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You are here: Home  About Us FAQ’s Is exercise good for people with Multiple Sclerosis?
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Is exercise good for people with Multiple Sclerosis? |
Exercise for people with Multiple Sclerosis
As recently as twenty years ago, people with multiple sclerosis (MS)
were advised to avoid physical activity/exercise because it could
increase symptoms or possibly even increase disease activity. Today it
is well accepted that exercise is beneficial in maintaining or
increasing one’s health, decreasing secondary complications and
improving psychological well-being. There is no evidence that exercise
affects the disease process, either positively or negatively, but there
is ample evidence of the effects of exercise on overall physical and
psychological health.
In general, exercise is separated into three broad categories,
cardiorespiratory or aerobic, strengthening and stretching. Most
activities can be classified into one of these particular areas,
however, many activities have benefits in one or more of these
categories.
Cardiorespiratory/Aerobic Exercise
Cardiorespiratory exercise
or aerobic exercise is designed to improve conditioning of the
cardiovascular and respiratory systems. The cardiovascular system
includes the heart and blood vessels. The respiratory system primarily
includes the lungs. These systems are trained through aerobic (with
oxygen) exercise. Aerobic exercise allows the heart to pump blood,
carrying oxygen, to the working muscles.
Any physical activity that includes continuous, rhythmic movements of
large muscle groups is considered aerobic exercise. Aerobic exercise
includes, but is not limited to, swimming, cycling, walking, jogging,
dancing, rowing, pushing a wheelchair and upper body ergometry. In
order to gain the benefits of aerobic exercise, it is important to
participate in the activities on a regular basis. Therefore, it is
important to find an activity (or varied activities) that is enjoyable.
Once the type or mode of activity is determined, it is important to
determine the frequency, intensity and duration of the activity. If
initiating an exercise program, it would be beneficial to consult a
physician, physical therapist or exercise physiologist with experience
in managing people with MS. A cardiovascular fitness evaluation may be
appropriate to rule out any cardiac problems. In addition, this
evaluation can provide additional information related to the proper
exercise intensity and duration.
The preferred method for measuring exercise intensity is through a rate
of perceived exertion (RPE) scale. One of these scales is a 0-10 scale
with 0= no exertion and 10= maximal exertion. The RPE scale is
advantageous because it automatically adjusts as one improves their
fitness to allow slow increases in work rate, adjusts to different
activities and allows adjustment for exercise intensity depending upon
environmental conditions, etc.
Exercise duration is also an important factor to consider when starting
an exercise program. As little as ten minutes of activity can provide
cardiovascular benefits. Progression of exercise duration should be
done slowly to avoid the symptoms of fatigue and overuse injury.
Progressing exercise duration by 10% per week will reduce the problems
associated with overdoing it and will permit development of a healthy
habit.
Another aspect to consider when starting your exercise program is the
frequency of the program. The optimal frequency for aerobic
conditioning is to start with three times per week with progression to
five days per week.
Some tips for success with your aerobic or cardiorespiratory program are:
- Avoid using absolute amounts of work (i.e. mileage, speed,
distance) to measure your exercise program because you will have good
days and bad days. It is better to use exercise duration (time) as your
measure.
- You should feel as well or better two hours following your exercise
program as you did when you started. If you don’t, you probably did too
much. It is OK to back off.
- It is what you do every day that counts not what you do on one day.
Be consistent with your exercise program. If you miss a day it is OK,
but don’t try to do two days of exercise because you missed the
previous day.
- Try not to miss more than two days in a row. There will be times
you are not able to participate in your exercise program, because of
family commitments, meetings etc. Have a goal to schedule so you don’t
miss more than two days in a row.
- If you are heat sensitive, plan your aerobic exercise in a cool
environment or consider cooling aids such as vests, cool towels.
- Drink plenty of water before, during and after your exercise session.
If you are having trouble getting started, think about exercising as
part of a group. Studies have shown that adhering to an exercise
program is increased when participating as part of a group. Strength
Training Strength is defined as the quality of being strong or powerful
as it relates to muscular activity. Muscle strength is needed to
perform daily activities. Weakness can decrease function. People with
MS often report weakness or lack of strength as a problem. Strength can
be affected by fatigue, spasticity and limitations in range of motion.
Strength training is designed to improve muscle power, bone strength
(decrease the risk of osteoporosis), physical capacity for daily
activities and prevent injury. Additional benefits for people with MS
may be increased endurance (delaying the onset of muscle fatigue),
increased strength which can help with posture, balance and movement.
