TMS – By Rachael Mears Over 2.3 million people are affected by multiple sclerosis (MS) through- out the world. In the United States, only estimates can be made regarding the prevalence of MS since the CDC does not require new cases to be reported and the symptoms of MS can be undetectable (National Multiple Sclerosis Society). Those affected by MS experience a variety of symptoms that greatly interfere with activities of daily living. Aquatic intervention for individuals with MS has been shown to improve overall quality of life. Engaging in well-designed aquatic programs, such as Ai-Chi, offers invaluable positive outcomes. Multiple sclerosis is thought to be an immune-mediated, chronic disease in which the body attacks the myelin sheath of the central nervous system. Symptoms can include poor coordina- tion and balance, fatigue, respiratory weakness, and tremors, among oth- ers. Onset is usually between ages 20 and 50 and women develop MS more often than men. There is thought to be a genetic link, but environmental fac- tors such as smoking and low vitamin D may also lead to an increased risk of being diagnosed with MS. Treatments include drugs to manage symptoms and physical therapy to improve activ- ities of daily living (ADLs) and reduce fatigue (National Multiple Sclerosis Society; Rubin 2013). Patients living with MS experience extreme fatigue making ADLs such as walking, climbing stairs, sitting for a prolonged amount of time, or reach- ing for high objects, increasingly harder. Exercise is one way to help reduce symptoms, however, it can be difficult to get someone experiencing this level of fatigue and discomfort to exercise on a regular basis. This is where the aquatic environment comes in. The water provides a fun, soothing atmosphere that eases joint pain and provides many positive benefits. The aquatic environment offers unique considerations, including buoyancy, hydrostatic pressure, viscosity, and a thermodynamic aspect. The buoy- ancy of the water unloads the joints from the pressure of the body weight and makes movements easier to per- form. More movements become pain- free and exercise can be performed without expending as much energy. Immersion up to the xiphoid pro- cess provides a 60% offload of body weight in the pool. Hydrostatic pres- sure compresses the body evenly and makes the body less sensitive to pain. This allows the body to work through a wider range of motion and exercise for a longer period of time. The vis- cosity of the water provides resistance in all directions allowing exercises to have muscle balance and ensure that work is being performed at all times. The thermodynamic aspect of the water can help regulate body temperatures during exercise, a very important factor when dealing with MS. A cool temperature pool can decrease heat sensitivity and allow for more vigorous exercise. A study by Gehlsen showed an increase in muscular strength, work performance, and a decrease in fatigue 2015). Aquatic exercise programs of substantial time periods, typically 10 weeks, have shown numerous pos- itive affects for the MS population. Decreases in fatigue and increases in work in the lower extremities and increases in power in total work val- ues in the upper extremities are just a few benefits (Gehlsen et.al. 1984). Ai Chi is a water-based program that involves strengthening and relax- ation techniques shown to benefit nearly all populations. It involves arm movements paired with controlled breathing in a smoothly transitioning progression that provides relaxation, strengthening of respiratory muscles, and overall strengthening. For indi- viduals with MS, this technique has been shown to improve static standing balance, functional mobility, upper extremity strength, lower extremity strength, and fatigue levels (Bayraktar et.al. 2013). after a 10-week swimming and calisthenics protocol in MS patients. Another study by Marandi showed an increase in dynamic bal- ance after 12 weeks of aquatic exer- cise in MS patients (Frohman et.al. Incorporating a sense of community and belonging, along with making the exercise environment safe and fun, represent important aspects of program design for the MS popula- tion. A sense of belonging will keep participants engaged and more likely to return to class time and time again. A sense of community and the chance to socialize can help participants improve quality of life. In addition to this, aquatic fitness professionals should ensure that all participants feel safe by explaining equipment, pool procedures, and water safety to all new participants, and reiterate before each class. A final thought when designing a workout is to keep it fun and inter- December 2017 / January 2018 | Akwa | 15 he Benefits of Aquatic Exercise
