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Thursday

 

Exercise Beneficial For Children With Multiple Sclerosis, Study Finds

























Image source: ALLPARENTSTALK

Children with multiple sclerosis (MS) who engage in regular exercise may potentially have a milder form of their disease with fewer symptoms, according to results of a new study published online today in the Journal, Neurology.

“Up to three-quarters of children with MS experience depression, tiredness, or memory and thinking impairment,” said lead author E. Ann Yeh, MD, of The Hospital for Sick Children (SickKids) in Toronto and Associate Professor at the University of Toronto in Toronto, Canada.  “Our research is important since little is known regarding how lifestyle behaviors may affect the disease.”

This area is of particular interest to neurologists because children with MS generally experience a more severe course compared to adults, developing more relapses leading to recurrent episodes of weakness. As a result, any intervention to improve quality of life for children with MS would represent a step forward.

MS typically develops in adults between the age of 20-40, and may present with episodes of visual loss, tingling, fatigue and generalized weakness. The exact cause is not yet clear but we do know that the body begins to attack itself, targeting myelin, the fatty substance protecting and covering nerve fibers in the central nervous system.  Treatment is with high dose steroids in the acute phase,  followed by newer so called “disease-modifying” therapies helping to significantly reduce relapse rates and symptoms.

MS is rare in children compared to adults, making up between 2-10 percent of all patients with MS, typically occurring episodically in a so-called “relapsing and remitting” form.

The investigators in this study studied a total of 110 patients from the ages of 5-18. They provided questionnaires to 31 children with MS, inquiring about tiredness, depression and how often they engaged in exercise. They also evaluated 79 children who had experienced a single inflammatory neurologic episode as well. Sixty of the 79 patients also underwent MRI brain scans to evaluate brain volume and to characterize their particular MS lesions.

Based on the study data, just 45 percent of the children with MS reported participating in any strenuous physical activity while 82 percent of the other children participated in strenuous physical exercise.

Compared to the children with MS who did not engage in strenuous activity, those children with MS who did participate in strenuous physical activity were more apt to have a lower density of brain lesions that are a marker for disease activity, otherwise known as T2 lesions.

Those who did strenuous activity had a median of 0.46 cm3 of T2 lesions, compared to 3.4 cm3 for those with no strenuous activity. Also, those with strenuous activity had a median of 0.5 relapses per year, compared to 1 per year for those with no strenuous activity.

The take home message is that children who engaged in strenuous activity had fewer relapses and lower lesion volumes on MRI, ultimately reflecting a lower disease burden.

Children with MS in this study were also noted to have greater depressive symptoms and fatigue compared with the other children evaluated. Whole brain volumes revealed no differences in those with MS and those without the disease, with the results revealing no differences after researchers adjusted for the severity of the children’s disease.

Yeh emphasized that her study only revealed an association between level of physical activity and disease severity in MS, not a cause and effect relationship. In other words, it’s not clear if children with a milder form of  disease are able to exercise more, or if exercise itself reduces the severity of the disease.

“These findings add to the possibility that physical activity may have a beneficial effect on the health of the brain,” explained Yeh.


“This is an excellent article,” said Dr. Paul Wright, Chair of Neurology at North Shore University Hospital in Manhasset, NY and Long Island Jewish Medical Center in New Hyde Park, NY, “that shows physical activity in children with multiple sclerosis and demyelinating disease is beneficial.”

“In this day and age where we are looking for the ‘medical edge’ for disease reduction and prevention, a simple approach of routine strenuous physical activity should be one of the arrows in our quiver for disease management,” explained Wright. In fact, “We would be very impressed, as physicians, if we developed a new medication that provided us with this study’s results,” offered Wright, adding “Physician’s treating pediatric multiple sclerosis may need to adopt a new approach to their patients.”

“It may be difficult to exercise with fatigue and depression; however, it appears that this is exactly what is needed,” concluded Wright.

That said, potential barriers continue to exist in implementing exercise programs among neurologists who currently care for children with MS.

“The main barrier,” explained Yeh, “is that formal exercise programs are hard to fit into the everyday lives of children when they are busy with activities.” “Lifestyle changes are really hard to implement and sustain without support, and there may be issues related to perception of disability despite no clear motor disability that may keep children with MS from choosing to be more physically active.”

One interesting question raised by this study is whether there might be a benefit to considering the use of antidepressants earlier in children with MS and depressive symptoms in order to evaluate if there might be improvement in mood followed by exercise capacity and strength. This could be further validated by a reduction in lesions seen on MRI.

While Yeh admits that her research did not address this type of intervention, “what I can say is that if there is an issue with clinically significant depression, children should be assessed by a physician and appropriate therapy should be initiated if needed.  A different type of study would be required to determine the potential impact of prescribing antidepressants in this way.”

Overall, Yeh explains that her study “suggests that there may be a relationship between high levels of physical activity or strenuous activity and disease activity in children with MS.”

“There is a need for further longitudinal studies focusing on these issues, and furthermore, for interventional studies that evaluate practical ways of increasing physical activity in children,” she concluded.

Story Source: The above story is based on materials provided by FORBES
Note: Materials may be edited for content and length

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