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Neurodegenerative Diseases: Integrative PPPM Approach as the Medicine of the Future pp 277–299Cite as

Exercise in Multiple Sclerosis – An Integral Component of Disease Management

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Part of the book series: Advances in Predictive, Preventive and Personalised Medicine ((APPPM,volume 2))

Abstract

Multiple sclerosis (MS) is the most common chronic inflammatory disorder of the central nervous system (CNS) in young adults. Depending on the underlying pathology, its localization and further characteristics the disease causes a wide spectrum of symptoms and disabilities. Up to date management of MS comprises both drug-based and non-drug approaches complementarily to reduce existing symptoms and to prevent sequelae, such as infections or orthopedic diseases. To improve the individual patient’s outcome substantially, it is necessary to adapt physical therapy like exercise and physiotherapy to the individual needs. However, high quality systematic data on physical therapy in MS, that support this process of customization, are rare.

This chapter summarizes the current knowledge on the influence of physical activity and exercise on disease-related symptoms and physical restrictions in MS patients. Drug-based treatment strategies, cognitive training or other treatment strategies are not in the focus of interest in this chapter.

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References

  1. Kantarci O, Wingerchuk D (2006) Epidemiology and natural history of multiple sclerosis: new insights. Curr Opin Neurol 19:248–254

    Article  PubMed  Google Scholar 

  2. Compston A, Coles A (2002) Multiple sclerosis. Lancet 359:1221–1231

    Article  PubMed  Google Scholar 

  3. Compston A, Coles A (2008) Multiple sclerosis. Lancet 372:1502–1517

    Article  PubMed  CAS  Google Scholar 

  4. Ziemssen T (2009) Multiple sclerosis beyond EDSS: depression and fatigue. J Neurol Sci 277(Suppl 1):S37–S41

    Article  PubMed  Google Scholar 

  5. Chiaravalloti N, Hillary F, Ricker J, Christodoulou C, Kalnin A, Liu W-C, Steffener J, DeLuca J (2005) Cerebral activation patterns during working memory performance in multiple sclerosis using FMRI. J Clin Exp Neuropsychol 27:33–54

    Article  PubMed  Google Scholar 

  6. Dalgas U, Stenager E, Ingemann-Hansen T (2008) Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. Mult Scler 14:35–53

    Article  PubMed  CAS  Google Scholar 

  7. White LJ, Dressendorfer RH (2004) Exercise and multiple sclerosis. Sports Med 34:1077–1100

    Article  PubMed  Google Scholar 

  8. Petajan JH, White AT (1999) Recommendations for physical activity in patients with multiple sclerosis. Sports Med 27:179–191

    Article  PubMed  CAS  Google Scholar 

  9. Motl RW, McAuley E, Snook EM, Gliottoni RC (2009) Physical activity and quality of life in multiple sclerosis: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 14:111–124

    Article  PubMed  Google Scholar 

  10. Waschbisch A, Tallner A, Pfeifer K, Mäurer M (2009) Multiple sclerosis and exercise: effects of physical activity on the immune system. Nervenarzt 80:688–692

    Article  PubMed  CAS  Google Scholar 

  11. Thompson AJ (2005) Neurorehabilitation in multiple sclerosis: foundations, facts and fiction. Curr Opin Neurol 18:267–271

    Article  PubMed  Google Scholar 

  12. Multiple Sclerosis Therapy Consensus Group (MSTCG), Wiendl H, Toyka KV, Rieckmann P, Gold R, Hartung H-P, Hohlfeld R (2008) Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol 255:1449–1463

    Article  PubMed  CAS  Google Scholar 

  13. Henze T, Rieckmann P, Toyka KV (2006) Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur Neurol 56:78–105

    Article  PubMed  CAS  Google Scholar 

  14. Kesselring J, Beer S (2005) Symptomatic therapy and neurorehabilitation in multiple sclerosis. Lancet Neurol 4:643–652

    Article  PubMed  Google Scholar 

  15. White LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, Vandenborne K (2004) Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler 10:668–674

    Article  PubMed  CAS  Google Scholar 

  16. Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A (2007) Physical training and multiple sclerosis. Ann Readapt Med Phys 50(373–376):369–372

