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. 

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.

MS 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 overheating
• 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. 

References:
Desert Southwest Fitness Author: Karl Knopft, EdD Copyright 2005