Research Article| Volume 319, ISSUE 1-2, P42-46, August 15, 2012

The effects of heat stress on physical functioning in persons with multiple sclerosis


      Heat sensitivity is a well-recognised feature in multiple sclerosis (MS). However, little is known about how heat affects physical performance in persons with MS. The objective of the study was to evaluate the effects of short-term heat stress on physical functioning in persons with MS. Twenty-three heat-sensitive MS subjects and 19 healthy controls participated. Moderate heat exposure took place in a dry Finnish sauna. Measures of upper and lower extremity function, static and dynamic balance, and walking capacity were applied. Core body temperature was measured by a telemetric physiological monitoring system. Assessments were conducted before, immediately, 1 hour, and 1 day after the heat exposure. Subjects with MS showed a significantly (P=0.002) higher core body temperature than the controls following the heat stress. Performances in walking (P<0.001), chair rise (P=0.005) and functional reach (P=0.04) were poorer in MS subjects than in controls immediately after the heat. No prolonged heat effects were observed. An increase in ambient temperature causes a higher core body temperature rise in MS subjects than in healthy controls. This rise in temperature is associated with acute, but not prolonged detrimental effects on physical functioning.


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        • Flensner G.
        • Ek A.-C.
        • Söderhamn O.
        • Landtblom A.-M.
        Sensitivity to heat in MS patients: a factor strongly influencing symptomology—an explorative survey.
        BMC Neurol. 2011; 11: 27
        • Petrilli S.
        • Durufle A.
        • Nicolas B.
        • et al.
        Influence of temperature changes on clinical symptoms in multiple sclerosis: an epidemiologic study.
        Ann Readapt Med Phys. 2004; 47: 204-208
        • Nilsagård Y.
        • Denison E.
        • Gunnarsson L.-G.
        • Boström K.
        Factors perceived as being related to accidental falls by persons with multiple sclerosis.
        Disabil Rehabil. 2009; 31: 1301-1310
        • Freal J.E.
        • Kraft G.H.
        • Coryell J.K.
        Symptomatic fatigue in multiple sclerosis.
        Arch Phys Med Rehabil. 1984; 65: 135-138
        • Bergamaschi R.
        • Romani A.
        • Versino M.
        • Poli R.
        • Cosi V.
        Clinical aspects of fatigue in multiple sclerosis.
        Funct Neurol. 1997; 12: 247-251
        • Stewart T.M.
        • Tran Z.V.
        • Bowling A.
        Factors related to fatigue in multiple sclerosis.
        Int J MS Care. 2007; 9: 29-34
        • Flensner G.
        • Ek A.C.
        • Söderhamn O.
        Lived experience of MS-related fatigue—a phenomenological interview study.
        Int J Nurs Studies. 2003; 40: 707-717
        • Bol Y.
        • Smolders J.
        • Duits A.
        • Lange I.M.J.
        • Romberg-Camps M.
        • Hupperts R.
        Fatigue and heat sensitivity in patients with multiple sclerosis.
        Acta Neurol Scand. Mar 8 2012;
        • Guthrie T.C.
        • Nelson D.A.
        Influence of temperature changes on multiple sclerosis: a critical review of mechanisms and research potential.
        J Neurol Sci. 1995; 129: 1-8
        • Syndulko K.
        • Jafari M.
        • Woldanski A.
        • Baumhefner R.W.
        • Tourtellotte W.W.
        Effects of temperature in multiple sclerosis: a review of the literature.
        J Neurol Rehabil. 1996; 10: 23-34
        • Davis S.L.
        • Frohman T.C.
        • Crandall C.G.
        • et al.
        Modeling Uhthoff's phenomenon in MS patients with internuclear ophthalmoparesis.
        Neurology. 2008; 70: 1098-1106
        • Malhotra A.S.
        • Goren H.
        The hot bath test in the diagnosis of multiple sclerosis.
        JAMA. 1981; 246: 1113-1114
        • Saari A.
        • Tolonen U.
        • Pääkkö E.
        • et al.
        Sweating impairment in patients with multiple sclerosis.
        Acta Neurol Scand. 2009; 120: 358-363
        • Keast M.L.
        • Adamo K.B.
        The Finnish sauna bath and its use in patients with cardiovascular disease.
        J Cardpulm Rehabil. 2000; 20: 225-230
        • Kukkonen-Harjula K.
        • Kauppinen K.
        Health effects and risks of sauna bathing.
        Int J Circumpolar Health. 2006; 65: 195-205
        • Vähä-Eskeli K.
        • Erkkola R.
        The effect of short-term heat stress on uterine contractility, fetal heart rate and fetal movements at late pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 1990; 39: 9-14
        • Tataru N.
        • Vidal C.
        • Decavel P.
