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Flashcards in Overweakness and Fatigue Deck (18):

Describe Buchner's curve and it's relevance

- Buchner's curve relates function - walking speed (y axis) to strength (x-axis)
- slope looks like a cliff edge
- past a certain threshold of strength, further increases in strength yield no increases in function
- but BELOW that threshold, drops in strength - even small ones - can result in precipitous drops in function
- this can mean the difference between walking VERY slowly - losing strength and not being able to walk at all


Define overwork weakness

PROLONGED reduction in strength and endurance due to EXCESSIVE activity especially ECCENTRIC activity


What are symptoms of overwork weakness?

2. Temporary reduction in max force


Do strengthening execises cause overwork weakness?

NO - unless high intensity performed 4x/week - this is based on Kilmer's study that increased subjects from 3 to 4x/week
- might be due to less recovery between sessions


What effect do strengthening exercises have on activity and strength?

- improves activity
- effect on strength is inconclusive


How to strengthen without causing overwork weakness?

- no more than 3x/week
- change only 1 training parameter at a time
- monitor for fatigue/exertion/mm soreness
- start SLOW - mod intensity


Define fatigue (in MS)

- a subjective lack of physical + mental energy perceived by the individual or caregiver to interfere with activities of daily living


Characteristics of fatigue in MS

- may be physical/mental
- worse in PM
- agg by heat, depression, pain, excessive exertion
- interferes with physical/social function


Causes of fatigue in MS

- depression
- sleep
- pain
- bladder dysfunction


What are 1º causes of fatigue in MS?

- demyelination
- cortical reorganization

- higher levels of immune markers?


What are 2º causes of fatigue in MS?

- reduced PA causing reduced strength and cardiorespiratory fitness
- heat (0.5º C rise in body temp = heat fatigue)
- anti spasticity meds (reduces force generation of mm's)
- low sense of control or environment mastery (?)


How is fatigue managed? (list 2 basic ways)

1. Acknowledge it as a genuine symptom d/t nervous system damage resulting from the disease
- medications - amantadine (anti viral agent) benefits people with MILD fatigue but has a few SEs (dizziness, nausea, dry mouth, constipation,loss of balance)
- emotional support

2. Multidisciplinary approach (OT/physio/dietician/psychologist/social worker/pain+sleep clinic etc)


How does the following help to manage fatigue?
- diet
- psychologist
- OT

Diet - low fat/low chol diet = reduction in fatigue impact

Psychologist - mindfullness based training "non-judgemental awareness of experiences" = reduction in fatigue impact and reduces depression and increases QoL

OT - energy conservation course (2hrs/week for 6 wks) = increased self efficacy and reduces fatigue impact


How can physiotherapy help with fatigue?

FITNESS! - address 2º causes of fatigue and increase strength, PA levels, and fitness


What is the effect of exercise on fatigue? On fitness?

Heine et al (2015) (Cochrane SR) - favors exercise training group for reducing fatigue in MS

No evidence that one exercise protocol is superior to another to pick based on patient preference

Platta et al (2016) - exercise improves fitness


Examples of aerobic training protocols

Ahmadi et al(2013):
- treadmill training
- 8 wks, 3x/week for 30mins
- 40-75% MHR
- 20 mins stretch

Skerbjaek et al (2014)
- arm ergo
- 10 wks, 5 min warmup, 6x3min intervals (65-75% VO2)

Petajan et al (1996)
- arm/leg cycle ergo
- 15 wks, 3x/week, 5 min warmup, 30 mins @ 60% VO2, 5 min cool down, 5-10 mins stretchin


Can telephone counselling/telehealth help with fatigue?

Turner et al (2016)
- motivational interviewing - 1x/week for 6 wks 60-90min sessions
- tracked PA, phone calls for problem solving + counselling
- REDUCED fatigue and depression, INCREASED self reported PA


What are some exercise guidelines for the management of fatigue?

C - clothing (loose and breathable)
H - hydration
A - aquatic physio 25-30ºC
T - time of day (not in the evenings since more likely to be tired)*
T - temperature (not in hot part of day)*
I - intensity (start light intenisty and progress)

* to address heat - try pre-exercise cooling? 30mins LL immersion in 16-17º water - reduces RPE during and fatigue post exercise