Exercise for MS patients

Exercise and MS

By Yvonne Learmonth

How does exercise help with MS

Many of the symptoms associated with MS are reduced through physical exercise. Exercise is a great way for everyone to stay strong, control weight, improve fitness and ward off chronic disease. While managing the consequences of MS, exercise represents a crucial tool and is an important approach for improving health and wellness. Unfortunately, inactivity invites consequences such as fatigue, poor strength and poor fitness. If someone is feeling fatigued, they might be less likely to exercise, and as a result they will have even more fatigue over time. Being inactive also raises the risk of developing other chronic health conditions. If you remain inactive, alongside MS, you might develop heart disease or diabetes too.

There is definite scientific evidence that exercise is associated with meaningful outcomes for persons with MS, and these outcomes range from the cellular level to quality of life. Research has indicated that persons with MS who engage in exercise have better brain health based on magnetic resonance imaging, better cognition based on speed of information processing, and increased mobility and cardiovascular health. Plus, persons with MS who engage with exercise have less fatigue, depression, anxiety, and pain and better sleep quality and quality of life. (2)

Is exercise safe for people with MS?

Yes! Exercise is not associated with any greater risk for persons with MS than for healthier individuals. Research which summarised the risk of relapse and other adverse events associated with exercise training has shown that exercise is not associated with increased risk of relapse or risk of adverse events for persons with MS (3).

What type of exercise is best / recommended for MS?

To be effective exercise should be performed regularly at a suitable intensity. Choose exercise that you enjoy.

The Internationally recognised physical activity guidelines for adults with mild to moderate MS are a great starting point. They are important guidelines when recommending exercise to persons with MS and they are applicable to persons with mild to moderate disability. Other important recommendations have been written by the American College of Sports Medicine (ACSM) for persons with chronic diseases and disabilities (4).

Physical Activity Guidelines for adults with mild to moderate MS are: 30 minutes of moderate intensity aerobic activity two days per week and strength training for major muscle groups, including the calf muscles, leg muscles, abdominal and arm muscles on two days per week(5).

Our advice is;
If you are beginning again with exercise slowly, work up to this volume of exercise over 2 to 3 months.

Break exercise into shorter bouts of 10 to 15 minutes at a time if necessary. For strength training exercise slowly work up to doing two sets of 10-15 repetitions of each strength training exercise. Experiment with timing so that exercise is not counterproductive to the rest of your day.

Aerobic exercise

  • Can be performed in a variety of settings including individual and group training sessions on land or in water
  • Can be performed on at least two days of the week
  • Walking is the number one choice of aerobic exercise by persons with MS(6), and walking intensity can be measured by counting your steps over a period of time
  • Use of exercise bikes and elliptical trainers is preferable to the use of a treadmill when there is a risk of tripping and falls

Our advice is;
Walking 100 steps in a minute is moderate intensity aerobic exercise for persons with MS (7). Build this up to achieve your 30 minutes of aerobic exercise.

Strengthening Exercises

  • Can be performed in a variety of settings including home, community centre or gym
  • Can be performed on at least two days of the week
  • Can be performed with resistance from free or machine weights; body weight, resistance bands, or water
  • Progressive resistance with high weights and low repetitions is beneficial
  • Frequent rest breaks and alternating muscle groups during training helps minimise the effect of fatigue

Stretching & Balance Exercises

  • Can be performed in a variety of settings including home, community centre or gym
  • Can be performed on most days of the week
  • Stretching exercises can be performed using gravity or resistance bands
  • Balance exercises can be performed by challenging one normal sitting and standing posture
  • Can be useful to relieve muscle spasms and cramps
  • Can improve relaxation and sleep patterns

Overcoming Barriers

Fatigue

Fatigue is common in MS, exercise and fatigue management education strategies will actually help your fatigue level in the long term(8).

Heat Sensitivity and MS

Physical and sensory symptoms may temporarily increase with small increases in environmental or body temperature. People with MS should be encouraged to keep cool and well hydrated during exercise sessions, for example using cool clothing and try to exercise inside or in the shade.

Research is continuing to address what exercise and strategies are best for fatigue and heat sensitivity; for now it is recommended to follow the Physical activity guidelines, remember to build up to these guidelines slowly. Stretching exercises are important too, and continuing these when fatigue levels, or temperatures, are high is still important.

Finding support

Support to help you exercise is not to be underestimated. Research indicates that learning about exercise, working with other to overcome your barriers and identifying facilitators to exercise will make you more successful (9). Tell your friends, family, work colleagues and neighbours about the benefits of exercise for you and tell them that you want to be more physically active and they might join you too. Exercise is beneficial for everyone.

