A novel exercise initiative to improve walking ability in people with multiple sclerosis having higher levels of disability.

Devasahayam, Augustine Joshua (2020) A novel exercise initiative to improve walking ability in people with multiple sclerosis having higher levels of disability. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Multiple Sclerosis (MS) is an auto-immune mediated inflammatory and degenerative disease of the central nervous system characterized by loss of myelin and axonal integrity. MS often leads to an accrual of walking disability and worsening of fatigue. Exercise-dependent plasticity in the central nervous system, which involves upregulation of growth-promoting neurotrophins and suppression of inflammatory cytokines, may help restore lost ability to walk. Although aerobic training is an intervention that can potentially improve walking disability and reduce fatigue, these factors are also significant barriers to participating in exercise. Furthermore, because of thermal dysregulation, exercise-induced increases in body temperature leads to temporary worsening of symptoms in some MS patients. The purpose of my doctoral work was to develop and determine the feasibility of implementing a progressively intense aerobic treadmill training, in a room cooled to 16°C, for people with MS having walking disability, fatigue, and heat sensitivity. In the first study, I critically appraised and consolidated the research in animal models and clinical trials in order to determine the optimal training dosage and outcomes for a future exercise trial. The second study showed that people with MS-related disability consumed about three times more oxygen to complete relatively simple mobility activities such as rolling in bed, when compared to age and sex-matched healthy controls. The results of this study supported the importance of testing therapeutic aerobic training for this cohort of patients with barriers to exercise, such as fatigue. The third study outlined the effects of maximal aerobic exercise on neurotrophins and inflammatory cytokines among people with MS and controls. The final study established preliminary evidence for the feasibility of conducting progressively intense aerobic training on a bodyweight supported treadmill in a room cooled to 16°C. The benefits included significant improvements in walking speed, fatigue, aerobic fitness, and quality of life, while simultaneously altering serum levels of blood biomarkers of recovery such as brain-derived neurotrophic factor and interleukin-6, shifting the balance between repair and inflammation. Randomized controlled trials are needed to substantiate these preliminary findings, which in turn could lead to effective training options for people living with MS-related barriers to exercise participation.

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