Can exercise benefit people who have multiple sclerosis?

 

For the almost 2.5 million people in the world living with multiple sclerosis (MS), simple exercise can become a daunting challenge. The disease—which damages the central nervous system, including communication connections in the brain—brings disabling fatigue and, oftentimes, exquisitely sensitive body temperatures.
Hop on a treadmill and work up a sweat? For those with MS, that can simply be an exercise in pain.
According to Adam Carpenter, M.D., however, there’s increasing evidence that exercise actually induces changes in the brain, increasing the number of neurons and the size of blood vessels, and even improving brain function. Carpenter, a neurologist and assistant professor who splits his time between the Minneapolis VA Health Care System’s Brain Sciences Center and the University’s Department of Neurology, found himself wondering, could exercise help people who have MS?
“Most of the studies on exercise done to date tend to use very targeted strategies,” says Carpenter, “but because people with MS are all over the map, from very active to very incapacitated, we decided to go a different route and ask, ‘What happens if you just increase exercise?’”
Working with postdoctoral researcher Shikha Jain Goodwin, Ph.D., Carpenter designed a study, which has already enrolled eight veterans who have MS, that divides patients randomly into two groups: one that maintains their current level of activity and another that aims to increase their current level of activity by 100 percent. So if one person currently walks 3,000 steps a day, the study goal becomes 6,000 steps a day. 

There’s no list of approved activities; rather, it’s about maintaining or increasing whatever it is—walking, running, swimming, biking—that the person already does.

As Goodwin explains, each participant starts with baseline magnetic resonance imaging and magnetoencephalography scans, which measure brain activity, as well as tests to evaluate cognition, fatigue, mood, neurologic disability, and overall well-being. Each participant is then given a wristband activity tracker; after four weeks, they return for reassessment and then continue at their assigned activity level for six more months. Carpenter and Goodwin decided to limit the study to six months because they don’t want to discourage additional activity in the control group for longer than that.
“We’re asking a lot of these participants either way,” says Goodwin. “They have to be up for drastically increasing their activity level, or not changing it at all.”
Because Carpenter and Goodwin are still seeking funding for a larger study, they’ll keep this pilot program quite small. Ideally, though, they’d like to expand the work to give them a better survey of exactly what effects increased activity can have on people who have MS.
“Other studies have demonstrated that, yes, exercise can physically change brains in beneficial ways,” says Carpenter, “but can it work in brains that have suffered damage from MS? That’s what we hope to answer.”

Some researchers have theorized that regular physical activity reduces the risk of developing multiple sclerosis. A new analysis demonstrates that, as a preventative measure, exercise does not appear to have the desired effect.

Recent research clears up the debate about physical exercise and MS risk.

Although the exact number of people with multiple sclerosis (MS) in America is not known, there are estimated to be 2.3 million people affected worldwide.
MS is a varied condition that affects the brain and/or spinal cord.
It can cause a wide range of symptoms including difficulties with the movement of limbs, changes in vision, and problems with balance and sensation.
Although there is no cure, scientists have demonstrated that, for individuals with mild to moderate disability, exercise can improve the severity of certain symptoms.
Exercise has been shown to increase muscular strength and aerobic capacity and improve the individual's sense of wellness. Additionally, there is some evidence that exercise might help slow the progression of MS, although the data is conflicting.
How exercise reduces the symptoms of MS is not known, but researchers believe that it could be due to the modulation of immune factors or stress hormones, or perhaps by altering the expression of neuronal growth factors.

Risk factors for MS

A number of MS risk factors are known; for instance, the condition is more prevalent in women than men, and it seems to have links with certain infections, including Epstein-Barr. White people and those who live in temperate climates are also more likely to develop MS. However, the full list of risks is yet to be uncovered.
One potential risk factor that has received some attention from scientists is the level of exercise an individual is involved in prior to the onset of MS. It is commonly believed that a higher level of physical activity reduces the risk of MS; however, this is still very much up for debate.
Findings are contradictory or unclear; for instance, some studies have shown that individuals who develop MS tend to be more physically active before onset; others showed no difference in pre-onset activity.
However, earlier studies did not use detailed, validated questionnaires to assess physical activity levels. There is also a confounding variable that makes some of the results difficult to interpret. Two of the early symptoms of MS are weakness and fatigue. So, did the lack of physical exercise promote the onset of MS, or was the lack of exercise a sign of the onset of MS?
A team of scientists from Harvard T.H. Chan School of Public Health in Boston, MA, recently set out to investigate whether physical activity has an effect on MS risk once and for all. Their results are published this week in the journal Neurology.