    Article  Google Scholar 

  17. Asano M, Dawes DJ, Arafah A, Moriello C, Mayo NE (2009) What does a structured review of the effectiveness of exercise interventions for persons with multiple sclerosis tell us about the challenges of designing trials? Mult Scler 15:412–421

    Article  PubMed  CAS  Google Scholar 

  18. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C, Overgaard K, Ingemann-Hansen T (2009) Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology 73:1478–1484

    Article  PubMed  CAS  Google Scholar 

  19. Pilutti LA, Lelli DA, Paulseth JE, Crome M, Jiang S, Rathbone MP, Hicks AL (2011) Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: a pilot study. Arch Phys Med Rehabil 92:31–36

    Article  PubMed  Google Scholar 

  20. Dodd KJ, Taylor NF, Denisenko S, Prasad D (2006) A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis. Disabil Rehabil 28: 1127–1134

    Article  PubMed  CAS  Google Scholar 

  21. Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G (2005) Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev 1:CD003980

    PubMed  Google Scholar 

  22. Romberg A, Virtanen A, Ruutiainen J, Aunola S, Karppi S-L, Vaara M, Surakka J, Pohjolainen T, Seppänen A (2004) Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Neurology 63:2034–2038

    Article  PubMed  CAS  Google Scholar 

  23. Cakit BD, Nacir B, Genç H, Saraçoğlu M, Karagöz A, Erdem HR, Ergün U (2010) Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study. Am J Phys Med Rehabil 89:446–457

    Article  Google Scholar 

  24. DeBolt LS, McCubbin JA (2004) The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. Arch Phys Med Rehabil 85:290–297

    Article  PubMed  Google Scholar 

  25. Harvey L, Smith AD, Jones R (1999) The effect of weighted leg raises on quadriceps strength, EMG parameters and functional activities in people with multiple sclerosis. Physiotherapy 85:154–161

    Article  Google Scholar 

  26. Taylor NF, Dodd KJ, Prasad D, Denisenko S (2006) Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil 28:1119–1126

    Article  PubMed  CAS  Google Scholar 

  27. Rasova K, Havrdova E, Brandejsky P, Zálisová M, Foubikova B, Martinkova P (2006) Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis. Mult Scler 12:227–234

    Article  PubMed  CAS  Google Scholar 

  28. Schulz K-H, Gold SM, Witte J, Bartsch K, Lang UE, Hellweg R, Reer R, Braumann K-M, Heesen C (2004) Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis. J Neurol Sci 225:11–18

    Article  PubMed  CAS  Google Scholar 

  29. Newman MA, Dawes H, van den Berg M, Wade DT, Burridge J, Izadi H (2007) Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler 13:113–119

    Article  PubMed  CAS  Google Scholar 

  30. Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW (1996) Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 39:432–441

    Article  PubMed  CAS  Google Scholar 

  31. Mostert S, Kesselring J (2002) Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler 8:161–168

    Article  PubMed  CAS  Google Scholar 

  32. Rampello A, Franceschini M, Piepoli M, Antenucci R, Lenti G, Olivieri D, Chetta A (2007) Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized crossover controlled study. Phys Ther 87:545–555

    Article  PubMed  Google Scholar 

  33. Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Castellano V, White LJ (2005) Resistance training improves gait kinematics in persons with multiple sclerosis. Arch Phys Med Rehabil 86:1824–1829

    Article  PubMed  Google Scholar 

  34. Surakka J, Romberg A, Ruutiainen J, Aunola S, Virtanen A, Karppi S-L, Mäentaka K (2004) Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis: a randomized controlled trial. Clin Rehabil 18:737–746

    Article  PubMed  Google Scholar 

  35. Wiles CM, Newcombe RG, Fuller KJ, Shaw S, Furnival-Doran J, Pickersgill TP, Morgan A (2001) Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol Neurosurg Psychiatr 70:174–179

    Article  PubMed  CAS  Google Scholar 

  36. Lord SE, Wade DT, Halligan PW (1998) A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study. Clin Rehabil 12:477–486

    Article  PubMed  CAS  Google Scholar 

  37. Solari A, Filippini G, Gasco P, Colla L, Salmaggi A, La Mantia L, Farinotti M, Eoli M, Mendozzi L (1999) Physical rehabilitation has a positive effect on disability in multiple sclerosis patients. Neurology 52:57–62

