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Exercise: A Must for Both MS Patients to Partake In and Healthcare Providers to Promote

Exercise is an essential component of the Multiple Sclerosis patient’s treatment plan. Unfortunately, until the 1990s, exercise was highly regarded as contraindicated to MS patients. In 1993, the first medicine was approved by the FDA for MS and in 1996; the first research showing the benefits of exercise was published by the University of Utah. These were two major breakthroughs which have given hope to a population consisting of the most common disabling neurological disease of young adults (most common onset between ages 20 and 50).

Multiple Sclerosis is a neuroinflammatory autoimmune disease of the central nervous system (CNS), consisting of the brain, spinal cord and optic nerve.  The immune system attacks the myelin sheath of the nerves which insulates, protects as well as affects the signal speed from the CNS to the affected body part. Presentation of initial symptom of MS include optic nerve inflammation, poor balance (ataxia), dizziness (vertigo), weakness, double vision (diplopia), bladder/bowel dysfunction, pain, sensory loss, cognitive impairment, fatigue (most common) and a host of others including but not limited to gait impairment, depression,  tremors, thermoregulatory dysfunction (autonomic) and spasticity. Because many symptoms are invisible (not outwardly visible), most notably fatigue, pain and cognitive impairment, they can affect confidence, relationships, and discourage patients from seeking treatment or help.

Currently, with more than 16 FDA approved disease modifying treatments, as well as exercise being greatly encouraged by health care providers treating MS, the face of MS is changing for the better. While exercise will not change the course of the disease progression, both aerobic and anaerobic conditioning have greatly helped reduce secondary and tertiary symptoms such as falls, injuries, anxiety/depression, impaired activities of daily living (secondary) and increase self-esteem, and independence while reducing social isolation and family disruption (tertiary).

The benefits of a safe, progressive/adaptive exercise program are improved overall fitness, ability to perform activities of daily living, moods, sense of well-being, strength while decreasing spasticity, fatigue and may prevent a host of co-morbidities. Because MS patients may be less mobile and underweight/overweight, coupled with the possibility of side effects from the use of corticosteroids, it increases the likelihood of developing conditions such as osteoporosis and diabetes mellitus. This is an even a greater reason those affected with MS should work with professionals who understand the disease.

Although many patients are still hesitant to begin an exercise program because of fear of exacerbating their condition, lack of confidence or inability to find professionals skilled to work with them, now is the best time in the history of MS treatment for both patients and professionals to be on the same page. Exercise no longer has to be an activity of an MS patient’s past. It is simply a must of the present and future.

Jeffrey Segal, owner and chief operator of Balanced Personal Training, Inc., since 2004 is a personal trainer, motivational speaker and educator who has been working in the fitness industry for over 20 years. 

At the age of 25, Jeff was diagnosed with Multiple Sclerosis. He was told fitness was not going to be part of his future as an activity. Within a couple of years, Jeff was unable to walk, was visually impaired and barely able to speak.  Rather than succumb to his prognosis, he fought for the life he once knew while burying his head in research. Within a year, not only could he walk, see and speak but he used his knowledge, skills and abilities to physically train others in both sickness and in health with an emphasis on Multiple Sclerosis patients. 


Exercising & MS

If there’s anything certain about MS, it’s the uncertainty of the disease. Energy, strength and mobility can fluctuate over the years – especially if you’re living with Relapsing Remitting MS.

So it’s important, when considering an exercise plan, to have options that you can scale and honor your body.

Personally, I’ve always loved exercising. So my ability to maintain a consistent schedule is something I treasure. I start my mornings either at CrossFit or going for a run.

This is what works for me now.

Shortly before I was diagnosed my “workouts” looked drastically different.

The fatigue was so extreme, the most movement I could do was a child’s pose on the floor next to be bed. Slowly I worked my way to walking around the neighborhood and eventually as I went into remission I developed the stamina to strength train.

The most important thing to know when developing an MS-friendly exercise plan is to always honor what your body can do in the given moment.

Sometimes that means giving yourself a pep-talk to take a stroll around the block even though you’re feeling a little down. Other times, you may need to scale back your efforts as anyone with MS knows, the fatigue is not something you “push through.”

