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.