Hello friends and Happy Tuesday! I am coming your way with another Exercise Guide today. Multiple sclerosis is a scary diagnosis to receive and definitely has lifelong implications. But much like diabetes, management is key in living a mostly normal lifestyle. And one of the best tools we have for management is movement.

Multiple sclerosis, or MS as it is commonly abbreviated, is a degenerative autoimmune disease. In any autoimmune disease, the immune system attacks another part of the body. In the case of MS, the immune system attacks the central nervous system. Specifically the myelin sheaths that cover a majority of our nerve cells. The immune system eats away at the myelin over time.

Myelin is a fatty substance that wraps around the axons of the nerve cells. Myelin provides insulation for the nerve cell and more importantly, helps conduct nerve impulses quickly and fully. When myelin is damaged, nerve cells have trouble communicating with each other. There may be delays in messages getting from one part of the body to another. Or, perhaps, only part of a message is received. This can result in lots of issues. Feelings of pins and needles in the extremities. Blurry vision or trouble focusing the eyes. Loss of strength, stability, or coordination in the muscles.

MS can be diagnosed into several different categories. But what is true of all of them is the progressive loss of function. From a movement perspective, the central nervous system (CNS) is responsible for planning and initiating any movement. The CNS is also on call for modifying movement on the fly via input from the periphery. It’s the hub for everything we do. And if its nerve cells are damaged, we will lose our ability to move properly.

The good news is that movement and exercise also stimulate the need for proper nerve connections. By moving the body regularly, we demand that the CNS be able to communicate with our muscles well. In the damaged nerve cells, movement can help remove the cell debris from myelin breakdown and signal the repair process. Regular movement also stimulates the need for new nerve connections. Basically, movement is neuroprotective.

As with any chronic condition, there are challenges with MS. First, there are huge muscle symptoms to deal with. Sometimes muscles are rigid and inflexible. Sometimes they are spastic (prone to incomplete, unplanned, or unintended movements). Balance and mobility are definitely compromised. Secondly, MS symptoms can be impacted by increases in body temperature, something exercise does naturally.

How does all this scientific mumbo jumbo translate if you are living with or working with someone affected by MS? First, you need to understand the specific diagnosis and where in the disease progression timeline you are. Detailing these are way beyond my scope of practice (or any trainers for that matter), so this is a matter of listening to your client and seeking out professional medical advice as necessary.

If you are working with someone that experiences flares, you’ll have to accommodate the lower tolerances during a flare cycle. If you are dealing with a progressive form, be aware of baseline levels, keep an eye out for new symptoms, and be ready to adjust on the fly.

Rhythmic and repetitive exercises, like walking, biking, or swimming, tend to result in the best preservation or development of nerve cells. Plus low intensity cardiovascular exercise is good for the heart and lungs. Keep your eye on conditions that will cause body temperature to rise (i.e. ambient heat and intensity of exercise) and try to control those to help alleviate symptoms.

I believe that strength training is hugely important for MS. Beyond the muscle benefits, there are similar neuroprotective bonuses. It is a little known fact that even in young, healthy individuals, initial gains made during strength training have less to do with the muscles themselves and much more to do with improvements in the CNS and how our brain communicates with the muscles. Sounds like a win here.

Start with the most challenging versions of exercises that are well tolerated. Leave plenty of time for between set rest and recovery. Watch for mobility and balance issues, but if the individual is willing, don’t be afraid to challenge them. Obviously, keep safety in mind, though. Strength training will reveal weak spots or developing symptoms like nothing else, so have a keen eye and write it all down.

Stretching is highly recommended for MS due to muscle rigidity and spasticity. Exercises like yoga or tai chi will also aid in mobility and range of motion. These are also great exercises to have in your back pocket as they offer mental health benefits. These types of exercises are also especially critical if you are dealing with flares as these might be the only tolerable ones.

Low intensity across all types of exercise is important. Fatigue is a common symptom with MS and this isn’t a group you want pushing through that. Challenge during strength exercises is good, within reason. Make sure you are evaluating your client each and every workout for fatigue. Don’t assume that they feel good today because they did last week.

Movement and exercise for multiple sclerosis is an important way to help preserve nerve function and should be approached as one of the first line defenses or treatments.

0