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Client-clinician interaction for individuals with multiple sclerosis

This is an excerpt from Clinical Exercise Physiology 5th Edition With HKPropel Access by Jonathan K Ehrman,Paul M. Gordon,Paul S. Visich & Steven J. Keteyian.

Practical Application 28.1

The symptomatic fatigue noted by individuals with MS varies from day to day. The clinical exercise physiologist must anticipate the need to reduce exercise training volume (i.e., frequency, intensity, duration) if a person is fatigued. Doing this requires daily assessment for indicators of fatigue. Verbal communication is the best means of assessment. Appropriate questions include “How do you feel today?” and “Are you tired today?” Use of a visual analogue fatigue scale (91, 156) can also be helpful in ascertaining symptomatic fatigue before exercise. Intensity of exercise can be adjusted, and duration monitored, by use of the RPE score. As the RPE approaches the “hard” and “very hard” zones and the individual begins to experience fatigue despite reductions in exercise pace, the exercise session should be ended. Exercise above a moderate intensity, particularly on days when significant symptomatic fatigue is reported, should be carefully considered and perhaps avoided. Although exercise may acutely worsen or lead to increased levels of fatigue later in the day or even in the days soon after the training session, this transient phenomenon (167) normally lessens as the patient becomes more fit. Furthermore, exercise normally has a beneficial effect on the perceived level of chronic fatigue in persons with MS when rated after 2 to 4 wk (67).

Clinical depression or depressive symptoms are somewhat common in persons living with MS. Indicators of stress may be related to depression. These signs include poor sleep habits, noncompliance with lifestyle change, and elevated scores on standardized questionnaires such as the SF-36 and Beck Depression Inventory. The exercise clinician should share information about the potential positive effects of exercise on various psychological variables (e.g., mood, depression, anxiety). People who exhibit signs of depression or are concerned about it should be referred to the mental health professional on their MS management team.

The clinical exercise physiologist should counsel individuals with MS about the risk factors associated with a sedentary lifestyle, including coronary artery and cardiovascular disease, obesity, and type 2 diabetes. Any steps the person can take to include or increase daily activity levels will help with many health outcomes.

The clinical exercise physiologist should help motivate individuals with MS to exercise regularly. Because some people with MS have cognitive problems, the exercise clinician may need to repeat instructions, clarify explanations, or present the training plan in an easy-to-follow format. Reported reasons for nonadherence to exercise training include fatigue, disability, and lack of time (5). The clinical exercise physiologist must communicate the importance of regulating exercise training intensity each day to avoid excessive fatigue; the best way to do this is to use the RPE scale in combination with objective intensity measures (e.g., HR). Additionally, it can be stressed that regular resistance exercise may strengthen the skeletal muscles and allow people to perform and maintain activities of daily living with less overall symptomatic fatigue. This type of information can be helpful for maintaining motivation.

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