Approximately 400,000 Americans have multiple sclerosis (MS), a disease of the central nervous system (brain and spinal cord).  MS cannot be prevented and there currently is no cure.  The course of the disease is unpredictable.  However, physical activity makes life better for those diagnosed with this disease.

Jimmie Heuga, the first American male to win an Olympic bronze medal in Alpine skiing, is a perfect example.  At age 21, just one year after his success, he experienced a debilitating episode that led to five years of doctor’s visits and medical tests before being diagnosed with MS in 1970.  His doctors told him he was done skiing, running, and biking – exercise was forbidden.  Heuga complied at first but found his disability and frustration getting worse.  So he borrowed a friend’s bike and started exercising.  He was shocked to notice a great improvement in his symptoms and was eager to share his enthusiasm.  This led to him opening the Heuga Center in 1984 to help others with MS to be more active.

Exercise and MS

Prior to 1996, medical experts opposed exercise for people with MS, fearing it would worsen the condition.  Specifically, doctors were concerned that exercise would cause the body’s core temperature to increase; this was thought to be detrimental to people with MS because it can further slow neuron conduction.  However, researchers at the University of Utah thought differently after noticing that people with MS had higher rates of severe fatigue and depressive mood disorder and lower perceived quality of life than other people with chronic diseases.  Since they knew the physical and psychological benefits of exercise, they decided to test how 54 MS patients responded to exercise.  After 15 weeks of aerobic training, their study showed that the MS patients who exercised had better cardiovascular fitness and bladder and bowel function, a more positive attitude and less depression, less fatigue, and increased participation in social activities as well as improved perceived quality of life.

Since this ground-breaking study, multiple research studies have examined MS and exercise with similar findings.  In addition, a recent review of the MS and exercise literature found no detrimental effects of exercise.  In fact, although exercise can’t affect the course of the disease, it clearly improves quality of life if done properly.  Today, physicians encourage physical activity and exercise to help people with MS achieve a higher quality of life.

The National Multiple Sclerosis Society recommends 7 objectives for an effective exercise program:

1. Improve socialization, decrease isolation. Research indicates that people with MS exercise significantly less than the general sedentary population and have decreased social interaction and leisure time activities.  Therefore a good exercise program should be fun and have several opportunities for social interaction.
   
2. Promote well-being and improve self-esteem. Exercise programs that are goal-oriented, varied, and enjoyable will help improve the well-being and self-esteem of people with MS.
   
3. Provide an atmosphere to exercise that minimizes or prevents a rise in core body temperature. Exercise will increase body temperature but any related symptoms should disappear within an hour with rest and cooling.  People with MS should make sure to exercise in a cool environment at an appropriate intensity.  Wearing light clothing, having extra fans, pre-exercise cooling, and exercising in cool water can also help.
   
4. Prevent symptoms secondary to MS (muscle atrophy, joint contractures, pressure sores). Muscular training should emphasize passive range of motion, active flexibility, and resistance exercises such as yoga, tai chi, and exercises using the body weight as resistance.
   
5. Maintain or improve range of motion and flexibility of joints.
   
6. Maintain or increase endurance potential. Activities may also include activities of daily living such as parking the car further away, participating actively in sport and recreation, or a cardiovascular training program progressing to 3 or more days of aerobic exercise at 65% of VO2 max for 20-30 minutes.
   
7. Maximize muscle strength. If a person does not have much motor deficit, an appropriate program should include 10 to 12 repetitions through a full range of motion for 3 sets to a moderate level of fatigue.

Keep in mind that everyone with MS is different with people having good days and bad days.  Even people with severe disability may still benefit from an aquatic exercise program or using a cycle ergometer so their body weight is fully supported.  The most important thing is for people with MS to engage in regular physical activity and to do things they enjoy.

Sources:  Heuga Center, www.heuga.org; National Multiple Sclerosis Society, www.nationalmssociety.org; Natalie Digate Muth, MPH, RD, CSCS, “Improving Quality of Life for People with Multiple Sclerosis”, ACE Certified News (April/May 2006).