Every person with MS should have a program of exercise specifically tailored to their abilities and needs as part of their regular schedule, with the goal of achieving and maintaining optimal health and physical functioning. Regular exercise, including exercises for strengthening, stretching, and coordination and balance, can be useful in managing many common MS symptoms, such as fatigue, spasticity, weakness, bladder and bowel dysfunction, and mood changes.
If you have MS and are inactive, your risk for a variety of health problems will increase, including coronary heart disease, weakness, loss of bone density (with increased risk for fractures), and respiratory problems.
What do studies tell us about the benefits of exercise?
Results from several studies have shown that regular exercise has important benefits for people with MS.
In one randomized, controlled study conducted in 54 people with MS, a regular aerobic exercise program involving three 40-minute exercise sessions per week for 15 weeks resulted in improved cardiovascular health (blood lipids and triglycerides), increased strength (upper and lower body), improved bladder and bowel symptoms, decreased fatigue, and improvements in depression scores as well as attitude and psychosocial functioning.
Another randomized, controlled study conducted in 31 people with MS found that a 12-week program of resistance training (with progressive increases in resistance) resulted in significant improvements in fatigue, mood, and quality of life, and that these improvements continued when subjects were tested 12 weeks after the study ended.
Changes in Symptom Scores and Quality of Life in Exercise and Control Groups
|End of study
|End of study
Decrease in score = improvement
|Fatigue Severity Scale||5.8||5.2||5.5||5.6||P=0.04|
|Major Depression Inventory||10.3||7.9||8.8||9.9||P=0.01|
Increase in score or percentage = improvement
|Quality of life (SF-36) Physical Functioning||41.4||44.9||42.6||41.6||P=0.01|
|Adapted from Dalgas U, Stenager E, Jakobsen J, et al. Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Mult Scler 2010;16:480-90.|
A 2008 meta-analysis (a study that reviews and analyzes results from several studies) of studies that evaluated the effect of exercise on quality of life in people with MS found that exercise provided a modest but significant benefit for people with MS, improving mental health, cognitive functioning, and level of fatigue and energy. Importantly, exercise had a positive effect on symptoms and functioning comparable to that of disease-modifying treatments on rate of relapses.
What kinds of exercise programs are safe and effective for people with MS?
A wide variety of types of exercise may beneficial for people with MS. However, whatever form of exercise is chosen, it must be appropriate for an individual’s physical limitations and abilities and may need to be customized to accommodate symptoms and limitations. Several members of your care team, including your doctor, nurse(s), physical therapist, or occupational therapist will be able to assist in designing an exercise program that suits you. They will have invaluable advice about what sorts of exercises will be most helpful, how long you should exercise, and when is the best time for exercise. For people with MS, it’s a good idea to avoid exercising during the hottest part of the day so that you don’t get overheated or fatigued.
You have many different options when it comes to choosing the right exercise program . It turns out that moderate activity (you don’t need to kill yourself with a grunt-and-sweat type of workout) will give you the same health benefits as rigorous exercise. So, keep this in mind when you hit the gym or track or swimming pool. Options may include:
- Swimming or walking (these don’t require a team or partner, however, you may find it fun to have a work-out buddy you can walk or swim with).
- Adaptive sports, if you have limitations that affect mobility (examples include wheelchair basketball) or team sports, if you have a competitive streak
- Group workouts are a good option if you thrive on mixing social interaction with physical activity
Consult with your doctor before starting an exercise program
Before you start exercising, it is important to talk to your doctor and get his or her OK.
Are there any special concerns that I should have as I start to exercise?
Because people with MS may have special challenges when it comes to exercise and activity, there are a few things to keep in mind as you start an exercise program. (Remember, every person with MS is unique and the disease affects each individual differently, generalizations regarding one’s experience with exercise are difficult to make.)
Tips to Keep in Mind As You Start Your Exercise Program
- Stay within your ability and be tuned into your needs and symptoms
- As your body temperature rises during exercise, you may experience some symptoms, including numbness, tingling, or vision changes: these should resolve as you cool down after finishing your exercise
- You should start your exercise program under the supervision of a health professional who understands the special needs of people with MS
- A health professional can monitor how your body is reacting to activity (by measuring blood pressure, heart rate, and other parameters), specifically, how a rise in body temperature may be affecting you
- Work with your physical therapist or other health professional to set targets for heart and breathing rate
- Monitor your heart rate and breathing rate and pace yourself to avoid overdoing it
- Feel free to modify exercise routines (such as Yoga classes or aerobic classes) and adapt to accommodate your individual symptoms and limitations
- Talk to your doctor or another member of your care team about when you should exercise and be especially careful to take into consideration your medication schedule (for instance, you may want to plan your exercise according to when you take your antispasticity medication)
- Understand your symptoms (such as heat sensitivity, poor balance, fatigue, spasticity, and muscle weakness) and know when you should stop or hold back to be safe
- Build up to more demanding and challenging exercise slowly and carefully
What should I do to warm up before and cool down after exercise?