Fitness level and the onset of MS

The team took data from more than 193,000 women who participated in the Nurses' Health Study and Nurses' Health Study II; these individuals were followed up for 20 years, starting in 1976. Each woman completed detailed questionnaires about their current levels of physical activity and also their activity levels as teens and young girls. Over the course of 20 years, 341 women developed MS.
Once the data were collated, the researchers calculated the hours of exercise each individual carried out per week and what types of exercise they did. The group adjusted the results for ethnicity, age, smoking, place of residence at the age of 15, BMI at 18, and vitamin D supplement intake.
After the analysis had been completed, the data showed that, contrary to expectation, exercise was not correlated in any way to the appearance of MS.

"Overall, there was no consistent association of exercise at any age and MS. Exercise has been shown to be beneficial to people with the disease, but it seems unlikely that exercise protects against the risk of developing MS."

Kassandra Munger, study author

When Medical News Today asked Munger whether the results had come as a surprise, she said:
"Given the overall health benefits of physical activity, in addition to recent studies suggesting that physical activity in persons with MS may provide some benefit, our working hypothesis was that physical activity would be associated with a reduced MS risk."
Although the team has no further MS studies planned at this stage, in a perfect future, Munger told MNT that she would "spend time and money on better understanding the role for physical activity in promoting wellness and improving quality of life among MS patients."
We still have much to learn about MS and the risk factors involved. No doubt further research will steadily provide the vital details necessary to prevent this debilitating condition.
Learn about a new MS drug that promises to reduce progression.

Written by Tim Newman

 

Today on my way home from the gym, I got to thinking…..I am a HUGE believer in exercise – whether it be training for a marathon (so NOT ever going to be me,) playing sports, hitting the gym for cardio & strength and training, taking a walk or a hike OR yoga and stretching, the health benefits for anyone are enormous! But for those of us with a disease like Multiple Sclerosis, that can wreak havoc and even destroy mobility it is even more important.  To keep those body parts that can move, moving and to maintain strength.  What works and doesn’t work will certainly dictate what you can or can’t do but I started thinking that there is plenty that we can learn from each other.  So I wanted to start a new segment on my blog…

Wednesday Workouts

Some weeks I will share my accomplishments for the week, others I may share a story from my past about fitting exercise into my post MS life, I may share a product, piece of equipment or specific exercise that I have found helpful and I hope to have some guest posts from other badass MS Warriors out there! I would LOVE to hear from you about your own experiences with trying to fit exercise into your “new” life!

I have ALWAYS worked out – it is just a part of who I am.  On my Segway Into My Life post I talk about the fact that prior to being diagnosed with Multiple Sclerosis I was running an average of 6-8 miles MOST days.  I also frequently swam (topped off at about 2 miles) and did lots of strength and core training.  Shortly after experiencing my first symptoms my walking and balance rapidly declined, and running (or even walking without my soon to be BFF, “Pinky” the cane) was out of the question.  But being in such good shape at the time most definitely helped me; I have no doubt that if I hadn’t had such a strong core things could have been WAY worse on the “stumbling around like a drunk” front.

I knew that I needed to keep it up, to keep my strength and endurance up as much as possible.  Initially the only form of exercise that I felt safe doing was swimming (can’t really fall down when in the pool:)  I became quite the oxymoron.  I would hobble into the pool area, with trusty “Pinky” at my side, awkwardly (and sometimes dangerously) manage down onto my butt at the pool’s edge, and kinda of fall forward into the pool (the only safe falling I was doing at the time!:)

Once in, immersed in the cool and quieting water, all my clumsiness and floundering were left behind.  I was able to swim, lap after lap, tied together in sequence by the flip-turns I had struggled as a child to master.  Back and forth I would continue, finding some of the first moments of silencing the damn voice of doubt (What I Hate Most About Having Multiple Sclerosis.) It made me feel good to know that I could still do something well, that I had found at least one thing that I didn’t have to do differently to accommodate the unwelcome guest of MS.

My time would be up, whether dictated by the pool hours or time constraints to pick the kids up from school (damn kids!) I would reach the end of my final lap, throw my swim cap and goggles on the edge and begin my less than stellar exit.  The initial act of doing so wasn’t too bad.  Supporting myself on the wall and using my arms I was able to easily pop up and get my ass onto the ledge.  That’s where the grace and beauty would end.  I always left Pinky laying there in wait for my exit, but it was almost inevitable that the pool deck was by then wet and getting up off your ass with just a cane and noodle legs on a slippery surface is never going to go well and is often going to go bad.