You might seek out help from a physiotherapist or exercise physiologist to give you specific instructions, ask them to help you overcome any exercise barriers you might have and make sure they know about the Exercise Guidelines

Using technology to your advantage

Your physiotherapist, or exercise trainer may live far from you but you can still access them using the telephone, email and telehealth option for ideas and advice.

Online videos and resources are engaging and will offer education on exercises for persons with MS. Suggested websites are listed below.

Mobile Apps for your smartphone are useful for monitoring physical activity, connect with professionals over video-chat and track your progress. Downloading these apps to your smartphone is very easy, and many are free, suggested mobile Apps available at the time of publication are listed below.

Connect to wearable technology such as digital devices worn as a wristwatch or band, these can track your step count, heart rate and sleep. Wearables allow you to monitor your activity without thinking about it.

Online Resources

Exercise is Medicine Australia www.exerciseismedicine.org.au

Multiple Sclerosis Australia www.msaustralia.org.au – the national website of MS Australia

Find an Accredited Exercise Physiologist www.essa.org.au

Find an Accredited Physiotherapist www.physiotherapy.asn.au

Exercise Right www.exerciseright.com.au

Yoga and Non-Cardio Exercises: Your Allies in Managing MS Symptoms and Improving Overall Health- telelearning brought to you by the National MS Society and Can Do MS

Workout Your Worries: Anxiety and Exercise in MS- telelearning brought to you by the National MS Society and Can Do MS

Your Mind is a Muscle, Too: The Relationship Between Exercise and Cognition- telelearning brought to you by the National MS Society and Can Do MS

ChairFit with Nancy- series of free exercise videos developed by a physical therapist with years of experience working with people with MS.

The MS Trust’s (United Kingdom) series of exercise videos for people with MS can be done in a seated or standing position to address balance, endurance, strength and flexibility.

14 Weeks to a Healthier You – free, personalized, web-based physical activity and nutrition program targeted to people with mobility limitations, chronic health conditions and physical disabilities. Created by National Center for Health, Physical Activity and Disability (NCHPAD), the program can help you get moving and make healthy nutrition choices.

The Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis can help adults with mild to moderate disability, resulting from relapsing or progressive forms of MS, to improve their fitness.

The Aquatic Physical Therapy and MS video produced by Laura Diamond, MS, PT, Diamond Physical Therapy Associates, PC, and Jill McElligott, PT, DPT, offers an introduction to the potential benefits of aquatic physical therapy for managing MS symptoms and enhancing fitness. It also provides interviews with a neurologist, a physiatrist and an aquatic physical therapist, all of whom specialize in working with people with MS, as well as with people with MS about their perspectives on aquatics exercise.

Health Focused Mobile App Examples (available in 2017)

MySidekick for MS

MSAA — My MS Manager

Charity Miles

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2. Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8(9):487–97.

4. Moore G, Durstine JL, Painter P, Medicine AC of S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities, 4E. Human Kinetics; 2016.

5. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta A, Mackibbon KA, et al. The effects of exercise training on fitness, mobility, fatigue, and health related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94(9):1800–28.

6. Weikert M, Dlugonski D, Balantrapu S, Motl RW. Most Common Types of Physical Activity Self-Selected by People with Multiple Sclerosis. Int J MS Care. 2011 Jun;13(1):16–20.

7. Agiovlasitis S, Beets MW, Motl RW, Fernhall B. Step-rate thresholds for moderate and vigorous-intensity activity in persons with Down syndrome. J Sci Med Sport Sports Med Aust. 2012 Sep;15(5):425–30.

9. Sangelaji B, Smith CM, Paul L, Sampath KK, Treharne GJ, Hale LA. The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: A systematic review and meta-analysis. Clin Rehabil. 2016;30(6):559–76.

New Exercises and Activities to Try If You Have MS

If you have multiple sclerosis (MS), you may feel tired, weak, or low on energy, and exercise may be the last thing on your mind.

In fact, exercise has many benefits for people with MS, including improvements in strength, balance, muscle stiffness, and bowel and bladder control. It can also reduce MS spasticity and may improve or delay cognitive impairment.

The key is to start slowly and build your fitness gradually. Check with your doctor before you begin a new exercise routine to ensure you’re not overexerting yourself. You can also see a physical therapist if you want assistance in choosing the right activities for your particular condition.

Remember that exercise doesn’t have to take place in a gym. Activities such as gardening and household chores all add up to an increased activity level. Here are some other activities and exercises to help you strengthen your body and combat MS.

Walking

Many people with MS have gait disorders, or difficulty walking. Walking regularly gives you a light cardio workout and helps maintain your sense of balance. Keep up regular walking as long as you can, even if it’s only for a short distance. Bring a friend or family member for security if you have a fear of falling. Treadmill walking is another option as you can adjust the speed and intensity, and there are handrails to hold onto.