To get the best results from your exercise routine, warm up before and cool down after exercising. Your body needs some careful preparation for the exertion of exercise and a series of stretching exercises can help prepare ligaments, tendons, and muscles by lengthening them. Stretching exercises will also help you to stay flexible and keep optimal ranges of motion. Talk to your physical therapist or another member of your care team to get specific suggestions and instructions on warm-ups to do before exercising. Keep in mind that you should probably spend about 5 to 8 minutes on a pre-exercise warm-up and the same amount in a post-exercise cool-down. Don’t rush things: it’s best to be careful and safe. Some suggestions for warming up include:
- Before exercise, make sure to drink water or juice
- Also, drink water or juice as part of your cool-down after exercise
- Do a systematic stretch of major muscles before and after exercise
- Rest for a period of time after exercise; if you are fatigued for more than an hour after exercising, you may be over-doing it
Can you suggest some specific exercise options that might be appropriate for me?
There are a wide variety of options for getting the exercise you need, from walking in your local park, to horseback riding and taking part in organized exercise classes at a fitness center in your local community. The following list of exercise options will give you a sense of the possibilities.
Suggestions for Exercise Options
- Swimming or exercising in a pool is ideal for people with MS
- Water (unless it is too warm) prevents overheating and provides buoyancy that makes movements easier on muscles and tendons, while providing aerobic exercise that enhances endurance and stamina
- Aqua exercise allows people with MS who are limited in mobility to do exercises that they might not normally be able to perform out of the pool
- Use of free weights, weight machines, or resistance machines is an ideal way to get exercise
- Programs can be adapted to individual levels of flexibility and mobility
- Weight or resistance training provides benefits including bone health, weight loss or maintenance, and increased strength
- Yoga provides many benefits for people with MS, including stretching (for tightness or spasticity), breathing, relaxation, and improved range-of-motion
- Yoga postures and breathing exercises have been developed over centuries to alternately stimulate and stretch the body and provide relaxation
- Yoga can be adapted for people with a range of disabilities (see the resources listed below for more information)
- Pilates is an exercise system that has become increasingly popular and provides many of the same benefits as Yoga
- Involves controlled movements (with emphasis on breathing and precise flow of movement) that promote increased flexibility and strength
- Your physical therapist can design a program using different exercises that focus on improving balance, many involving use of what is called a Swiss ball (a large inflatable ball)
- A balance program can be very useful to a person with MS, because demyelination often affects the part of the brain and parts of the body (eyes, ears, and major muscles) that we depend on for coordination and balance
- A variety of martial arts are available, including Tai Chi, Kung Fu, karate, and Qi Gong
- Each of these is useful for building strength and promoting flexibility and balance (with minimal stress to joints)
- Aerobic exercise is defined as anything that raises heart rate and breathing above the normal resting level
- Aerobic options including running, dancing, bicycling (stationary, trail, or road), treadmills, elliptical, instructor-led movement classes
- If you tire easily, you can do aerobic exercise in 3 to 5 minute periods
- Whatever equipment you use should be adjusted to suit your individual needs and some equipment can be adapted for individuals with mobility limitations
- There are a variety of team and individual sports that provide exercise, activity, and social interaction
- Many of these incorporate a competitive element, such as golf and volley ball, but others, such as boating and hiking, simply allow the participant to be active in an outdoor setting
- Adaptive technologies make many sports and activities accessible for people living with disabilities, including golf, basketball, and tennis
- See below for a list of resources for information on adaptive sports
Sources for Information on Adaptive Sports
27 Main Street, Suite 303Edwards, CO 816321-
Web site: www.mscando.org
- Nonprofit provides innovative programs in lifestyle empowerment for people with MS and their support partners
Web site: www.accessanything.net
- Resource for travelers with disabilities, with the mission of improving the quality of life of people living with disabilities by encouraging them to travel and explore the world
PO Box 266, 100 Silverman WayWindham, NY 12496
Web site: www.adaptivesportsfoundation.org
- Resource for individuals with physical and cognitive disabilities and chronic illnesses, offering programs that provide outdoor physical activity, education, support, and community
P.O. Box 1290Winter P ark, CO 80482
Web site: www.nscd.org
- Nonprofit that provides winter and summer recreation opportunities for people living with disabilities
Programs include snow skiing, snowshoeing, and cross-country skiing, fishing, hiking, rock climbing, whitewater rafting, camping, mountain biking, sailing, therapeutic horseback riding, and baseball