        • Berger E.
        • Rumbach L.
        Limited impact of the summer heat wave in France (2003) on hospital admissions and relapses for multiple sclerosis.
        Neuroepidemiology. 2006; 27: 28-32
        • Ku Y.E.
        • Montgomery L.D.
        • Lee H.C.
        • Luna B.
        • Webbon B.W.
        Physiologic and functional responses of MS patients to body cooling.
        Am J Phys Med Rehabil. 2000; 79: 427-434
        • NASA/MS Cooling Study group
        A randomized controlled study of the acute and chronic effects of cooling therapy for MS.
        Neurology. 2003; 60: 1955-1960
        • Meyer-Heim A.
        • Rothmaier M.
        • Weder M.
        • Kool J.
        • Schenk P.
        • Kesselring J.
        Advanced lightweight cooling-garment technology: functional improvements in thermosensitive patients with multiple sclerosis.
        Mult Scler. 2007; 13: 232-237
        • Hämäläinen P.
        • Ikonen A.
        • Romberg A.
        • Helenius H.
        • Ruutiainen J.
        The effects of heat stress on cognition in persons with multiple sclerosis.
        Mult Scler. 2012; 18: 489-497
        • Polman C.H.
        • Reingold S.C.
        • Edan G.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”.
        Ann Neurol. 2005; 58: 840-846
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Rudick R.A.
        • Cutter G.
        • Reingold S.
        The Multiple Sclerosis Functional Composite: a new clinical outcome measure for multiple sclerosis trials.
        Mult Scler. 2002; 8: 359-365
        • Paltamaa J.
        • West H.
        • Sarasoja T.
        • Wikström J.
        • Mälkiä E.
        Reliability of physical functioning measures in ambulatory subjects with MS.
        Physiother Res Int. 2005; 10: 93-109
        • Whitney S.L.
        • Wrisley D.M.
        • Marchetti G.F.
        • Gee M.A.
        • Redfern M.S.
        • Furman J.M.
        Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test.
        Phys Ther. 2005; 85: 1034-1045
        • Mong Y.
        • Teo T.W.
        • Ng S.S.
        5-Repetition Sit-to-Stand test in subjects with chronic stroke: reliability and validity.
        Arch Phys Med Rehabil. 2010; 91: 407-413
        • Meretta B.M.
        • Whitney S.L.
        • Marchetti G.F.
        • Sparto P.J.
        • Muirhead R.J.
        The five times sit to stand test: responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation.
        J Vestib Res. 2006; 16: 233-243
        • Frzovic D.
        • Morris M.E.
        • Vowels L.
        Clinical tests of standing balance: performance of persons with multiple sclerosis.
        Arch Phys Med Rehabil. 2000; 81: 215-221
        • Iverson B.D.
        • Gossman M.R.
        • Shaddeau S.A.
        • Turner Jr., M.E.
        Balance performance, force production, and activity levels in noninstitutionalized men 60 to 90 years of age.
        Phys Ther. 1990; 70: 348-355
        • Duncan P.W.
        • Weiner D.K.
        • Chandler J.
        • Studenski S.
        Functional Reach: a new clinical measure of balance.
        J Gerontol. 1990; 45: M192-M197
        • McKenzie J.E.
        • Osgood D.W.
        Validation of a new telemetric core temperature monitor.
        J Therm Biol. 2004; 29: 605-611
        • Paltamaa J.
        • Sarasoja T.
        • Wikström J.
        • Mälkiä E.
        Physical functioning in multiple sclerosis: a population-based study in Central Finland.
        J Rehabil Med. 2006; 38: 339-345
        • Baker D.G.
        Multiple sclerosis and thermoregulatory dysfunction.
        J Appl Physiol. 2002; 92: 1779-1780
        • Saboisky J.
        • Marino F.E.
        • Kay D.
        • Cannon J.
        Exercise heat stress does not reduce central activation to non-exercised human skeletal muscle.
        Exp Physiol. 2003; 88: 783-790
        • Vetrugno R.
        • Liguori R.
        • Cortelli P.
        • Montagna P.
        Sympathetic skin response: basic mechanisms and clinical applications.
        Clin Auton Res. 2003; 13: 256-270
        • Davis S.L.
        • Wilson T.E.
        • White A.T.
        • Frohman E.M.
        Thermoregulation in multiple sclerosis.
        J Appl Physiol. 2010; 109: 1531-1537
        • Kage H.
        • Okuda M.
        • Nakamura I.
        • Kunitsugu I.
        • Sugiyama S.
        • Hobara T.
        Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach.
        Arch Phys Med Rehabil. 2009; 90: 2103-2107
        • Solari A.
        • Radice D.
        • Manneschi L.
        • Motti L.
        • Montanari E.
        The multiple sclerosis functional composite: different practice effects in the three test components.
        J Neurol Sci. 2005; 228: 71-74