What kind of exercise therapy can be recommended in PwMS?
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Workshop D sightseeing That’s the question
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What kind of exercise therapy can be recommended in PwMS? Workshopslides by Dr. Claude Vaney, Montana and Jens Bansi, MSc, Valens
Transcript of What kind of exercise therapy can be recommended in PwMS?
Workshop D
sightseeing
That’s the question
Berner Klinik Montana
Klinik Valens
0
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7.5
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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
0 .0
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C.Vaney 2013 ; unpublished data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)
So
cce
r
Bo
dy b
uild
ing
Ru
nn
ing
Ba
ske
tba
ll
Cyclin
g
Row
ing
Sw
imm
ing
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