The primary goal of strength training for people with MS is to improve
strength and endurance due to deconditioning.
The first step in determining an appropriate strength training program
is identification of the muscle weakness. Your physician, physical
therapist, occupational therapist and/or exercise physiologist can
measure muscle strength (and weakness) to help guide your strength
training program.
Once muscle strength has been evaluated, a strength training program
can be established. There are different types of resistance which can
be used to strengthen specific muscles or muscle groups. Free weights,
weight machines, elastic tubing, water (pool exercises) and manual
resistance are common modes of strength training. For individuals who
have significant difficulty, the use of gravity as a form of resistance
can be effective. The amount of resistance is determined by the
strength assessment and the goals of the strength training program.
The frequency of the strength training program is also dependent upon
the goals of the program. It is important to work within symptoms,
particularly fatigue. The usual recommendation for strength training is
2-3 days per week. It is important to allow rest in between strength
training to allow for adequate muscle recovery. If training on
successive days it is important to alternate muscles or muscle groups
unless otherwise instructed by your physician, physical/occupational
therapist or exercise physiologist. Some tips for success in your
strength training program are:
- Identify the goals of your strength training program; consult a
physician, physical therapist, occupational therapist or exercise
phyisologist for assistance and identification of appropriate strength
training exercises.
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- Perform exercises through a full range of motion; this will help reduce the risk of injury to muscles, tendons and joints
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- It is not necessary to work your muscles to the point of fatigue
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- Don’t be impatient. Allow yourself adequate time for recovery
between sets of exercises if doing more than one set of exercises per
muscle or muscle group.
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- Be practical. Plan your strength program so you don’t fatigue yourself to do the things you enjoy.
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Strengthening exercises are important as part of a
comprehensive exercise program. It is important to identify appropriate
exercises before initiating your program. Your healthcare team can be
helpful in establishing an individualized program to meet your needs.
Stretching has many benefits for all people. Some of the benefits of stretching include:
- Reduction in muscle tension/promotion of relaxation
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- Prevention of muscle strains
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- Increase in range of motion at specific joints/increase flexibility
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- Increase in range of motion at specific joints/increase flexibility
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- Development of body awareness
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- Promotion of circulation
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- Improvement in posture secondary to muscle tightness
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- Reduction in pain due to muscle or tendon tightness
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Stretching can be even more important for people with MS who
experience symptoms of spasticity or increased muscle tone. The
specific benefits may include:
- Decreased muscle tightness
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- Decreased pain caused by muscle spasms or poor posture
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- Prevention of contractures due to spasticity
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- Improved posture for sitting and walking
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- Improved mobility
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Stretching for people with MS, who experience spasticity, may
sometimes be sufficient in reducing the muscle tension and managing
spasticity. However, many times stretching in combination with
medications is the most effective means of managing spasticity.
Stretching can generally be accomplished without any equipment.
However, certain situations require use of equipment or assistance from
a partner. Equipment sometimes used includes a towel or belt to assist
with the stretching. Proper posture during stretching is important in
order to gain the maximum benefit.
Stretching is separated into two general categories, Ballistic and
Static. Ballistic stretching is not recommended because it includes
bouncing which can cause injury. Static stretching is recommended and
includes performing the stretch in a relaxed, sustained manner. Each
stretch should be held in a position where a comfortable, pulling
sensation is felt, but not pain. Holding the stretch for 20-60 seconds
is recommended. When stretching, it is important to maintain a regular
breathing pattern. DO NOT HOLD YOUR BREATH! Stretching exercises are
usually recommended on a daily basis, but it may be appropriate to
stretch more frequently if spasticity or “tightness” is a specific
problem.
Some tips for success in your stretching program include:
- Take advantage of “peak medication effect” if taking anti-spasticity medications (consult your physician for this information).
- Perform stretching in a quiet, comfortable setting.
- Consult a physical therapist, occupational therapist, or exercise
physiologist with training in neurological conditions to help you
identify the appropriate stretching exercises based on your needs. In
addition, they can provide you with appropriate training on body
position and partner stretching programs.
There are other activities which incorporate stretching techniques and
may be effective in promoting relaxation, body awareness, and
flexibility. Activities such as yoga, Tai Chi and Feldenkrais lessons
are some alternatives.
The most important aspect about any exercise program is to develop a consistent routine and enjoy!
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