Symptom Management

Exercise.

Examine your reaction to that word, and you may find no small amount of resistance, even dread. At best, many of us think of exercise as a duty, an obligation to self-care about as appealing as drinking vegetable juice or taking medicine. Living with a diagnosis of primary or secondary progressive multiple sclerosis makes the question of exercise even more complex, of course. MS symptoms, such as fatigue, weakness, and spasticity, can interfere with training in more traditional ways, and we can become frustrated when our bodies do not function how they used to. Sometimes a strengthening or cardiovascular routine can put us face-to-face with precisely the thing we have difficulty doing. Given these experiences, it’s no surprise that a consistent regimen can be hard to maintain.
 
And so it would seem that a slight shift in our mindset is necessary before we continue this discussion, a change in how we think about this activity that truly is as essential for our health as both food and sleep are. Perhaps we can consider exercise as an arena in which to learn how to more effectively connect with our bodies. For instance, we can notice the effect of cardiovascular training on our breath, and the feeling of endorphins that often follow that type of workout. We can pay attention to the experience of working into a deep stretch, and the sensation of relief and relaxation as we come out of that stretch. In short, we can learn to enjoy the process of exercise and use it as an opportunity to develop a friendlier relationship with our bodies.
 
In the context of a MS diagnosis, the development of an effective program helps us to maintain the strength and function we have, and even possibly recover lost strength and function over time. Where recovery is not possible, we learn to compensate for the changes that have taken place. As one of my patients puts it, “adapt and adjust!”
   
Before we discuss the elements of an effective exercise regimen, it’s important to make sure we are not laboring under a false assumption: that exercise has a negative effect on MS.
 
Many years ago, the medical establishment cautioned those with MS to avoid exercise based on the fact that MS symptoms were sometimes exacerbated following a workout. In 1996, a study published by the University of Utah debunked this myth and demonstrated the benefits of exercise for people with MS. Among the findings were that consistent exercise over time resulted in better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities.
 
Since that time, countless studies have demonstrated the positive effects of exercise for people who have MS, as well as highlighting the negatives of a less active lifestyle. According to a 2016 statement from the National Center on Physical Activity and Disability: “In addition to improving overall health, cardiovascular fitness, range of motion, and flexibility, exercise can help one increase energy, improve balance, manage spasticity, decrease muscle atrophy, and better perform activities of daily living.”
   
Traditionally, there are four general categories of exercise: cardiovascular training, strengthening/resistance training, stretching, and balance.
 
It is important to work with a professional (ideally a physical therapist) to develop a personalized routine that targets key areas of maintenance and recovery. It may be necessary to think creatively about how to achieve particular activities in different ways. You must learn to work with limitations without creating unnecessary anxiety or tension. Of course, safety is key, particularly when practicing sitting or standing balance, and a professional can also assist in assuring that exercises are being done correctly and at an appropriate level of difficulty. One of the most common and significant limitations that comes with a diagnosis of MS is fatigue, and modifications are often necessary to accommodate this symptom. Particularly with cardiovascular exercise, it is important to monitor level of exertion using the Borg Scale, pacing your routine in the 11-13 range (“fairly light” to “somewhat hard”). Utilize cooling equipment during your routine, and consider precooling before your start. Most exercise-induced increase in symptoms will resolve quickly, so plan a short period of down time following your routine; if you find that you have longer duration fatigue, consider performing shorter duration workouts throughout the day.
 
The primary element in a successful exercise program is consistency. No matter how hard you work or how dedicated you are, changes only occur in the body with consistent practice. You want to create a comprehensive plan that feels manageable and realistic, convenient and accessible. Options to consider for exercise are: hospital-based wellness programs with accessible equipment, aquatic exercise (water temperature from 80-85 degrees is ideal), senior or online exercise classes, or use of gaming systems like the Nintendo Wii or Xbox Kinect.
 
Remember that exercise is a wonderful opportunity to develop a stronger connection and friendlier relationship with your body! The important piece is to consider your situation workable, and to notice and celebrate the small gains as they occur.