Responding to Multiple Sclerosis-The PACE Model Part 3-Movement and the Stress Response
Olenik, Lisa, Palaestra
At the beginning of this series, the Physical Activity, Creativity, and Evaluation (PACE) model was used to frame parameters by which someone with multiple sclerosis (MS) could navigate a physical and health culture based on able-bodied scripts of what it means to move competently and create opportunities for exercise. In other words, medical evidence and exercise physiology advice were shared to assist someone with this disease in capturing the benefits of an active lifestyle, while preventing the secondary disabling conditions that come with being inactive. In the first two articles (PALAESTRA, 21(3), 26-29; 60; PALAESTRA, 21(4), 28-35; 43) the focus was on the nature of the disease itself, treatment protocols, benefits of exercise, physical activity options, and contraindications. This article focuses on the stress response and aspects of initiating, sustaining, and then ammending physical activity patterns as the disease changes and progresses.
I began writing this article from my hospital bed while undergoing my eighth Solumederol (steroid) IV treatment. After living well for much of the past 10 years with MS, I was struck once again by the lack of control experienced, not just when losing sight, falling, or running into walls, but the lack of control felt in a hospital environment. Although I had been through this ritual before, I was immediately quieted and constrained by the surroundings. Typically, the medical environment is viewed as a rehabilitative environment, but it was not until I was being interviewed by the in-take nurse that I realized the extent to which health practitioners are focused on re-establishing some semblance of normalcy. They endeavored to counter the awkwardness, fear, sadness, and anger I was feeling about the way I was or was not moving. The most important question I was asked by the nurse practitioner was whether or not I had any coping strategies. I responded with an affirmative answer; however, it took me two or three days before I could admit to myself that my coping strategies needed to be re-examined and re-evaluated in order to respond better to my current exacerbation. I needed to think once more about the level at which I could be physically active, the way I wished to engage the physical environment, my need to be creative in the decisions I make, and the daily and sometimes hourly evaluation of my body's needs. I needed to PACE myself once again--all over again.
Unpredictable Nature of Multiple Sclerosis and Associated Stress
As reported in the first and second articles in this series, MS is an unpredictable inflammatory autoimmune disorder of the central nervous system. According to Compston and Coles (2002), the disorder is of unidentifiable origin, but the clinical course of the disease is often characterized by episodes of exacerbation and recovery and episodes leaving persistent deficits. These authors point out there is no evidence trauma causes MS, triggers latent disease in someone who has the underlying disease process, or alters the course in individuals who have already experienced symptoms. They do state in the same article, however, that "people with MS cope less well with symptoms while exposed to stress, but psychological factors do not directly affect disease activity." (Compston & Coles, p. 1224)
In 2005, Brown, Tennant, Dunn, and Pollard reviewed results of research discussing the stress-relapse interaction in MS. They noted that the nature and strength of interrelationships between life stress and disease activity are complex; however, they concluded that the impact stress may have on disease activity is likely to depend on factors such as stressor frequency, severity and type, and individual characteristics such as depression, health locus of control, and coping strategies in use. In 2001, Mohr and Cox published a review of empirical literature related to the psychological response to multiple sclerosis and particularly studies completed at that point on chronic and acute stress. …