Only you can be the true judge in striking that right balance – and it will likely be a fluid process. But keep in mind, even small efforts with diet and lifestyle can add up to create a healing environment in your body.

Need some ideas on where to start? Check out these New Exercises and Activities to Try if You Have MS

This post originally appeared on www.alenebrennan.com. Reprinted with permission.

Alene Brennan has been featured in USA Today, Philadelphia Inquirer, Huffington Post and Mind Body Green. Alene overcame debilitating migraine headaches through diet and lifestyle and is now once again using a “Less Pharm, More Table” approach is managing her diagnosis of Multiple Sclerosis. Alene holds four certifications: Nutrition Coach, Yoga Instructor, Personal Trainer and Natural Food Chef. She also completed specialized training in nutrition for autoimmune disease specifically the Wahls Protocol and the Autoimmune Protocol. Since receiving her MS diagnosis and seeing first-hand the power of using diet and lifestyle to create a healing environment in the body, she dedicated her virtual nutrition coaching practice to helping people with MS and autoimmune dieseases take back control of their health. Visit her website, alenebrennan.com.


MS and Tai Chi

It cannot be stressed enough how important it is to stay active with MS. Movement is the key, even if you are limited in doing so. Exercise has been shown to help with strength, mobility, fatigue and depression. Exercise also has can help develop a positive attitude and make you more likely to participate in group activities. These positive attributes of exercise can really help a patient overcome some of the isolating symptoms of MS.

As someone living with MS, I am always trying to find something new and interesting that may be beneficial to those of us living with the disease. In this installment, we will learn how an ancient art may provide therapeutic healing to those of us living with MS today.

Tai chi, an ancient Chinese tradition that was originally a form of self-defense, has been transformed into a form of exercise that is considered good for people of all ages and fitness levels. Tai Chi is a series of slow movements combined with deep breathing.

Tai Chi is considered to be low impact, meaning that it does not put a lot of stress on the muscles. If you have MS and have tried yoga, but struggle to hold some of the poses, then you may want to try Tai Chi. Much like adaptive yoga, adaptive Tai Chi can be done either standing or sitting.

Tai Chi is thought to have many health benefits for people living with MS, including:

• Improved strength and balance
• Increased energy and mood
• Decreased stress, anxiety and depression

To get started in Tai Chi, it is recommended that you take a class. There are videos available, but working one-on-one with an instructor will give you a great head start. Instructors can also provide safe modifications for your ability level. If you start a Tai Chi class, meet with the instructor ahead of time. Let the instructor know of any physical limitations that you may have with MS, like balance issues.

If your instructor learns your limitations, they will ensure that they teach you a routine that is safe, yet gives you the benefit of the workout. Then, over time, you may feel yourself becoming stronger and be able to take on more of a routine with less modifications.

If you have MS and have struggled in other forms of exercise, it may be time to try Tai Chi. The health benefits associated with the ancient form of low-impact movements can help you with your battle against MS, but make sure that you let your instructor know of any limitations you may have. The key to winning the battle against MS is to stay moving which is exactly what the ancient art of Tai Chi can help you achieve.

Originally printed on MS Focus Magazine. Reprinted with permission from Matt Cavallo.

Matt Cavallo, MPH is a patient experience speaker, author, and podcaster who motivates audiences worldwide with his personal patient experience and genuine storytelling style. At age twenty-eight, Matt was diagnosed with Multiple Sclerosis. Seemingly overnight he went from a fully-functioning, healthy man to someone who was numb from the waist down and unable to walk. As a result of his diagnosis, Matt has dedicated his life to improving the patient experience. Matt is the founder of PatientActivation Network

Essential oil made from medicinal cannabis

An Introduction to Cannabis’s Role as an Emerging Therapeutic Agent

With cannabis becoming increasingly mainstream in modern culture, its population is becoming aware of its use for a number of purported medical reasons ranging from skin ailments to digestive issues and pain. California has recently allowed its recreational use. Today, the industry is still nascent with a market of ill-vetted products with equally nascent scientific claims. However, cannabis may be unique in its application to holistic care as mediated by the endocannabinoid system and thus it is prudent to know what is useful and what isn’t.

