When a doctor suggests exercising to maintain strength and flexibility, some patients diagnosed with multiple sclerosis (MS) may think, “Why should I bother?”
But a regular exercise program, tailored to the individual’s physical condition and symptoms, can make a huge difference for those with MS, says neurologist Mary Rensel, MD.
Physical or occupational therapists can put together specific programs for MS patients. The programs tend to vary widely because of the disease’s unpredictable course.
“Some patients run triathlons; others can’t take two steps,” Dr. Rensel says. “There is not any one particular exercise that works for everybody.”
So what might be the most important exercise that most MS patients can do?
“Probably stretching,” Dr. Rensel says. “MS patients tend to have tight muscles. Those with more weakness tend to have more stiffness, but those with normal strength still can have stiffness, too.”
Exercise is important for MS patients for other reasons, too, Dr. Rensel says. Cardiovascular exercise can help avoid obesity and other conditions that may speed up the damage wrought by MS. Regular exercise also increases brain health and wellness, including memory.
Physical therapy vs. occupational therapy
Physical therapists tend to work with patients who have issues with feelings of stiffness, involuntary muscle spasms, balance, frequent falls, leg weakness and difficulty walking, Dr. Rensel says. Therapists prescribe strengthening exercises that help stabilize the legs and make the gait more regular.
For those who have weakness in coordination or tremors, occupational therapists focus on a patient’s arms and upper extremities.
“They can tailor a program to strengthen those muscles and help with those symptoms,” she says.
Working with a personal trainer is helpful for patients at all levels of disability, Dr. Rensel says, although she advises to check with your health insurer to see if you’re covered.
The National Multiple Sclerosis Society sometimes helps MS patients pay for gym memberships. Check with your local chapter.
Severe vs. mild symptoms
Exercise plans for MS patients will differ from person to person, depending on the individual’s level of symptoms and overall strength and flexibility, Dr. Rensel says.
While all patients suffer some stiffness, those with more severe symptoms need to stretch that much more intentionally. Dr. Rensel recommends yoga, pilates and other exercise classes “that incorporate long, slow stretches.” Some studies show that tai chi helps with pain, fatigue and overall quality of life.
Patients with more severe symptoms need to pace themselves while exercising, Dr. Rensel says.
“Do it a few times a day, but more slowly, or over shorter periods of time to decrease poor endurance,” she says.
Some patients tend to have trouble with their core overheating, which can make exercising in water an attractive choice.
“Some people, if they’re outside, need to keep the sun off of them. Also, it helps to wear cooling vests and collars, drink cold water and otherwise keep the core temperature down,” she says.
Do what you can
If you have limited strength, lifting soup cans might be the best you can do, Dr. Rensel says.
“There can be people in wheelchairs who, that’s the only strengthening action they can do comfortably,” she says. “But it’s important for people with a high level of disability to do weights and stretching.”
For those with milder symptoms, weightlifting and aerobics are still important. “Folks with little to no disability should do something they enjoy,” she says.
–Brain and Spine Team, health.clevelandclinic.org