Multiple Sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (brain, spinal cord and optic nerves).

The exact antigen remains unknown. This is why MS is considered by many experts to be “immune-mediated” rather than “autoimmune” {1}.

Fatigue not related to physical activity, muscle weakness, depression, spastic paresis (an upper motor neuron impairment that involves exaggerated tendon reflexes and is resistant to passive stretching), poor balance/fall risk, respiratory diseases, elimination dysfunction and secondary diseases such as coronary heart disease are all symptoms and conditions that can be related to MS.

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As many as 40% of people with MS say fatigue is the single most disabling system {4}.

In addition, over 50% of MS patients experience depression. Risk of fracture from falls in MS patients is 2-3 times higher than for a healthy person.

Elimination dysfunction is estimated to affect approximately 80% of MS patients during the course of their disease.

Contrary to perception, MS is not always a steady degenerative downward spiral.

There is no cure, but about 85% of cases are known as “relapsing-remitting”. This means attacks with acute symptoms are followed by recoveries that can last for long periods of time {3}.

However MS affects you, there are exercises that can be helpful to stay as healthy as possible and improve some of your symptoms {2}.

According to the MS Society UK, exercise can:

• Improve the overall health of people with milder MS

• Help people with more severe MS stay as active as possible

• Help some people manage MS symptoms and decrease the risk of other diseases, such as heart disease

Improve muscle strength and endurance, which helps with mobility or weakness issues {2}

Studies have shown that cardio-respiratory fitness, muscle strength and endurance, bone health, flexibility, systemic fatigue and shortness of breath have shown positive outcomes with regards to the MS population {4}.

According to Mostert S, Kesselring J., MS patients have been shown to make favorable improvements in cardio-respiratory fitness in as little as four weeks.

Modes of training to improve cardio-respiratory fitness may include: cycling (stationary or road/trail), swimming/aquatic and elliptical which are all great non-weight bearing activities. Treadmill/walking/hiking activities may be suitable for high functioning patients.

Intensity levels may vary depending upon symptoms. It might also be suitable for patients to alternate bouts of activity with rest periods in the beginning stages of their training {4}. Three to five sessions per week, again depending upon an individual’s level of fitness are recommended.

Exercises to help Multiple Sclerosis_2A resistance training program should be individualized to allow for gradual progression of muscle tone improvement, as well as improvement of muscle strength and endurance. Closed chain resistance exercises that go through the available range of motion are recommended.

Consideration should be given to limited range of motion due to loss of connective tissue elasticity {4}. Modes of training can vary from body weight, tubing, free weights, machines and pulley systems. The level of the patient’s disability will influence to type of resistance used.

Two to three strength training sessions per week consisting of 1-3 sets of about 8-15 repetitions per major muscle group are recommended {4}. It is extremely important to use the overload principle with caution.

One should allow for full recovery between strength training sessions to prevent musculoskeletal overuse injuries. Resistance training can be safely increased by 2-5% when 15 repetitions are correctly performed in consecutive training sessions {4}.

Variability in fatigue from day to day normalcies will also have to be used for changes in the strength training program.

The goals or a flexibility program are similar to persons with MS as persons without.

Increase muscle length, joint mobility and improve posture and balance. With regards to individuals with MS, flexibility exercises will also help counteract the effects of spasticity.

According to Burks and Johnson, stretching exercises should be performed at least once daily and include all of the major muscle groups. General guidelines for stretching are:

• Daily for about 10-15 minutes

• Performed before and after aerobic and resistance training sessions

• Performed slow, gentle and prolonged

• Each stretch should be held for 20-60 seconds

• Do not stretch to the point of pain

Exercises such as progressive muscle relaxation, deep breathing, yoga and meditation may be additionally helpful, especially for the persons with spasticity {4}.

Aquatic exercise in water temperatures of 27-29 degrees C (80-84 degrees F) may be advantageous for MS patients, especially those who are heat sensitive or have a higher disability {4}.

A major benefit of exercising in moderately cool water is that body heat is dissipated more easily than during land-based programs. In addition, water reduces the effects of gravity and the buoyancy in water helps patients with weakened limbs achieve a greater range of motion {4}.

Persons with MS should consult with their physician before starting a new exercise program. A general rule of thumb should be to avoid strenuous exercise on days that the patient/client reports an increase in systemic fatigue.

While there is no single exercise that could be called an ‘MS exercise’, the variety of a well-planned program, that encompasses all of the components of fitness (cardiovascular/aerobic, flexibility, muscle strength/endurance and body composition), can benefit people with MS.

Postural exercises to help with body alignment will also help to reduce strain on the bones and muscles. Exercise has shown to have benefits well beyond the improvement of just MS-related fatigue {5}.

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References 

1. http://www.nationalmssociety.org

2. https://www.mssociety.org.uk

3. Landro, Laura, ‘Exercise, Diet and Sleep Can Improve MS Symptoms.’ The Wall Street Journal, http://www.wsj.com/articles/exercise-diet-and-sleep-can-improve-ms-symptoms-1413218026.

4. White, Lesley J. and Rudolph H. Dressendorfer, Exercise and Multiple Sclerosis. Sports Medicine 2004. Pp 1077-1100.

5. Carmen Tur, MD, MSc,PhD. Fatigue Management in Multiple Sclerosis. Current Treatment Options in Neurology. (2016) 18:26

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