I would eventually make it back into the upright position to then begin my stumble back to the locker room, knowing that there had to be people staring in wonderment – how could someone that was just swimming like “that” then be so apparently physically challenged, as I “walked” away like I did.  I got it – I would probably wonder the same thing if it had been someone else, and not me.

I would eventually garner up enough courage to return to the gym to try and tackle new ways of doing things but I feel so fortunate that I had swimming as an option in those first months.  It allowed me to keep a little bit of myself in tact, while not threatening my safety.

EXERCISE IN MULTIPLE SCLEROSIS: Catherine W. Britell, M.D.First, MS is a disease of nerves, not of muscle. So the muscle wasting you get with MS is not due to any abnormality of the muscle itself, but due to an inability of the nerves to tell the muscle to contract and atrophy of the muscles, essentially from disuse. This, of course, causes weakness and this effect of “weakness” is often compounded by spasticity (inappropriate short or prolonged muscle contractions) and lack of coordination (the muscles can be made to contract but not in a way to work together to do the necessary task).
Exercise will NOT:
(1) reverse the demyelination caused by MS
(2) prevent the demyelination caused by MS
(3) alter the neurologic course of the disease.
Exercise MAY:
(1) improve a person’s overall mood, affect and feeling of well-being,
(2) be the only effective measure in weight control
(3) improve stamina, decrease fatigue, improve sleep, and allow more independent functioning.
From the above, it seems that exercise, done properly, is a pretty good treatment for MS…medical science has so far not given us much else that could be as useful with as few side effects.
But, speaking of adverse effects, there are some caveats about exercise in MS:
(1) Overexercise can lead to increased weakness, fatigue, pain, and spasticity.
(2) MS and/or some medications you take (bladder meds in particularly) can alter the body’s ability to dissipate heat, and so people with MS are susceptible to overheating–and of course overheating will increase MS symptoms.
(3) Muscle weakness around joints can cause joint instability, and it is particularly important to prevent injury to joints when doing exercise. An injury will cause pain, which will often make spasticity worse as well as lead to more weakness.
(4) If one is deconditioned (very sedentary) one must make certain that suddenly increasing the workload on the cardiovascular system doesn’t have catastrophic consequences (e.g. angina or heart attack).
Of course, there are people with MS who have completely or almost completely recovered from an exacerbation and who run 5 miles per day, and those who are severely quadriparetic who drive powered wheelchairs. The optimal exercise programs for these two groups of people (and everybody in between) are going to be very different. For this reason, it’s a very good idea to work with a doc and physical therapist who understand MS and are experienced in evaluating for potential complications and designing optimal exercise regimens.
In general, one should have a program that combines training for cardiovascular fitness and strength. It has been shown that most patients with MS CAN improve their strength and fitness levels….however the improvement will vary greatly. In general, swimming (NOT in a hot “therapeutic” pool, but rather one in which the water is kept cool) is often an excellent exercise modality for MS because it provides maximal total body exercise, minimal joint stress, and optimal heat dissipation. Other effective exercise modalities will depend on the individual, his/her abilities, needs, specific contraindications, etc.
One last thing…it’s important, I believe for the person with MS not to become a “professional patient”. If a little exercise is good, more is not necessarily better. Even if one doesn’t get symptoms of overuse, there is a limit to the effective benefit of an exercise program in terms of time spent. If an exercise can be functional and fun, it’s not only a great deal more likely to fit into a person’s life, but it will be more useful to the individual. Although one must naturally spend some time each day dealing with MS and self-maintenance issues, including an exercise program, there’s a great deal more to life. Focusing one’s attention and energy outward, away from the MS and all the challenges it brings is generally the most healthy thing to do most of the time.