The history of cannabis use is ancient and has resulted in many breeds of cannabis which differ in the phytocannabinoid content, ratio and terpene profile. Cannabinoids are molecules that act on cannabinoid receptors that comprise the endocannabinoid system. The endocannabinoid system modulates the psychological stress, emotionality and inflammation responses. CB1 and CB2 are examples of receptors within this system whose span is diverse, for example, they are found in the brain, gut and persist in osteoarthritic cartilage despite degradation grade. Interaction with these receptors can occur through phytocannabinoids; each of which has differing effects. To complicate matters, phytocannabinoids influence the effects of one another. Furthermore, the method of delivery also influences the effects; for example, ingestion allows the liver time to process phytocannabinoids into its derivatives which have their own effects.

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two well-known examples of phytocannabinoids. THC has claims to work as an analgesic, antiemetic and antispastic; although, adverse effects include paranoia, lethargy, and tachycardia. THC can also induce euphoria which may play a role in how the analgesic properties work. CBD has claims to work as an anti-inflammatory, antiepileptic and works to block the binding of THC to CB1 and CB2 receptors. The interplay that cannabinoids have on one another has led to the notion of the “entourage effect.” (The idea that cannabis plant as a whole has curative effects.) Pharmacologically speaking, only a combination of THC and CBD, in a 1:1 formulation, manufactured by G.W. Pharmaceuticals has been vetted for its medical claims.

From oils and tinctures to hash and kush, the recreational market has driven into existence a myriad of products with a myriad of claims akin to the early days of the dietary supplement market. Assuming the source comes from one that complies with the current regulation, medical cannabis falls into three categories: plant, processed and formulations. Plant products refer to cannabis products in which the cannabinoids have not been altered and removed from the cannabis plant. These products use no heat or chemicals in their preparation and include: buds, keef, hash.

Processed products apply heat or chemicals to the cannabis plant in order to remove desired terpenes and cannabinoids. Processed products include oils, tinctures, e-juice, etc. and can be assumed to contain a higher percentage of cannabinoids in natural and unnatural ratios. Formulations are processed products whose consistency in manufacturing and medical claims have been vetted by the FDA. Formulations include products like Sativex and Epidiolex. Of course, marketing practices blurs the usage of terms; therefore, it is incumbent of the self to understand the product.

Jakub Pritz, Ph.D. has been working in the cannabis industry since 2015 as a separation operator and consultant for the production of recreational cannabis oils and other cannabis-related products.  He can attest to current cannabis production methods and what the person should be aware of.  His interest is to create botanical extracts of cannabis to be delivered in differing modalities depending on the effects sought and data affirmation.  For example dosage control in inhalation for acute pain relief, transdermal applications for arthritic pain and oral methods for digestive symptoms.  Patrons should be aware of the euphoric effects of THC and the interactions cannabinoids have with one another in varying ratios.   

Prior to this, Jakub held a post-doctoral position at UCSD’s Moore’s Cancer Center where he was in charge of data management and accruing international radiation oncology centers to join the International Evaluation of Radiotherapy Technology Effectiveness in Cervical Cancer (INTERTECC).  This trial required the coordination of several centers to follow strict data collection standards, quality checking of the institution capabilities and implementation of plan protocol.  He received his Ph.D. in Applied Physics (concentration in Medical Physics) from the University of South Florida in 2011.

As an athlete, Jakub competed in the Patriot League as a swimmer, setting records along the way.  During his graduate school years at the University of South Florida, he participated in, coached and competed with their water polo club.

Disabled Man with family practicing yoga outside.

Patient Activation Network Interview with Alene Brennan

Matt Cavallo, MPH, patient advocate, author and speaker, interviews Alene Brennan, a Nutrition Coach, Yoga Instructor, Personal Trainer and Natural Food Chef.  Alene overcame debilitating migraine headaches through diet and lifestyle and is now once again using a “Less Pharm, More Table” approach is managing her diagnosis of Multiple Sclerosis.

