Exercise early in the course of MS and FES effects on bladder symptoms


31 July 2018

The study in brief

Ideas for new research often come from unexpected and apparently random observations or a hunch which slowly develops through discussions with colleagues. Two examples cropped up in the latest batch of MS research papers.

Should we be testing the benefits of exercise earlier in the course of MS?

A group of Danish researchers has considered whether the benefits of early treatment, which are well-established for disease modifying drugs, could also be applied to exercise therapy.

They analysed studies of exercise therapy and found that none have looked at the effects of treatment any earlier than three years after diagnosis. Studies typically include people with an EDSS of at least 3, equivalent to mild to moderate disability in several functional systems. This means that the vast majority of studies have evaluated exercise therapy once someone’s MS is well established.​ However, more recent studies have shown that exercise therapy can have a direct effect on the brain, producing improvements in brain volume and cognition.

They suggest that we may have overlooked an early “window of opportunity”, starting from the first episode of neurological symptoms and continuing into the first few years following diagnosis, where exercise therapy might have the potential to modify the course of MS. They propose that studies should investigate exercise therapy as an add-on to disease modifying drugs in the early stages of MS.

Could FES improve bladder symptoms as well as walking?

People have reported unexpected improvements in bladder symptoms when they started using an FES (functional electrical stimulation) device to improve walking. A team based in London decided to check this out by gathering data from people being fitted with one of these devices.

47 people attending a clinic to set up their FES device were asked to complete a questionnaire assessing bladder symptoms at the start and after three months of using the device. For people with MS, there were improvements in both urgency and incontinence.

They suggest that further research should investigate whether this is a direct effect on the bladder with a similar mechanism to that of percutaneous tibial nerve stimulation, a recognised treatment for overactive bladder.

The study in more detail

Background

Where do ideas for new research come from? Well, not so much from “Eureka” moments but more often from an unexpected and apparently random observation or a hunch which slowly develops through discussion with colleagues, background reading and preliminary tests. Two examples cropped up in the most recent batch of MS research papers.

Should we be testing the benefits of exercise earlier in the course of MS?

It is well-established that starting a disease modifying drug early in the course of relapsing MS gives greater benefits from fewer relapses and fewer new lesions, ultimately leading to less long term disability.

A group of Danish researchers wondered whether the same principle could be applied to exercise.

Exercise therapy, which covers a range of different approaches such a endurance, resistance or aerobic training, has been extensively studied in MS and has been shown to have significant beneficial effects on a variety of symptoms such as fatigue, walking, balance and depression.

The researchers analysed studies of exercise therapy and found that none have looked at the effects of treatment any earlier than three years after diagnosis. Studies typically include people with an EDSS of at least 3, equivalent to mild to moderate disability in several functional systems. This means that the vast majority of studies have evaluated exercise therapy once someone’s MS is well established.

The researchers suggest that there may be an early “window of opportunity”, starting with the first episode of neurological symptoms and continuing into the first few years after diagnosis, where exercise therapy may have the potential to modify the course of MS. They point out that recent studies have shown that exercise therapy can have a direct effect on the brain, including improvements in brain volume and cognition. They propose that studies should investigate exercise therapy as an add-on to disease modifying drugs in the early stages of MS.

Riemenschneider M, et al.
Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation.
Mult Scler. 2018 Jun;24(7):886-894.
Abstract

More about exercise and MS

Could FES improve bladder symptoms as well as walking?

Anecdotally, people have reported unexpected improvements in bladder symptoms when they started using an FES (functional electrical stimulation) device to improve walking. A team based in London decided to check this out by gathering data from people being fitted with one of these devices.

An FES device applies small electrical charges to a muscle that has become paralysed or weakened, due to damage caused by MS in your brain or spinal cord. The electrical charge stimulates the muscle to make its usual movement. In MS, FES devices are typically fitted on the lower leg and apply electric shocks to the lower leg muscles to compensate for foot drop.

47 people attending a clinic to set up their FES device were asked to complete a questionnaire assessing bladder symptoms at the start and after three months of using the device. Of the group, 35 had MS and the remainder had other neurological conditions.

Improvement in overactive bladder symptoms was not significant for the group as a whole. But for people with MS, changes were significant, with particular improvements in urgency and incontinence. The biggest improvements in bladder symptoms were seen in those with slower initial walking speeds.

The researchers conclude that FES use does improve overactive bladder symptoms in people with MS. They suggest that further research should investigate whether this is a direct effect on the bladder with a similar mechanism to that of percutaneous tibial nerve stimulation, a recognised treatment for overactive bladder, rather than through improved mobility.

Hare N, et al.
Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking.
Clin Rehabil. 2018 Jun 1:269215518780974.
Abstract

More about getting help with bladder problems

Find out more

On this page