Stretching

Stretching is good for everyone. Not only does it help you prepare for and recover from exercise, it also helps to maintain the flexibility that makes movement easier and reduces your chance of injury. If you have MS, stretching also helps to combat muscle stiffness. Try stretching areas such as your calves, hip flexors, and hamstrings. Some forms of exercise have an element of stretching built in, such as wall pushups performed with the heels on the ground. This stretches out both the calves and the hamstrings.

Water-based exercise

Whether it’s swimming or water aerobics, exercising in the water eliminates the risk of falling that can accompany MS. In addition to preventing falls and providing support, water also reduces the stress on your muscles and joints that activities on dry land can cause. Start with a low-intensity beginner class and progress at your own pace.

Balance exercise

Your balance is affected when you have MS, so dedicate some of your exercise time to work on this area. Try activities such as standing on one leg to practice your balance. Make sure you have a wall or chair to hold if you need support, and try closing your eyes to increase the level of challenge. Even two-legged exercises like plie squats are more difficult when your eyes are closed, making them a worthwhile task to master in your quest to remain steady on your feet.

Strength training

Muscle weakness and fatigue are a part of MS that you can prevent with strength training. Try activities such as step-ups or squats, using a chair or railing for balance. Use light weights for arm exercises such as bicep curls and shoulder presses. If you don’t have hand weights, try bodyweight strength exercises such as wall pushups or tricep dips using a chair or counter.

Core training

Your core is the foundation of your balance and stability. It’s made up of your abdominal, back, and pelvis muscles. Good exercise regimens include a core component as a way to increase performance as well as prevent injury in areas like the spine. Try exercises such as pelvis raises while lying on your back with your knees bent, and planks or pushups. If traditional planks and pushups are too difficult, try a modified version from your knees rather than your feet.

Yoga

Yoga therapy is a safe and effective way to improve fatigue, balance, flexibility, and strength. Some benefits reported after a short 12-week, bi-weekly yoga program were improved fatigue, balance, step length, and walking speed. While this may not be true for everyone, it is an option to try.

The takeaway

Exercise can seem challenging when you’re faced with the physical changes brought on by MS. But building your fitness level can stave off the progression of the disease and help you manage your symptoms. Start slowly with simple activities you feel comfortable with. Get clearance from your doctor before starting a new exercise program, and consult a physical therapist when choosing the best exercises for you.

Exercise & Multiple Sclerosis

What should I know about exercise and multiple sclerosis (MS)?

You may have heard the principles “stretch till it hurts” or “feel the burn” as they relate to exercise, but those approaches are counterproductive for people with MS. If you overdo it, you can end up straining an already compromised muscular system, increasing pain, and causing your body and mind to become overstressed, overworked, and overtired.

Check with your doctor before beginning any exercise program. He or she might make recommendations about:

  • The types of exercise best suited to you and the types you should avoid
  • The intensity of the workout (how hard you should be working)
  • The duration of your workout and any physical limitations
  • Referrals to other professionals, such as a physical therapist, who can help create a personal exercise program that meets your needs (The type of exercise that works best for you depends on your symptoms, fitness level, and overall health.)

How can I exercise safely if I have multiple sclerosis (MS)?

  • Always warm up before beginning your exercise routine, and cool down at the end.
  • If your goal is to work out for 30 minutes, start with 10-minute workout sessions and work your way up.
  • Work out in a safe environment. Avoid slippery floors, poor lighting, throw rugs, and other potential tripping hazards.
  • If you have difficulty with balance, exercise within reach of a grab bar or rail.
  • If at any time you feel sick or you begin to hurt, STOP.
  • Select an activity that you enjoy and HAVE FUN. Water aerobics, swimming, tai chi, and yoga are examples of exercises that often work well for people with MS.

What should I do if I get overheated while exercising and I have multiple sclerosis (MS)?

Some people with MS are sensitive to heat, which means they notice that their symptoms either reappear or become worse when their body temperature rises. An increase in body temperature occurs when you exercise. Here are some tips to avoid overheating:

  • Don’t exercise during the hot time of the day (10 a.m. to 2 p.m.). Try to exercise in the morning or evening if you are exercising outside.
  • Drink plenty of cool fluids.
  • Become aware of your body. If you notice any symptoms that you didn’t have before you began exercising, slow down or stop exercising until you cool down.
  • Swimming and water aerobics are good exercise options to keep you cool while exercising. Ask your pool manager about the temperature of the water. Ideally, it should be between 80 and 84 degrees. Also, make sure that there are non-slip floors in the locker room and around the pool.

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