Since receiving her MS diagnosis and seeing first-hand the power of using diet and lifestyle to create a healing environment in the body, she dedicated her virtual nutrition coaching practice to helping people with MS and autoimmune take back control of their health. She connects with clients around the world via phone and video chat to help them transition to a healing diet and lifestyle and manage the symptoms of chronic illness.

Listen to the podcast from Patient Activation Network:


Our health is truly the only thing that connects us. Whatever your age, gender or background, health is the great equalizer. The Patient Activation Network was created by patients for patients to accomplish real change in healthcare. Visit patientactivationnetwork.com for more podcasts.

Matt Cavallo, MPH is a patient experience speaker, author, and podcaster who motivates audiences worldwide with his personal patient experience and genuine storytelling style. At age twenty-eight, Matt was diagnosed with Multiple Sclerosis. Seemingly overnight he went from a fully-functioning, healthy man to someone who was numb from the waist down and unable to walk. As a result of his diagnosis, Matt has dedicated his life to improving the patient experience. Matt is the founder of PatientActivation Network


Tips for Exercising With Multiple Sclerosis

Exercise and stretching are very important for someone who has Multiple Sclerosis. Each individual, however, is different and exercises need to be tailored specifically to that person. The exercises that are chosen depend on the progression of the disease, what the individual is capable of doing, and even the day. Exercises may have to be changed if the client is too tired or is feeling stronger and has more energy.

What exactly causes Multiple Sclerosis is not known but there are symptoms to look out for. The symptoms are fatigue, walking difficulties, vision problems, spasticity or stiffness, weakness, bladder problems, depression, dizziness or vertigo, emotional changes, cognitive changes, pain, headaches, tremors and breathing problems. Exercise prescriptions need to be planned according to the symptoms that are being presented. Each time you work with your trainer talk to them about how you feel that day. This will help to ensure that you don’t overdo a workout.

Many times, we hear the saying no pain, no gain. Please keep in mind that this is not true for individuals with Multiple Sclerosis. You want the workout to feel challenging but it is important not to overheat. If you feel warm, simply take a break and continue when you feel that you have cooled down. Individuals in wheelchairs benefit from exercise as well. I would like to share an example of a client of mine.

My client, Sally, (the name has been changed) was a client of mine for 4 years. She is in a wheelchair and had no leg movement and minimal arm movement. Through exercise she is almost able to feed herself and I have her doing simple leg movements. I cannot see any leg movement but she can feel it. She reports that her muscles are sore when we are finished. The important thing is to just move.

It is important to start an exercise program slowly and to set goals. If you would like to get to 20 minutes of activity maybe start with 10. Do not assess how well you are doing by comparing yourself to others. Look for progress in yourself through reaching personal goals as in the example of my client.

As an individual with Multiple Sclerosis starts exercising they may have less depression, improved strength, better bladder and bowel function, a positive attitude and be better able to participate in social activities. Please remember that it is important to share any symptom changes with your trainer. The exercises may have to be adjusted frequently for a safe and effective workout.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.


a trainer helping a senior woman doing fitness

Exercise and Multiple Sclerosis

A study published by researchers at the University of Utah in 1996 was the first to demonstrate clearly the benefits of exercise for people with MS. Those patients who participated in an aerobic exercise program had better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities.

multiple-SclerosisMS is the most common neuromuscular disease affecting young adults. The onset of symptoms usually occurs between the ages of 20 and 40. The disease is twice as prevalent in woman as in men.

The National MS society provides the following parameterof different functional levels of people with MS:

Level 1 – Mild: People with this level of MS may be walking independently but may also walk with a cane. They may have some visual and coordination issues.

Level 2– Moderate: People with this level of MS may be dependent on a walker or a wheelchair. They may be able to transfer themselves or they may require assistance.

Level 3 – Progressive: People with this level of MS may be paralyzed primarily in the lower extremities. They will spend most of their time in a wheel chair.