    Article  PubMed  CAS  Google Scholar 

  38. Guthrie TC, Nelson DA (1995) Influence of temperature changes on multiple sclerosis: critical review of mechanisms and research potential. J Neurol Sci 129:1–8

    Article  PubMed  CAS  Google Scholar 

  39. White AT, Wilson TE, Davis SL, Petajan JH (2000) Effect of precooling on physical performance in multiple sclerosis. Mult Scler 6:176–180

    PubMed  CAS  Google Scholar 

  40. Rasminsky M (1973) The effects of temperature on conduction in demyelinated single nerve fibers. Arch Neurol 28:287–292

    Article  PubMed  CAS  Google Scholar 

  41. Schulz K-H, Heesen C (2005) Effects of exercise in chronically ill patients. Examples from oncology and neurology. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48:906–913

    Article  PubMed  Google Scholar 

  42. Gleeson M (2007) Immune function in sport and exercise. J Appl Physiol 103:693–699

    Article  PubMed  CAS  Google Scholar 

  43. White LJ, Castellano V (2008) Exercise and brain health–implications for multiple sclerosis: part 1–neuronal growth factors. Sports Med 38:91–100

    Article  PubMed  Google Scholar 

  44. Steensberg A, Toft AD, Bruunsgaard H, Sandmand M, Halkjaer-Kristensen J, Pedersen BK (2001) Strenuous exercise decreases the percentage of type 1 T cells in the circulation. J Appl Physiol 91:1708–1712

    PubMed  CAS  Google Scholar 

  45. Heesen C, Gold SM, Hartmann S, Mladek M, Reer R, Braumann K-M, Wiedemann K, Schulz K-H (2003) Endocrine and cytokine responses to standardized physical stress in multiple sclerosis. Brain Behav Immun 17:473–481

    Article  PubMed  CAS  Google Scholar 

  46. Lancaster GI, Halson SL, Khan Q, Drysdale P, Wallace F, Jeukendrup AE, Drayson MT, Gleeson M (2004) Effects of acute exhaustive exercise and chronic exercise training on type 1 and type 2 T lymphocytes. Exerc Immunol Rev 10:91–106

    PubMed  Google Scholar 

  47. Bennett JL, Stüve O (2009) Update on inflammation, neurodegeneration, and immunoregulation in multiple sclerosis: therapeutic implications. Clin Neuropharmacol 32:121–132

    Article  PubMed  CAS  Google Scholar 

  48. Castellano V, Patel DI, White LJ (2008) Cytokine responses to acute and chronic exercise in multiple sclerosis. J Appl Physiol 104:1697–1702

    Article  PubMed  CAS  Google Scholar 

  49. White LJ, Castellano V (2008) Exercise and brain health–implications for multiple sclerosis: part II–immune factors and stress hormones. Sports Med 38:179–186

    Article  PubMed  Google Scholar 

  50. Ozenci V, Kouwenhoven M, Link H (2002) Cytokines in multiple sclerosis: methodological aspects and pathogenic implications. Mult Scler 8:396–404

    Article  PubMed  CAS  Google Scholar 

  51. Vaynman S, Ying Z, Gomez-Pinilla F (2004) Hippocampal BDNF mediates the efficacy of exercise on synaptic plasticity and cognition. Eur J Neurosci 20:2580–2590

    Article  PubMed  Google Scholar 

  52. Fabel K, Fabel K, Tam B, Kaufer D, Baiker A, Simmons N, Kuo CJ, Palmer TD (2003) VEGF is necessary for exercise-induced adult hippocampal neurogenesis. Eur J Neurosci 18: 2803–2812

    Article  PubMed  Google Scholar 

  53. Swain RA, Harris AB, Wiener EC, Dutka MV, Morris HD, Theien BE, Konda S, Engberg K, Lauterbur PC, Greenough WT (2003) Prolonged exercise induces angiogenesis and increases cerebral blood volume in primary motor cortex of the rat. Neuroscience 117:1037–1046

    Article  PubMed  CAS  Google Scholar 

  54. Christie BR, Eadie BD, Kannangara TS, Robillard JM, Shin J, Titterness AK (2008) Exercising our brains: how physical activity impacts synaptic plasticity in the dentate gyrus. Neuromolecular Med 10:47–58

