Multiple sclerosis (MS) has a negative impact on health-related quality of life and leads to a general decrease in function, participation and productivity at work.
Treatment strategies for MS include pharmacological and non-pharmacological interventions, the latter of which have become increasingly important. What a person does in their daily lives, the level of stimulation they engage in, the psychosocial environment in which they move, the quality of their leisure time, have an impact on their health and well-being and on the control of the disease itself. Here, borrowed from science, relevant and interconnected concepts such as the hypothesis come into play. use it or lose it, cognitive reserve and neuroplasticity. the hypothesis use it or lose it (“use it or lose it”), has traditionally been used in the field of aging and believes that active participation in intellectual, social and motor activities has a protective effect on the decline of various systems and capacities. The idea of cognitive reserve has to do with the brain’s ability to respond and adapt to the damage it suffers from, minimizing the manifestation of clinical symptoms associated with neurodegenerative processes. In turn, neuroplasticity is a biological mechanism that relates to the brain’s ability to change functionally and structurally in response to external (eg, physical or cognitive training) or internal (eg, brain damage) events. A brain that does not settle down and is challenged (brug go or lose it), adjusts its structure and function (neuroplasticity) and becomes better able to mobilize resources to deal with adversity (cognitive reserve).
The importance of these concepts in the approach to MS has gained considerable ground in recent years, and scientific research has given a good push in this direction. There is evidence that the level of cognitive reserve has a mediating effect on the relationship between biological markers of MS (eg brain damage and brain atrophy) and the level of influence of cognitive domains, such as verbal fluency and cognitive flexibility. In other words, in people with greater cognitive reserve, the decline in some areas of cognitive function is felt only in more advanced stages of the disease (characterized by greater neurological damage). Now a greater cognitive, but also functional and affective reserve and a greater capacity for resilience and for dealing with the disease depends to a large extent on what the individual chooses in their daily lives. Social life, characteristics of working life, new learning, regular exercise, meditation practice are some examples of modifiable factors that contribute to greater or lesser success in the individual approach to the disease. In this sense, and similar to what happens in other clinical groups, the design of intervention programs with multimodal characteristics that promote the development of different dimensions of the person’s global function is promising. These programs may include physical activities focusing on functional physical fitness (eg aerobics, strength and balance activities), but also cognitive training (eg dual-task) and body-mind activities (eg relaxation and breathing) that helps with the development of body awareness and emotional self-regulation.
Ultimately, and in summary, the way people live with MS has a major impact on controlling the disease and quality of life. It is not only what happens to each person that dictates the course of life, but it is also how each person handles what happens to them; In the case of MS, as in other neurodegenerative diseases, it is important to adopt an active lifestyle from a physical, cognitive and social point of view.
An article by José Marmeleira, from the Department of Sport and Health, School of Health and Human Development, University of Évora. Collaborates with SPEM in the project “EM Movimento”, whose main purpose is to promote physical activity in people with multiple sclerosis.