Associated Impairments

Fatigue: Usually mid-afternoon after waking up feeling reasonably rested
Spasticity: Most common areas of the body to be affected are the legs and postural muscles.
Weakness: May be present all the time or only during times of acute flare-up. Pain leads to disuse and disuse leads to even greater weakness and los of functional fitness.
Tremors: These are not predictable as exhibited with Parkinson’s disease. They tend to vary widely in intensity and oscillation.
Balance, Coordination, and Gait: Often the first symptom of MS is the great mental effort it takes to perform movements that previously were automatic. They may observe foot dragging and shuffling or a foot that turns in while walking. They may exhibit shaking and jerky movements know as ataxia.
Muscle Cramps and Spasms: Flexor spasms in muscles that increase flexion of a muscle may occur.
Numbness and Tingling: Most often sensed toward the periphery of the extremities such as fingers and toes.
Heat Sensitivity: High ambient temperature and humidity can exacerbate the symptoms and lead to fatigue, loss of balance, visual changes and general worsening of symptoms.
Vision: people may experience optic neuritis in one eye where vision may be blurred for minutes. Response of the pupils to light is slowed.
Hearing: Changes in hearing are rare.
Cognition: 50% of people experience some degree of mild cognitive disfunction.
Cardiovascular Dysautonomia: Irregular function of the autonomic nervous system leads to blunted heart rate and decreased blood pressure in response to exercise.

Benefits of Physical Activity for People with MS

Research shows that the proper dose of exercise can provide people with MS with beneficial results.Loss of muscle strength resulting from the onset of neurological damage cannot be improved through exercise. However, muscle atrophy as a result of disuse can be.

Regular exercise can counteract muscle weakness, lower the risk of bone fracture, improve the efficiency of the respiratory system, increase bone density, lower stress, and contribute to a general feeling of well-being.

The benefits of regular exercise and therapeutic fitness training include:

  • Maintained optimal health and decreased incidence of secondary health problems related to disuse syndrome
  • Increased energy
  • Decreased muscle atrophy
  • Managed spasticity
  • Improved cardiovascular function and blood lipid management
  • Reduced risk factors for cardiovascular disease
  • Reduced obesity and glucose intolerance
  • Depression lessened or eliminated
  • Improved sleep
  • Enhanced self-esteem
  • Improved balance and basic motor skills
  • Activities of daily living become easier to perform

Exercise Guidelines:

  • Incorporating mild interval training is an effective method to prolong stamina, as it enables people to perform more exercises without fatiguing or overheating.
  • Activities that necessitate pointing the toes should be avoided as that position might increase spasticity in the legs.
  • When strength training, focus on areas of muscle imbalance. Coordinate the flexibility portion with strength training static flexibility movements after that focuses on increasing mobility and lengthening of tight areas (chest, calf, and hip flexors).
  • It’s important to develop strength before endurance and participating in balance activities.
  • Use eyes to follow movement of a limb. This will increase periphery input and influence adjustments in stability.
  • Emphasize proper body alignment during all activities. Poor posture hinders controlled and safe movement
  • Incorporate warm-ups before exercise
  • Exercise progressions should be gradual and based on response and tolerance
  • Minimize stress to joints. Be prepared for low impact or non-weight bearing activities if person experiences compromised balance or numbness in their lower extremities, or orthopedic problems
  • Weight bearing helps to reduce spasticity, therefore, standing exercise are recommended if possible
  • Incorporate rotational exercise patterns to break up abnormal motor patterns caused by spasticity or rigidity
  • Do not bend neck forward (cervical flexion) as this type of movement can cause Lhermitte’s sign – a brief stabbing, electric-shock-like sensation that runs from the back of the head down the spine.
  • Avoid overheatinga trainer helping a senior woman doing fitness
  • Simple movements before complex movements
  • Static moves before dynamic moves
  • Slow movements before fast movements
  • Low weigh loads before high weight loads
  • Two-arm movements (or two-leg) before single-arm(or single-leg) movements
  • Stable surfaces before unstable
  • Quality movements before quantity of movements
  • Focus on core of trunk as well as stabilizers of each joint
  • Employ proper use of open kinetic chain moves versus closed kinetic chain exercises.
  • Focus on proper use of concentric, eccentric, isometric, isokinetic and plyometric moves
  • Maintain functional range of motion – know the anatomical motions that occur at each joint
  • A comprehensive fitness program should incorporate perceptual-motor skills – visual, auditory, tactile, and proprioceptive senses.
  • Balance training is important as it underlies nearly every static and dynamic posture that requires the body to be stabilized against the pull of gravity
  • The goal of cardiovascular exercise is to between 50%-80% of max heart rate

There are medical fitness trainers that are certified to work with individuals with multiple sclerosis. They have acquired the tools and strategies to improve physical fitness and functional ability for clients with MS who have varying symptoms of the disease and levels of ability. They have learned exercise precautions, program design, perceptual motor and balance skill development, and much more.

