Multiple sclerosis, or MS, is a demylenating disease affecting the central nervous system. The loss of myelin, or fatty material that insulates nerves, eventually leads to rapid, spastic and uncoordinated movements. The Centers for Disease Control and Prevention estimates that nearly 1 million people worldwide have MS. The effects can range from minimal to severe disability. Because the disease presents so differently, there is not one particular exercise protocol for patients with MS. Instead, research has supported the benefits of exercise in patients with MS. Organizations, such as the American College of Sports Medicine, have taken the research and developed general exercise guidelines.
Exercise Benefits
In addition to preventing complications from inactivity, long-term exercise participation has many benefits in managing the symptoms of MS. One of the first studies, published in "Current Opinions in Neurology," examining the benefits of exercise for patients with MS came out of the University of Utah in 1996. Researchers found that MS patients who regularly exercised had better cardiovascular fitness, improved muscular strength, improved bladder and bowel function, and less fatigue and depression. Exercise reduces the incidence of cardiovascular disease, improves bone density and leads to a more positive sense of well-being. A 2010 study conducted at Ohio State University, published in "Brain Research Journal," showed that people with MS who are physically fit have better brain function than their less-fit counterparts.
Cardiovascular Exercise
When prescribing cardiovascular exercise, the American College of Sports Medicine recommends walking, jogging and aerobics for those with MS when strength and coordination are not affected. Stationary bicycles may be more practical during periods of exacerbation or when balance is impaired. Because some individuals with MS suffer from heat intolerance, it may be beneficial to incorporate swimming as a mode of cardiovascular training. The goal of cardiovascular exercise should be to improve cardiovascular function slowly over a period of four to six months. Ideally, MS patients should actively engage in cardiovascular training three times per week, for a duration of 30 minutes each time. Because MS can lead to the dysfunction of the autonomic nervous system, you may not see the typical rise in heart rate and blood pressure with cardiovascular exercise. You may have to rely more on your own perception of fatigue to determine how to progress through cardiovascular workouts.
Strength Training
Strength training may also be beneficial in increasing the functional capacity of patients with MS. Modes can include weight machines, resistance bands, free weights and pulley machines. ACSM recommends strength training on non-cardiovascular training days to preserve energy. Additionally, strength training the same muscle groups should never be performed on consecutive days. If your MS patient is currently experiencing any upper-body sensory deficits, avoid using free weights for fear that she drop them and incur injury.
Flexibility
MS patients typically experience lower extremity spasticity, which in turn limits flexibility in the hips, knees and ankle joints. Flexibility training should include exercises that focus on reducing stiffness in the hip flexor muscles, hamstrings and calves. They can be performed before each cardiovascular and strength training session to increase and maintain range of motion. Consistent flexibility training also reduces the risk of developing contractures, or permanent shortening of the muscles, that are often affiliated with multiple sclerosis.
Additional Considerations
If you have MS and exercise, pay close attention to your energy levels on your exercise days. If you are unable to complete your other daily activities on your exercise days, you may need to cut back on the intensity or duration of your exercise program. Additionally, an occupational therapist could assist you with energy conservation techniques that allows you to do more with less physical energy throughout your day. Fitness professionals should also be conscious of selecting appropriate activities when balance is affected, or when there is sensory loss. Exercise in an environment that is cool to limit heat intolerance. When spasms or tremors are present, the use of straps to keep extremities on exercise equipment may be beneficial. Remember that every day is different with an MS patient. Your program should change as your disease changes.
References
- Centers for Disease Control and Prevention: The Prevalence of MS in 3 U.S. Communities
- Ohio State University: Exercise Helps Protect Brain of Multiple Sclerosis Patients
- NCPAD: Disability/Condition: Multiple Sclerosis and Exercise
- National MS Society: Exercise
- "ACSMs Exercise Management for Persons with Chronic Diseases and Disabilities," 3rd edition; Human Kinetics, 2009
- ScienceDaily: Exercise Helps Protect Brain of Multiple Sclerosis Patients, Study Suggests
