Exercise and Multiple Sclerosis (MS)
Is exercise considered safe for people with MS?
Recent research has demonstrated that exercise has no association with increased risks of adverse events or risk of relapse for people with MS.
Exercise under the guidance of a health professional is an important component to a healthy lifestyle for us all. As well as targeting strength, flexibility or aerobic based goals that you may have, regular physical activity can reduce the risk of cardiovascular and metabolic disease risk factors, improve mood and be used as a tool to manage MS symptoms such as fatigue and muscle stiffness.
What types of exercise are best for MS?
Exercise and Sports Science Australia (ESSA) released an updated position statement on exercise for people with mild to moderate multiple sclerosis in August of 2021. In this latest position statement, there is outlined supportive evidence that exercise interventions can benefit people with MS both in managing physical impairments as well as functionally and socially.
To attain optimal benefits from engaging in a physical activity program, individuals with MS who have mild to moderate disability need to engage in at least 30 minutes of moderate intensity aerobic exercise 2-3 times per week as well as strengthening exercises of major muscles affected by MS 2-3 times per week. Additional balance-training exercises are recommended for those people with MS with poor balance, a history of falls or muscle tightness.
Exercise programs should be designed and delivered by an allied health professional such as an Accredited Exercise Physiologist or Physiotherapist and should always be tailored to the individuals concerns, while accommodating for fluctuations in MS symptoms.
Overcoming barriers to exercise
Fatigue
The most commonly reported barrier to exercise in clients with MS is fatigue. Fatigue can significantly impact activities of daily living, mood, functional capacity and brain function. There are two types of fatigue seen in MS, primary MS fatigue, which directly relates to the disease processes and secondary fatigue MS fatigue, which is due external factors such as deconditioning, sleep disturbances and low mood.
Exercise and Sport Science Australia’s recent position statement on exercise with MS indicated that exercise has the potential to improve primary and secondary fatigue.
Another concern clients have when beginning an exercise program with MS is post exercise fatigue. This fatigue can be misinterpreted as an exacerbation of MS, however research indicates that this is not the case. With the guidance of a health professional las physical capacity improves with training the bodies systems should adapt over time and fatigue levels should decrease.
Heat sensitivity
For individuals who find their MS symptoms are exacerbated by heat, exercising can seem daunting as physical activity naturally increases your body’s temperature, which can temporarily increase symptom presentation. This is known as Uhtoff’s phenomenon, it is theorized that a rise in core body temperature of 0.5°C can slow or block conduction of demyelinated nerves temporarily, exaggerating symptoms. There is no evidence that the increase in core temperature, and associated increase in MS symptoms if present associated with exercise leads to MS episodes or exacerbations.
Some strategies to manage heat sensitivity while exercising include trying to
Exercise in cool, well ventilated spaces out of direct sunlight
Wearing loose, cool clothing
Staying well hydrated throughout exercise sessions, having cold water nearby
Hydrotherapy can be a great option for those who are heat sensitive, provided the pool is not heated beyond 27-29dedgrees.
Relapses and safely returning to exercise
Around 70-80% of people diagnosed with MS are classified as having relapsing and remitting MS. A relapse is defined as a new or worsening set of neurological symptoms lasting for over 24hours before resolving or stabilizing. Recovery from relapses is not always complete and residual symptoms may arise. Exercise is an important component of relapse guidelines however it is recommended that exercise programs are paused or amended by health professionals until the symptoms have stabilized. It is extremely important to listen to your healthcare professionals and your body during a relapse, safety is the biggest consideration when returning to exercise.
Reference:
Hoang, P. D., Lord, S., Gandevia, S., & Menant, J. (2022). Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. Journal of Science and Medicine in Sport, 25(2), 146-154.