Lisa Dougherty founded Whole Body Fitness in 1999. She graduated from the University of CA, Irvine, Fitness Instructor Program, and is a Certified Personal Trainer and Health Coach through the American Council on Exercise. She has specialty certifications to work with those with medical conditions, post surgical/rehab as well as pre & postnatal fitness. Course work includes: Heart Disease, Breast Cancer Recovery, MS, Parkinson’s, Diabetes, Alzheimer’s/Dementia, Arthritis, Respiratory Disease, Fibromyalgia, Knee and hip replacement, and Pre and Postpartum fitness. Lisa founded the Medical Fitness Network in 2013. 

Desert Southwest Fitness Author: Karl Knopft, EdD Copyright 2005

Trainer helping senior woman exercising with a bosu balance

Five Tips for Training Clients with Parkinson’s and/or Multiple Sclerosis

When training clients with a neuromuscular disease such as Parkinson’s and/or Multiple Sclerosis there are many challenges.  The challenges can range from physical to emotional setbacks.  It is important to focus on the physical as well as mental capacity.  There are certain patterns associated with exercises that provide balance, core, flexibility, facial, and hand motor training, that keep the mind focused.  Below are five tips when working with clients who have Parkinson’s and/or Multiple Sclerosis.

Balance Training

Balance is one of the first things to decrease as we get older, but much quicker with those with Parkinson’s and/or Multiple Sclerosis.  One common injury is falling so it is important to focus on balance.  Start with simple single exercises to work on balance.  Even standing with just the eyes closed can provide a challenge.  Also try unstable surfaces like a balance board or Airex-pad to challenge balance.

Core Training

Incorporating core exercises will help your clients with the balancing and movement exercises.  If the client can stabilize core muscles during the balance exercises it will help them to be more aware of posture and overall strength.  Plank exercises are great for utilizing the core.  Also a seated ball lift one leg while maintaining posture helps with posture when sitting.

Flexibility Training

Flexibility or range of Motion exercises combine Balance and Core Training to help improve flexibility and coordination.  There are two types of flexibility training, Static and Dynamic.  Static stretching is holding a specific stretch for 45-60 seconds.  This is great after working out to prevent injury and improve range of motion.  Dynamic flexibility is more movement based.  Exercises such as reverse lunges help improve flexibility while moving, while challenging balance and the core.

Facial Exercises

Particularly with Parkinson’s clients, they will get a look to their face that looks like there is no expression.  To keep these muscles in the face active doing simple jaw, mouth, eyebrow, and cheek movements will help keep facial muscle active.


Writing is important keep the mind and emotional part of having Parkinson’s and/or Multiple Sclerosis active.  Motor skills in the hand will decrease as well as focus and concentration.  So things like cross word puzzles and word finds are great for incorporation of mind and body.

In summary, it is critical to use all of these tips for Parkinson’s and Multiple Sclerosis training in progression.  Each client is different, so challenge them to their fitness level.  Progress or digress exercises accordingly.  Take into account the psychological well-being of your client when progressing them in their workout regimen.

Jason Williams has been a personal trainer, pilates instructor, and wellness coach for 13 years and is a graduate from Lynchburg College in Virginia with a Bachelor of Science degree in Sports Medicine.  While at Lynchburg College he was a 1st team All-Conference Track and Field Athlete.  Jason has worked with a wide variety of clientele from kids, professional athletes, seniors and special populations.  He recently wrote a children’s health and fitness book, The Adventures of Frankie Fitness, which motivates kids and adults to live a healthy lifestyle.  He currently works at The Maryland Athletic Club in Baltimore, Maryland. Find Jason at Charm City PT.