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Cardiovascular dysfunction in MS-Practice
3.1 Incidence and impact
Cardiovascular dysfunction will affect 10–50% of
people with MS. The pattern of pathological findings
is highly heterogeneous, suggesting a predominantly
sympathetic involvement in some patients, and a
predominantly parasympathetic pathology in others.5
These impairments may be related to the number of
lesions within the mid-brain.10 The overall impact of
cardiovascular dysfunction in MS is unknown; it may
affect the safety of exercise participation.
3.2 Clinical characteristics
Cardiovascular dysfunction in people with MS may
involve reduced heart rate response11,12 and blood
pressure response to stimuli such as exercise and
stress.13 Self-reported symptoms may include postural
hypotension, dizziness, and light headedness which
can impact on the person’s ability to maintain balance,
or move around their environment.
3.3 Assessment and management
People with MS should be assessed for their response
to exercise prior to prescribing cardiovascular exercise.
This involves taking regular heart rate and blood
pressure measurements. If these measures show a
blunted response to exercise, alternative measures
such as Borg Rate of Perceived Exertion scale should
be used to monitor training exercise intensity. People
with a history of falling should also be screened for
orthostatic intolerance.5 People with MS who have any
cardiovascular risk factors should undertake formal
cardiovascular fitness testing prior to engaging in
stressful cardiovascular physical activities. For further
information refer to the Strength and cardiovascular
exercise for people with multiple sclerosis handout.
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