    Article  PubMed  CAS  Google Scholar 

  55. Gold SM, Schulz K-H, Hartmann S, Mladek M, Lang UE, Hellweg R, Reer R, Braumann K-M, Heesen C (2003) Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls. J Neuroimmunol 138:99–105

    Article  PubMed  CAS  Google Scholar 

  56. Griffin ÉW, Mullally S, Foley C, Warmington SA, O’Mara SM, Kelly AM (2011) Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiol Behav 104:934–941

    Article  PubMed  CAS  Google Scholar 

  57. Frystyk J (2010) Exercise and the growth hormone-insulin-like growth factor axis. Med Sci Sports Exerc 42:58–66

    PubMed  CAS  Google Scholar 

  58. Nishida Y, Matsubara T, Tobina T, Shindo M, Tokuyama K, Tanaka K, Tanaka H (2010) Effect of low-intensity aerobic exercise on insulin-like growth factor-I and insulin-like growth factor-binding proteins in healthy men. Int J Endocrinol. doi:10.1155/2010/452820

  59. Ibrahim I, Tintera J, Skoch A, Jirů F, Hlustik P, Martinkova P, Zvara K, Rasova K (2011) Fractional anisotropy and mean diffusivity in the corpus callosum of patients with multiple sclerosis: the effect of physiotherapy. Neuroradiology 53:917–926

    Google Scholar 

  60. Chard DT, Griffin CM, Parker GJM, Kapoor R, Thompson AJ, Miller DH (2002) Brain atrophy in clinically early relapsing-remitting multiple sclerosis. Brain 125:327–337

    Article  PubMed  CAS  Google Scholar 

  61. Prakash RS, Snook EM, Motl RW, Kramer AF (2010) Aerobic fitness is associated with gray matter volume and white matter integrity in multiple sclerosis. Brain Res 1341:41–51

    Article  PubMed  CAS  Google Scholar 

  62. Cifelli A, Matthews PM (2002) Cerebral plasticity in multiple sclerosis: insights from fMRI. Mult Scler 8:193–199

    Article  PubMed  CAS  Google Scholar 

  63. Rocca MA, Matthews PM, Caputo D, Ghezzi A, Falini A, Scotti G, Comi G, Filippi M (2002) Evidence for widespread movement-associated functional MRI changes in patients with PPMS. Neurology 58:866–872

    Article  PubMed  CAS  Google Scholar 

  64. Morgen K, Kadom N, Sawaki L, Tessitore A, Ohayon J, McFarland H, Frank J, Martin R, Cohen LG (2004) Training-dependent plasticity in patients with multiple sclerosis. Brain 127:2506–2517

    Article  PubMed  Google Scholar 

  65. Rocca MA, Falini A, Colombo B, Scotti G, Comi G, Filippi M (2002) Adaptive functional changes in the cerebral cortex of patients with nondisabling multiple sclerosis correlate with the extent of brain structural damage. Ann Neurol 51:330–339

    Article  PubMed  Google Scholar 

  66. Roosendaal SD, Geurts JJG, Vrenken H, Hulst HE, Cover KS, Castelijns JA, Pouwels PJW, Barkhof F (2009) Regional DTI differences in multiple sclerosis patients. NeuroImage 44:1397–1403

    Article  PubMed  CAS  Google Scholar 

  67. Coombs BD, Best A, Brown MS, Miller DE, Corboy J, Baier M, Simon JH (2004) Multiple sclerosis pathology in the normal and abnormal appearing white matter of the corpus callosum by diffusion tensor imaging. Mult Scler 10:392–397

    Article  PubMed  Google Scholar 

  68. Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, Stinissen P, Eijnde BO (2011) Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler 17:468–477

    Article  PubMed  Google Scholar 

  69. Mevellec E, Lamotte D, Cantalloube S, Amarenco G, Thoumie P (2003) Relationship between gait speed and strength parameters in multiple sclerosis. Ann Readapt Med Phys 46:85–90

    Article  PubMed  CAS  Google Scholar 

  70. Meyer T, Broocks A (2000) Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Med 30:269–279

    Article  PubMed  CAS  Google Scholar 

  71. Veauthier C, Radbruch H, Gaede G, Pfueller CF, Dörr J, Bellmann-Strobl J, Wernecke K-D, Zipp F, Paul F, Sieb JP (2011) Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study. Mult Scler 17:613–622

