Brief Review: Premature skeletal muscle fatigue in multiple sclerosis and its implications for exercise therapy
Elizabeth Harper
Department of Health Studies, Program in Therapeutic Recreation,
New York University, NY, 10003, USA;
Submitted 19 March 2008; first decision 9 April 2008; revised 21 May 2008; revision accepted 19 Jun 2008; published 4 Jul 2008
Abstract:
This paper reviews work on skeletal muscle fatigue as it relates to multiple sclerosis. Accumulation of products of metabolism contribute significantly to the onset of fatigue in normal healthy muscles whereas the primary cause of muscle fatigue in multiple sclerosis is due to impairment of central nervous system activation of motor units followed by changes in muscle metabolism due to progressive disuse. As performing repetitive gross motor activity of the limbs becomes increasingly difficult, the MS individual becomes vulnerable to a host of secondary health concerns including weak respiratory muscles. Pranayam is a type of yogic exercise that focuses one’s attention on regulation of the breath. Many of the benefits of practicing pranayam are similar to the physiological and psychological benefits attributed to performing repetitive gross motor exercises of the limbs. Pranayam should be explored as a potential adjunctive therapeutic exercise modality in individuals with multiple sclerosis.
Content outline:
1. Introduction
1.1 Noninvasive muscle testing techniques
1.1A Electromyography
1.1B Magnetic resonance spectroscopy
2. Fatigue in healthy muscle
3. Fatigue in multiple sclerosis
3.1 Origin of fatigue in MS
3.2 Central motor drive in MS
3.3 Deconditioning in MS
3.4 Skeletal muscle fatigue vs. perceived fatigue
3.5 Exercise in the management of multiple sclerosis
3.6 Potential role of pranayam as adjunctive therapy
3.7 Summary and Research Directions
Please cite this article as Harper E. Premature skeletal muscle fatigue in multiple sclerosis and its implications for exercise therapy. Medical Physiology Online, 4 Jul 2008, available from http://www.medicalphysiologyonline.org
Some rights reserved (C) 2008, E. Harper. This is an open access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by-nc-sa/3.0/
Medical Physiology Online 
Madanmohan, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India; e-mail: drmadanmohan123 at rediffmail dot com
Referring to the recent review by E Harper [1], it may be fruitful to compare the effects of physiotherapy, slow pranayams and fast pranayams in multiple sclerosis. I guess that slow pranayams will be more valuable and they are easier to perform. The effect may be apparent in 3 weeks.
Conflict of interests: none
Reference: [1] Harper E. Premature skeletal muscle fatigue in multiple sclerosis and its implications for exercise therapy. Medical Physiology Online, 4 Jul 2008, available from http://www.medicalphysiologyonline.org
Madanmohan
July 7, 2008 at 10:00 AM