Why Exercise is important to those who have Multiple Sclerosis

Have you or a loved one been affected by Multiple Sclerosis (MS)? If so, don’t forget the power of EXERCISE in improving quality of life! MS is a heterogeneous chronic disease of the central nervous system characterized by different patterns of inflammation, demyelination and axonal loss, predominantly effecting young adults in their most productive years (6). Functional impairments in MS such as abnormal walking mechanics, poor balance, muscle weakness and fatigue typically result from axonal degeneration and conduction block (5). An estimated 400,000 Americans have MS, according to the National Multiple Sclerosis Society, with 200 new cases being diagnosed each week.

According to Ehrman et al. (1), the initial diagnosis of MS is most common in individuals between the ages of 15 and 50. MS can be devastating, as demonstrated by the fact that within 10 years of diagnosis, more than 50% of individuals with MS will become unemployable (1).

Fatigue is the most common symptom of multiple sclerosis along with muscular weakness, spasticity, sensory disturbances, and decreased quality of life. There is no universally effective cure for MS (3) so treatment is aimed at reducing the incidence and severity of symptoms and to improve quality of life. This can be achieved through medications and exercise. In the past, MS patients have been advised to avoid physical activity because symptoms may worsen with an elevated body temperature (2, 6). However, it is now well known that MS patients benefit from both resistance and aerobic training (1, 2, 6, 7). For example, White, et al. (7) found that resistance training exercise increased strength, reduced fatigue, improved mood and enhanced the ability to perform tasks of daily living with increased energy in MS patients; whereas, Mostert et al. (2) found that an aerobic training program improved aerobic fitness, lessened fatigue, increased PA outside of the training program and improved perception of health status. Also, Romberg et al. (5) found that a 6-month resistance and aerobic training program resulted in improved walking speed and increased upper body endurance, which in turn lead to improved quality of life.

Although such research studies support the use of physical exercise to alleviate some of the symptoms of MS, there is no consensus which modality of exercise (i.e. aerobic vs. resistance) produces greater benefits. With fatigue-related limitations faced by MS patients, it is important that they maximize their workouts using the most beneficial method of exercise to improve their disability, improve quality of life, and reduce or delay the onset of fatigue.

In 2007, the purpose of my graduate school thesis was to attempt to determine the optimal mode of exercise for lessening fatigue and improving quality of life in persons with MS through an extensive literature review.

I concluded that under appropriate supervision, resistance training appears to be a well-tolerated intervention for improving strength and ambulatory function in MS patients, while simultaneously reducing fatigue and improving quality of life. Similarly, research strongly indicates that there are tremendous cardiovascular benefits to aerobic training. However, aerobic training has not been shown to significantly reduce fatigue in persons with MS. With distinct benefits to both aerobic training and resistance training alone, perhaps the ideal exercise program would be a combination of both. A combined program may provide more functional benefits, without sacrificing the cardiovascular benefits achieved with aerobic exercise.

If you have been affected by this disease, don’t forget about the power of exercise! I would recommend working with a physical therapist or personal trainer who is knowledgeable and experienced in working with MS patients. Be sure to inform the therapist or trainer of your conditions and take it slow. Progression is essential. Regardless of your MS severity, it’s never too late to start a customized resistance training program.

References

1. Ehrman, J., Gordon, P., Visich, P., Keteylan, S. Osteoporosis. Clinical Exercise Physiology. 28: 527-542, 2003.
2. Mostert S, Kesselring J. Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple scerlosis. Mult Scler. Apr 8(2):161-8, 2002.
3. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov 2006.
4. National Multiple Sclerosis Society. www.nmss.org 2006.
5. Romberg A et al. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Journal of Neurology. 63(11): 2034-2038, 2004.
6. Schulz, K-H., Gold, S. M., Witte, J., Bartsch, K., Lang, U. E., Hellweg, R., Reer, R., Braumann, K. M., Heesen, C. Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis. Journal of Neurological Sciences. 225: 11-18, 2004.
7. White LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, Vandenborne K. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler. Dec 10(6): 668-74, 2004.

Written by Jessica Tillery, M.S.
Jessica is currently the Wellness Program Manager for Gilead Sciences. Jessica oversees a comprehensive wellness program while also working in the Sport Medicine field as an exercise physiologist. She graduated from the Master’s program in Exercise Physiology at San Francisco State University. During grad school, she taught the undergraduate Exercise Physiology lab course, assisted with undergraduate research projects, and ran the Exercise Physiology Lab at SFSU. She also personal trained and taught undergraduate activity courses. Her thesis/project topic was “The influence of aerobic training and resistance training on fatigue and quality of life in persons with mild to moderate Multiple Sclerosis.” Jessica was a collegiate athlete participating in soccer and still loves to play. She spends most of her weekends on the river wakeboarding or in Tahoe snowboarding.