Several studies have shown that exercise can improve movement in multiple sclerosis (MS), but new research indicates that it specifically may also  improve reaction time, a measurement of cognitive impairment. The study, titled “Acute effects of varying intensities of treadmill walking exercise on inhibitory control in persons with multiple sclerosis: A pilot investigation“ and conducted by researchers at the University of Illinois and the State University of New York, Buffalo, appeared Nov. 10 in the journal Physiology and Behavior.
Treadmill walking could be the best form of exercise for people with MS who are fully ambulatory. However, researchers do not yet know how much walking is needed to have beneficial effects. The investigators of the current study, led by Brian M. Sandroff of the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, wanted to measure levels of walking against improve reaction times and to find out if there’s a correlation between the intensity of a walking exercise and increases in the level of improvement observed.
The study compared the influence of light, moderate, and vigorous treadmill walking on what is known as inhibitory control — a mental ability to react to stimuli. A fourth condition included a period of quiet rest, to compare the effects of no walking whatsoever. All of the 24 study participants undertook each of these four conditions for 20 minutes in a random order and then went through a modified flanker task, or test of reaction time, in which subjects either respond to specific relevant stimuli or ignore irrelevant stimuli. The time it took to respond correctly and appropriately was measured as reaction time.
Each of the three exercise levels improved reaction time in the flanker task when compared to quiet rest, but the different  treadmill speeds did not appear to bring different levels of benefit. In their study, researchers noted, “There were no differences in magnitude of reduction across the three exercise intensities.” They further stated, “The present results support light, moderate, and vigorous intensity treadmill walking as exercise stimuli that might particularly benefit interference control of reaction time. This represents the next step in delineating the optimal exercise stimuli for improving this cognitive function in fully-ambulatory persons with MS, and perhaps is important for informing a subsequent longitudinal exercise training intervention.”
Future studies may focus on comparing other exercises to treadmill running. Ultimately, understanding the best type of exercise and how much is optimal could help physical therapists and physicians in planning and recommending specific exercise programs to people with MS.

While many of us have heard of Multiple Sclerosis (MS) and its devastating effect on an individual’s quality of life, research does not support many commonly held misconceptions, including the impact of exercise on MS.

WHAT IS MS?

Let us begin by reviewing what MS is. Simply stated, it is a progressive neurological disorder in which myelin, a fatty tissue surrounding the nerves in the brain and spinal cord, is degraded. This results in the production of scar tissue (sclerosis). Myelin is essential in transmitting impulses along nerves, so an absence of this tissue slows down and disrupts communication between the brain and body causing difficulties with muscle contraction, movement, and cognition. 3,4,6,7 Roughly 55,000 to 75,000 Canadians and greater than 2 million individuals worldwide are afflicted with MS. 1

Figure 1.

Symptoms of MS Include: 1,3,6,7
– Tingling/numbness of limbs
– Fatigue/lack of energy
– Poor balance & coordination
– Muscle Weakness
– Bowel & Bladder dysfunction
– Pain Movement disorders /paralysis – Heat sensitivity

Figure 2.

What many of us don’t realize is that although MS can be fatal, many individuals with MS have a normal lifespan.4 Another common myth associated with MS is that it leaves individuals immobile. 4 There is no doubt that MS reduces an individual’s mobility, however, if caught early and managed with appropriate treatment, individuals with MS can maintain mobility and delay or avoid the need to use wheelchairs or other assistive devices.4 MS can be classified as mild, moderate or severe, based on a scale of disability from 0-6 known as the Kurtzke Expanded Disability Status Scale.3 Scores of 0 indicate normal function, 1 indicates symptoms of MS without disability, and finally scores of 2-6 indicate increasing levels of impairment. 3
Many of us have difficulties motivating ourselves to go to the gym and be active, myself included. We may lack motivation, feel fatigued and simply lack the energy to go for that run. This inactivity can hasten the development of secondary health conditions such as: 5,6
-Obesity
-Coronary heart disease
-Muscular Weakness
-Osteoporosis or low bone mineral density

Figure 3.

Imagine how the 89.6% of individuals with MS who suffer from excessive fatigue felt when medical professionals told them they should engage in more exercise.
Contrary to what we may think, studies
have shown that exercise can actually
reduce generalized fatigue in individuals
with MS.2,3,5,6 Individuals with MS who
exercised at least 2 times per week for a minimum of 30 minutes saw improvements in their quality of life and decreases in fatigue and depression levels.4
Keeping the body active is a great strategy to maintain mobility and muscle function, but also to prevent secondary complications associated with sedentary behavior. For most people, regular exercise leads to increased muscular strength, endurance, and improved cardiorespiratory health, the same is true for individuals with MS.6 While exercise can’t reverse the nerve damage, it will keep the body strong and reduce the chances of developing secondary health conditions which complicate MS symptoms.