    Article  PubMed  CAS  Google Scholar 

  72. Veauthier C, Paul F (2012) Fatigue in multiple sclerosis: which patient should be referred to a sleep specialist? Mult Scler 18:248–249

    Article  PubMed  Google Scholar 

  73. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ (1994) The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 21:9–14

    PubMed  CAS  Google Scholar 

  74. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437

    Article  PubMed  CAS  Google Scholar 

  75. MacAllister WS, Krupp LB (2005) Multiple sclerosis-related fatigue. Phys Med Rehabil Clin N Am 16:483–502

    Article  PubMed  Google Scholar 

  76. Stroud NM, Minahan CL (2009) The impact of regular physical activity on fatigue, depression and quality of life in persons with multiple sclerosis. Health Qual Life Outcome 7:68

    Article  Google Scholar 

  77. de Sa JCC, Airas L, Bartholome E, Grigoriadis N, Mattle H, Oreja-Guevara C, O’Riordan J, Sellebjerg F, Stankoff B, Vass K, Walczak A, Wiendl H, Kieseier BC (2011) Symptomatic therapy in multiple sclerosis: a review for a multimodal approach in clinical practice. Ther Adv Neurol Disord 4:139–168

    Article  PubMed  Google Scholar 

  78. Paci M (2003) Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med 35:2–7

    Article  PubMed  Google Scholar 

  79. Goodman AD, Brown TR, Krupp LB, Schapiro RT, Schwid SR, Cohen R, Marinucci LN, Blight AR (2009) Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet 373:732–738

    Article  PubMed  CAS  Google Scholar 

  80. Goodman AD, Brown TR, Edwards KR, Krupp LB, Schapiro RT, Cohen R, Marinucci LN, Blight AR (2010) A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol 68:494–502

    Article  PubMed  CAS  Google Scholar 

  81. Cattaneo D, Jonsdottir J, Zocchi M, Regola A (2007) Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil 21:771–781

    Article  PubMed  CAS  Google Scholar 

  82. Weinges-Evers N, Brandt AU, Bock M, Pfueller CF, Dörr J, Bellmann-Strobl J, Scherer P, Urbanek C, Boers C, Ohlraun S, Zipp F, Paul F (2010) Correlation of self-assessed fatigue and alertness in multiple sclerosis. Mult Scler 16:1134–1140

    Article  PubMed  Google Scholar 

  83. Lincoln NB, Yuill F, Holmes J, Drummond AER, Constantinescu CS, Armstrong S, Phillips C (2011) Evaluation of an adjustment group for people with multiple sclerosis and low mood: a randomized controlled trial. Mult Scler 17:1250–1257

    Article  PubMed  Google Scholar 

  84. Feinstein A (2006) Mood disorders in multiple sclerosis and the effects on cognition. J Neurol Sci 245:63–66

    Article  PubMed  Google Scholar 

  85. Prakash RS, Snook EM, Erickson KI, Colcombe SJ, Voss MW, Motl RW, Kramer AF (2007) Cardiorespiratory fitness: a predictor of cortical plasticity in multiple sclerosis. NeuroImage 34:1238–1244

    Article  PubMed  Google Scholar 

  86. van den Berg M, Dawes H, Wade DT, Newman M, Burridge J, Izadi H, Sackley CM (2006) Treadmill training for individuals with multiple sclerosis: a pilot randomised trial. J Neurol Neurosurg Psychiatr 77(4):531–533

    Article  Google Scholar 

  87. Smith RM, Adeney-Steel M, Fulcher G, Longley WA (2006) Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil 87(5):723–727

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors report no conflicts of interest. This work was supported by the DFG (Exc 257).

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Authors and Affiliations

  1. NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Andrea Döring, Caspar F. Pfueller, Friedemann Paul & Jan Dörr

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  1. Andrea Döring
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Correspondence to Andrea Döring .

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  1. , Molecular Pharmacology, Technion, Institute of Technology, Efron, Haifa, 31096, Israel

    Silvia Mandel

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Döring, A., Pfueller, C.F., Paul, F., Dörr, J. (2013). Exercise in Multiple Sclerosis – An Integral Component of Disease Management. In: Mandel, S. (eds) Neurodegenerative Diseases: Integrative PPPM Approach as the Medicine of the Future. Advances in Predictive, Preventive and Personalised Medicine, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5866-7_12

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