what kind of exercise therapy can be recommended in pwms?

Workshop D

sightseeing

That’s the question

Berner Klinik Montana

Klinik Valens

0

2.5

5

7.5

10

0 5 10 15 20 25 30

disease duration in years

EDSS

town

house

In spite of the disease modifying drugs MS is a chronic progressive disease

(Roxborough RH et al. Neurology 2005)

room

avec le tem ps la m aladie progresseeeee

ir rém édiablem ent

y = 2.5118x + 1.4394

R2 = 0.9358

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5 .0

1 0 .0

1 5 .0

2 0 .0

2 5 .0

3 0 .0

0 .0 2 .0 4 .0 6 .0 8 .0 1 0 .0

an

né

es

de

ma

lad

ieAvec le temps la maladie progresse irrémédiablement

(n= 1875 patients vus à la clinique depuis 2000)

EDSS

C.Vaney 2013 ; unpublished data

“le temps n’est pas venu pour sérieusement envisagé un

traitement de la sclérose disséminée…”

Jean Martin Charcot 1867

La Salpétrière 1853

Der Jungbrunnen 1546 J.Cranach Nationalgalerie - Berlin

« 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

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

“…. 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

Effect

Size:

0.3

“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

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

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

Særlige problemstillinger

Tallner et al. Mult Scler, 2011

…Our data suggest that physical activity has no

significant influence on disease activity

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.”

Petajan et al. 1996 Annals Neurology

Exercise training resulted in improved fitness

and had a positive impact on factors related to

quality of life

Særlige problemstillinger

Int J MS Care, 12, 1, 6-12, 2010

What is exercise therapy?

Resistance training Endurance training

Endurance training: Continous contractions against low loads

(Aerobic metabolism)

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Cyclin

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Resistance training: Few contractions against heavy loads

(Anaerobic metabolism)

Wo geht’s hin ?

Wo geht’s hin ?

Nach Valens !

☹

Ferien auf Kosten der Krankenkasse

?!

?

Nein werde mich mit Jens Bansi

sportlich betätigen !

Exercise during Rehabilitation in PwMS

Jens Bansi, Sports Scientist, MSc

Lucerne, 11.01.2014