EXERCISE CONSIDERATIONS FOR INDIVIDUALS WITH MS

Temperature is a major consideration in individuals with MS since roughly 80% of individuals diagnosed with MS will experience general heat sensitivity.3 Exercising in warm environments and elevating core body temperatures too much have been shown to increase individual’s weariness, and reduce exercise workloads which can be achieved before the onset of exercise induced fatigue. This is because increased body temperature further slows the conduction of impulses in damaged nerves.6

Figure 4

Cooling the body, however, produces reductions in the symptoms associated with MS (white). 6 In light of this, it is advisable that patients with MS:
– Exercise in the morning when minimally fatigued and when daytime temperatures are lower
– Exercise indoors out of the heat of the sun in hot, humid summer months
– Engage in pool exercise in water temperature of 27-29 degrees Celsius. Water is a fantastic medium to allow for the dissipation of heat and can also be used to cool the body before performing on land workouts. 6

 MUSCLE WEAKNESS & BALANCE

Poor transmission of nerve impulses may cause pronounced muscle weakness in individuals with MS. Weak musculature can result in poor balance and muscular coordination issues increasing the risk of falling and even fractures. In fact risk of fracture is 2 to 3.4 times greater in individuals with MS. 6
For this reason, it is recommended that individuals with MS perform cardiovascular exercise on a cycle ergometer or in a pool where the risk of falling is minimized. 6
Exercising in water has the additional benefit of providing a resistance to movement without any exercise equipment. The buoyancy of water also allows weak limbs to be supported through a greater range of motion. 7

Figure 5.

Figure 6.

EXERCISE PRESCRIPTION

Now that we’ve laid out the condition and all special considerations associated with MS, lets get to the “meat and potatoes”… how often, how long, and what muscle groups should be targeted?
For strengthening, and stretching exercises, particular focus should be placed on the major muscle groups of the body including the abdominals, hip flexors, hamstrings, groin muscles, buttock muscles, calf muscles, muscles which extend the neck, chest and anterior shoulder muscles. 3 These are all muscle groups we use on a daily basis in standing, walking, lifting or pushing objects. Weakness in one or more of these muscle groups may cause difficulty with activities of daily living. For example, weak buttock muscles may cause an abnormal walking gait in which one the hips drop while walking.

STRETCHING

Before you can begin strengthening muscles flexibility and good range of motion in the joints and muscles are essential. Increasing range of motion is done via stretching.
Stretching guidelines by the National MS Society suggest individuals with MS should:3,7
– Stretch daily and repeat the stretches at least twice per day
– Stretch until a pull is felt, but not to the point of pain
– Hold each stretch between 20 – 60 seconds.
– Avoid bouncing motions keep motions slow smooth and controlled

STRENGTH TRAINING

Now that joints are mobile, it is time to develop some muscular strength. Without some baseline strength, cardio and endurance exercises can be challenging, as a result some basic strengthening is usually performed before any intense cardio programs begin.
Strengthening progressions should begin with light resistance in the form of theraband tubing, progressing to exercise machines and finally to free-weight exercises. Free weights are the final progression because in free weight exercises many other muscles besides those we are specifically training are activated to stabilize the body.
Guidelines for Strength & Resistance Exercises are as follows: 3
– Exercise 2 – 3 times per week, cycling through a series of exercises targeting major muscle groups.
–  Rest between exercises for at least 1 minute or until you feel ready for the next exercise bout
–  1 – 3 sets are recommended ensuring you start low and progress to more sets as you are ready. 
It is important to ensure that exercise is tolerable at all times.
–  8 – 15 repetitions is the general recommendation, once 15 repetitions of an activity can be 
completed within 2 consecutive exercise sessions, this is a sign that the intensity of the exercise should be increased.


CARDIOVASCULAR EXERCISE

Cardiovascular exercise aims to improve the health of your heart and lungs to allow individuals to cope with the physical demands placed on the body and prevent any secondary conditions such as coronary heart disease. 
Cardiovascular Workouts should be: 3


- 3 days per week alternating with strengthening workouts

– 20- 40 minutes per workout session is favourable, or multiple shorter exercise bouts adding up 
to this approximate time frame.

– Performed at an intensity described as fairly light to somewhat hard.

CONCLUSION

In patients with MS, persistent inactivity is quite common and can complicate and worsen MS 
symptoms decreasing their overall quality of life. Exercise affords these individuals the opportunity to take some control over the course of their condition and strengthen their bodies to maintain as much physical function as possible. Research has revealed that contrary to past beliefs that exercise increases fatigue in MS patients, exercise may actually relieve some fatigue and serve as a motivator. It is important to be mindful of special considerations for individuals with MS during exercise and begin at a low level of physical exertion and slowly progress. Overall with proper supervision and adherence to recommended exercise guidelines individuals with MS may greatly benefit from being physically active.