Multiple Sclerosis Exercise Advice
Exercise Therapy for people with Multiple Sclerosis (MS) can help better manage many of the more common symptoms of MS.
What is multiple sclerosis?
Multiple sclerosis is a disorder of the central nervous system (CNS) that includes the brain, spinal cord and optic nerve. In people with MS, the immune system mistakenly attacks the myelin (the protective coating around nerve cells that facilitates nerve signals). In doing so, ‘scarring’ can form as well as ‘plaques’ and the nerve cells can also be damaged. Scarring slow or interrupt the transmission of nerve impulses, which leads to the various prominent symptoms of MS.
Symptoms can include:
• Sensory changes (e.g. pins and needles or numbness);
• Muscle weakness;
• Extreme fatigue/tiredness;
• Sensitivity to heat;
• Reduced balance and coordination;
• Bladder and bowel disturbances;
• Cognitive changes;
• Visual problems.
Exercise therapy for MS
Regular exercise can be useful for maintaining general fitness as well as managing the various symptoms of MS. Exercise can also reduce the risk of secondary complications due to inactivity. Exercise can help to enhance optimum overall physical function with benefits including:
1. Reduced fatigue levels, improved endurance;
2. Improved balance and coordination;
3. Improved muscle strength;
4. Improved posture and flexibility;
5. Improved mood and overall well being;
6. Improve alertness and concentration.
What exercise is best for people with MS?
There is great potential for physical therapy that includes exercise therapy to improve or preserve muscle function (strength, endurance) and aerobic capacity in patients with neuromuscular disease such as MS. In doing so, this can reduce the chance of secondary problems such as contractures, pain or fatigue. It is important for people with MS to choose activities that are enjoyable, match their physical and functional needs that can also be scheduled in to their weekly routine.
Strength training can be carried out across a range of settings, including the home, medical fitness facility, or gym. It can include resistance through the use of free or machine weights, body weight, resistance bands or water programs. In order to reduce the effect of fatigue, frequent rest breaks are recommended. Unlike other types of exercise such as general aerobic conditioning (cardiovascular fitness) programs, which raise core body temperature, strength training may have less temperature related issues for people with MS.
Cardiovascular (aerobic fitness) exercise
General aerobic conditioning of a low to moderate intensity can help improve endurance in people with MS. It is recommended that people start slowly at a lower intensity and then gradually increase the duration and intensity of their exercise. Aerobic fitness activities can be carried out in individual, group settings on land or in the water. Small bursts of aerobic fitness training can help to have a beneficial cumulative effect over time. For people with MS, fitness sessions should be performed in well ventilated/air-conditioned areas to reduce the effect of heat sensitivity.
Balance (proprioception) and stretching exercise
Balance and stretching exercises can be helpful in improving range of motion through various movements and improving overall posture. Gentle stretching routines may also help to improve relaxation and help with a nightly routine for good sleep habits.
Fatigue and MS
People with MS usually fatigue sooner than the general population, with recovery from activity being a longer process than in others. Increased ‘pacing and spacing’ of activity can help with overall fatigue management. For example, if carrying out an exercise session in the morning, it would be helpful to minimise other activities at that time. If fatigue persists for more than 1 hour, it would be useful reducing the intensity and duration of the following session.
Heat sensitivity and MS
In people with MS, increases in core body temperature can lead to a greater presentation of symptoms. People with MS should be encouraged to keep cool and well hydrated during activity. If sensory related symptoms increase due to heat and persist for more than 30-60 minutes, a reduction in intensity and duration of the next session would be useful.
How can we help?
The myPhysioSA fitness and rehabilitation team accredited exercise physiologists (AEPs) can help you with your goals to help manage the symptoms of neuromuscular disease, including MS. This can be one-to-one through a range of referral pathways including Medicare and through your private health insurance.
Accredited exercise physiologists (AEPs) are skilled in determining exercise prescription specific to your needs. You may be able to participate in a group class where you exercise alongside people with similar cardiac risk factors. If you would like further information, please do not hesitate to contact us at myPhysioSA.
by David Bentley, Accredited Exercise Physiologist
Exercise is Medicine Australia www.exerciseismedicine.org.au
Multiple Sclerosis Australia www.msaustralia.org.au
Find an Accredited Exercise Physiologist www.essa.org.au