Exercise for Multiple Sclerosis

Overview
As recently as 20 years ago, doctors discouraged people with multiple sclerosis (MS) from being physically active. Exercise was deemed too dangerous. However, in recent years, many studies have proven that various types of physical activity not only promote general health in people with MS, but can actually help manage a variety of MS symptoms. Aerobic exercise keeps your heart healthy, increases your strength, mobility and balance, and improves bladder and bowel function. Resistance training such as weight-lifting builds muscle strength and healthy bones as well as making you less prone to injury and quicker to recover from injuries. Stretching activities such as yoga can improve breathing, flexibility, strength, and range of motion as well as relaxing your muscles. Gentle martial arts such as tai chi or qi gong (pronounced chee gong) can improve balance and promote deep breathing and relaxation. Any type of exercise can lessen symptoms of fatigue and depression and promote social interaction.

Fatigue, weakness and lack of balance lead many people with MS to give up on exercise and become increasingly sedentary. However, lack of physical activity can accelerate the progression of the disease and contribute to the development of other conditions such as osteoporosis, heart disease, diabetes, depression and obesity.

What does it involve?
Always check with your doctor before beginning new exercise regimen. It is also a good idea to consult a physical therapist for help in determining a customized exercise plan that will be safe and beneficial for you.

Whatever type of exercise you choose, follow these general safety guidelines. Always begin your workout session with a gradual warm-up, and take time to cool down afterward. This will help prevent sore or pulled muscles. Exercise should be somewhat challenging, but never a struggle. If at any point during exercise you feel sick or in pain, stop right away. Make certain the exercise space is well-lit, not slippery, and free of trip hazards. If you are sensitive to heat, plan your workout for the morning or evening when it is cooler. Stay hydrated with plenty of cool liquids, choosing beverages without caffeine. If you have trouble maintaining your balance, stay within reach of a rail or bar you can hold.

It is important to choose a type of exercise you will enjoy. Consider joining a class to keep you motivated and incorporate social aspects.

Aerobic exercise can take many forms. Walking on a treadmill, riding a stationary or recumbent bike, or swimming can all provide effective exercise for your heart and lungs. These activities can easily be made safe even if you have problems with balance or coordination.

Resistance training such as lifting weights can be done seated, and it can involve as light a weight as you are comfortable with. Even small amounts of weight or resistance provide benefits.

Water exercises such as swimming laps or doing water aerobics help keep you cool while you exercise. Whatever type of activity you prefer, you may find it easier to do in the water. Because your body feels lighter and more buoyant, you may find it may be easier to lift weights or do cardiovascular exercises. You may also feel more flexible, making it less difficult to stretch. Water also provides some natural resistance to movement, increasing the benefits of even very gentle movements.

Yoga consists of moving your body into an array of different positions that provide stretching and various levels of challenge for strength, flexibility and balance. There are many types of yoga and many different teaching styles. The right yoga class can provide many benefits for those with MS. You may need to ask several questions before finding an appropriate class and an experienced teacher. You can also contact the National Multiple Sclerosis Society for a recommendation of a yoga teacher near you who has experience working with people who have MS. If you use a wheelchair or walker, consider a yoga class for older people or people with physical disabilities. Many yoga poses can be done while seated.

Gentle martial arts such as tai chi and qi gong consist of slow, gentle movements and deep breathing. They are popular exercises for the elderly in China, and they can be done while seated.

Take an inventory of the activities you enjoy. Be creative – many sports and activities can be modified for those with physical disabilities. Horseback riding, golf, cycling and skiing are just a few of the sports that can be adapted to suit those dealing with MS-related disabilities.

It is important not to become discouraged early on when beginning an exercise regimen. Focus on finding ways of staying active that are safe, enjoyable and easy to do regularly. If you experience new or worse MS symptoms, adjust your work-out program to keep it safe and rewarding.

Intended Outcomes
Exercise can help you achieve and maintain your best physical and psychological condition. A regular exercise regimen can reduce fatigue, increase strength, promote a healthy weight, stave off heart disease and diabetes, and improve your mood and self-esteem. It can help you avoid injury and recover more quickly. It may even slow the progression of MS by providing protection for your brain.

Results
Since the first study in 1996 hailing the benefits of exercise for people with MS, dozens of other studies have repeated and deepened these findings.

A 2004 clinical trial showed that 69 people with MS showed improvements in fatigue levels after six months of either yoga or stationary bike exercise.

A 2010 study explored the connection between aerobic exercise and brain health in people with MS. Researchers found that higher levels of cardiovascular fitness were associated with higher volumes of grey matter and better preserved white matter. Findings indicated that physical fitness has a protective effect on brain health and helps reduce long-term disability in those with MS.

In another trial, 38 people with MS who had mild physical impairment did resistance training with their legs for 12 weeks. All of those who completed the training showed better muscle strength and functional capacity at the end of the 2009 study.

A different trial in 2009 studied the effects of progressive resistance training in 13 people with MS. At the end of the eight-week study, participants’ muscular endurance had increased 84 percent, and their strength had increased by 51 percent. Functionality also showed significant improvement.

Constraints
Some MS symptoms, including fatigue, weakness, pain, bladder incontinence and depression can make it difficult to stay motivated to keep up with exercise. Side effects of medication can also interfere.

Some types of exercise can exacerbate certain MS symptoms. It is important to keep from overheating, respect your fatigue levels and rest when needed. If you exercise too hard, you may feel more pain than usual for a day or two afterwards. This is a sign that you should take it a little easier next time. If one type of exercise does not work for you, consider trying another.