010

18. What is exercise therapy?
Resistance training Endurance training
Endurance training: Continous contractions against low loads
(Aerobic metabolism)
Soccer
Bodybuilding
Running
Basketball
Cycling
Rowing
Swimming
Resistance training: Few contractions against heavy loads
(Anaerobic metabolism)

19. Wo geht’s
hin ?

20. Wo geht’s
hin ?
Nach
Valens !

21. ☹
Ferien auf Kosten
der Krankenkasse
?!

22. ?
Nein werde mich
mit Jens Bansi
sportlich betätigen !

23. Exercise during Rehabilitation in
PwMS
Jens Bansi, Sports Scientist, MSc
Lucerne, 11.01.2014