Saturday, 27 February 2016

BrainHealth & ClinicSpeak: can the Brits really beat the Aussies?

How competitive are you when it comes to the health of your brain? #BrainHealth #ClinicSpeak #MSBlog #MSResearch

"I have been banging 'the holistic management of MS - brain health' drum for sometime now, hoping that the community will take the message seriously. If you repeat things enough people may start to say, yes I think this Giovannoni character is making a serious point. This is why the paper below is so important; it shows that MSers who exercise more and have higher self-rated health had lower levels of functional limitations 11 years later, i.e. less disability. Is this chicken or egg? Did the exercise result in better outcomes or did those MSers who were doing well simply able to exercise more? Is this observation an association or is it causal? For this we need to do randomised trials or look to animal models and other data to make the case that exercise is actually good for you. It is clear that exercise is more than just a manifestation of being physically able; exercise has biological effects that change the way the brain functions. Therefore I am going to stick my head out and state that exercise should be classified as a disease-modifying treatment for MS and that everyone with MS should be enrolled in an exercise programme of some description. It doesn't matter how disabled you are there is always a form of exercise that you will be able to perform. If you don't have MS and are reading this post you should also be doing regular exercise. The data linking regular exercise to a reduced risk of developing dementia, or age-related cognitive impairment, is overwhelming. The problem we face is that as our society gets more sedentary how do we get people to do more exercise? This is a big public health challenge. Any ideas? May be we need to formalise our Barts-MS Brain Health Challenge into something more concrete? A MS clinical nurse specialist from Australia contacted me about setting up a platform so that Australian MS Healthcare professionals and MSers can compete against UK MS HCPs & MSers. I think this is great idea, but have no idea how to do it and how we would judge the outcome. I would also expect the Aussies to whip the Brits they seem to be much more competitive by nature. This may have something to do with the 'Empire always fights back' and wins. However, going on the last haul of medals in the summer Olympics I may be incorrect. Mouse Doctor tells me even his beloved county of Yorkshire won more medals than Australia; 'the times they are a-changin'. 

"The corollary to exercise and health was that stress and barriers in relation to health responsibilities were related to higher levels of functional limitations in year 11. Again this makes sense and suggests that we really need to proactively manage stress and do something to activate MSers to remove barriers that prevent them taking responsibility for their health. I see the latter play out in my clinic week after week; my patients who take responsibility for their disease and are proactive about their disease do better when compared to my patients who are passive recipients of our advice, remaining in denial about their disease or are perpetually worried about the future."


"Carpe Diem, seize the day, today will be yesterday tomorrow! You have don't have time to waste, remember 'time is brain'."




BACKGROUND: Multiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential.

OBJECTIVE: The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS.

METHODS: Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year.

RESULTS: After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11.

CONCLUSION: Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.

12 comments:

  1. This is so encouraging. I have upped my exercise to c. 6 hours a week, swimming and pilates. I do it because I feel it's really the ONLY thing I can do for my MS on my own account. I can't control what's going on in my body MS-wise but I'm enjoying feeling fitter. I've gradually built up stamina to the point where I can exercise 6 days a week and am determined to keep it up.

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  2. Anonymous-2 to add to my previous comment, I'm interested in what's being said about stress. I try and direct my stressful feelings into the exercise i.e. to concentrate on self-improvement, to have fitness goals rather than obsessing about MS symptoms. It helps me to belong to a sports club, where everyone is there to improve something. Seeing one's MS-limitations alongside non-MSers' arthritis/hip replacements etc is very positive and motivating - makes you realise that 'we're all in it together'.

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  3. What about North America - USA (ex-empire) and Canada (currently still under the realm) - can we join the competition?

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  4. MouseDoc is a plastic Yorkshireman. He's been in London for decades, abandoning the North and taking economic advantages offered in the South. Ta for not bothering to boost the status of your mother-county by sticking around.

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    1. Chunter chunter chunter
      I have been called many things but economic migrant is a new one. Happen the smoke is full of em:-).

      Indeed I can hear a Loiner from Leeds as I write chatting to a tourist on their way to work

      You can take the man from Yorkshire but you can,t take Yorkshire from the man :-) Any Texan would know that.


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    2. something like this? https://www.youtube.com/watch?v=6VLYpKGVBUg

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  5. Excellent recommendation! I practice sports since he was 8 years old, I learned to swim with 2 years old, and as the only active lesion that I had in the spinal cord affected the left leg with a paresis many neuros and physiotherapists said that I was to "get more light "in physical activity and I probably would not go back to working out. Even I always taking care me the "train" of MS dragged me somehow, and I had to try to regain control of my life and of my own health. I stuck it in my head that I would go back to bodybuilding gym as soon as possible and four months later I was working out again. And I can say that the physical exercises that have helped me before, have been instrumental in my recovery.

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  6. There is limited physical access to sports for anyone with physical or sensory disabilities and virtually no appetite / local government finance available to improve the situation. Publicly funded leisure facilities are STILL being built that do not enable disabled people to take part in sport or exercise.

    I belong to, and have recently become a trustee of, a disabled multi-sports charity. We have a weekly two hour swimming session at the local leisure centre and had to raise funds for a hoist, a metal stair case with handrails and other equipment (plus recruit lots of volunteer helpers and lifeguards) to enable disabled residents to use their local pool.

    Our local athletics track is billed as accessible because the clubhouse has a disabled toilet. However wheelchair users can't actually use the track.

    To access any of the three local authority and four private gyms in our town you have to be able to use stairs.

    Of course I wish I had a much higher level of fitness ahead of my MS diagnosis as I may be less affected now by MS and able to participate in mainstream exercise. I suspect a lot of MSers are like me and still want to take exercise but struggle to find a way to participate because of barriers to access.

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  7. Unfortunately, I laughed at this entry. "Again this makes sense and suggests that we really need to proactively manage stress and do something to activate MSers to remove barriers that prevent them taking responsibility for their health. I see the latter play out in my clinic week after week; my patients who take responsibility for their disease and are proactive about their disease do better when compared to my patients who are passive recipients of our advice, remaining in denial about their disease or are perpetually worried about the future." Are all your patients who are proactive about their disease exercising like there is no tomorrow (is that what you mean by proactive?). Does exercising = "taking responsibility" for the disease? Benefits of exercise are numerous and well established, in healthy people as well as people with MS. We should all eat less fat, less salt and less sugar, more greens and fruit and move more. Can we move away from suggesting exercise = "taking responsibility" for the disease (and by implication that those who don't exercise don't take responsibility for their disease?). Exercise for MS.... there is a new slogan for fundraising.

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  8. Thanks a lot for this blog entry. I've been diagnosed 15 years ago and became a yoga instructor as i realised how important it was for me to stay active. I meet many persons with MS who like the idea of being active but lack the motivation. Having a neurologist stating clearly that exercice should be classified as a disease-modifying treatment for MS is fantastic. You made my day!!!!

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  9. Agree with LisaJH - accessing facilities for people with some form of disability is a barrier to people doing useful exercise. As well as physical barriers, not being able to afford eg a gym membership is another potential barrier. How wonderful/sensible if the government would help with this aspect, as well as exhorting people to do more exercise. Removing barriers is surely the way to go?
    Thanks for posting.

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