The Promotion of Exercise for Multiple Sclerosis

Introduction

There are almost one million people in the United States living with multiple sclerosis (MS), and about 2.3 million globally (5). Research supports the benefits of a comprehensive exercise program that includes hydrotherapy exercises, resistance training, flexibility, and cardiorespiratory activities for those living with MS (2,3,4,6,7). This article aims to provide personal trainers with ideas for exercises to meet the needs of individuals with MS.

Exercise as Treatment

Research has shown that chronic pain experienced from MS is primarily due to muscle spasticity, weakness, or imbalance (5). Muscle spasticity is a condition that causes the muscles to contract continuously, and the prolonged contraction can cause stiffness and loss of flexibility (5). An option to help reduce pain from muscle spasticity, weakness, and imbalance is the use of hydrotherapy-based exercises. Hydrotherapy is the use of a water environment for exercise that creates physiological responses (vasoconstriction or vasodilation) to cold or warm temperatures.

Research has shown participants who participated in hydrotherapy exercises experienced relief of pain, spasms, and fatigue by exposure to a cooler environment (3). Results suggest that the cooler temperatures and pressure of the water block nociceptors and effect the thermal receptors and mechanoreceptors to produce a positive effect on spinal segmental mechanisms, and therefore, reduce pain (5). Further, participation within an eight-week hydrotherapy program may increase neural adaptations, improving overall muscular function (5).

Application of Exercise Exposure and Prescription

Hydrotherapy-Based Exercises

Exercise in a cooler or warmer water environment may allow for greater ROM and flexibility with less negative symptoms versus exercises that are land-based, especially in MS clients just beginning an exercise program. The necessity of two separate aquatic temperatures results from thermoregulation complications that many MS clients face. Due to the thermoregulation limitations, the temperature should not be so cold that the client begins to feel pain, nor so warm that the client becomes overheated. For increases in ROM and flexibility, clients should perform slow exercise movements in warmer water temperature between 86 – 92 degrees. To ensure comfort, it is pertinent that the client only engage in slower ROM movements in warmer water to prevent overexertion and fatigue. For improvements in balance, strength, and coordination, the ideal water temperature is slightly cooler at 80 – 85 degrees (3). The neurological adaptations from exposure to the aquatic-based program can improve muscular strength and performance of daily activities, and potentially lead to a more effective transition for the client to land-based exercises. Table 1 details sample hydrotherapy exercises for MS clients.

Table 1. Sample Hydrotherapy Exercises for MS Clients

Land-Based Exercises

Flexibility

Clients with MS tend to lack ROM in their joints, which can cause musculoskeletal pain, spasticity, and muscular imbalance around a joint (6). Flexibility exercises can reduce muscular tightness, increase ROM, and potentially reduce the risk of injury. Research has supported flexibility exercises for clients with MS, as it has shown to improve residual abilities, mobility, and functional fitness (6). A six-week training protocol that included, among other modes of training, static stretching and resistance training with bands, with a minimum frequency of twice per week showed significant reductions in fatigue-related symptoms from MS (6). Table 2 provides options for flexibility exercises for MS.

Resistance Training

Activation of additional neural synapses may help decrease muscle spasticity and muscular imbalance through increased muscle fiber activation. Additionally, adaptations can include increased muscle fiber diameter, increased energy substrate stores, stronger muscular contractions, and reduced fatigue (7). According to the American College of Sports Medicine (ACSM), individuals should participate in resistance training 2 – 3 days per week of 20 – 40 min per session for at least eight weeks (1). Programming for MS clients is not much different. Research suggests a resistance training focus on strength and endurance at a prescription of 8 – 12 repetitions of a moderate weight (7). However, some persons with MS may experience fatigue more quickly; therefore, it is critical for personal trainers to modify and progress the program according to the client’s ability. MS clients who have not participated in resistance training regularly, or have not completed hydrotherapy training first, may need to begin on the lower scale of the ACSM guidelines to build strength and endurance, and to prevent injury, pain, and/or overtraining. Table 2 includes sample land-based resistance exercises that are beneficial for those with MS.

Table 2. Sample Resistance and Flexibility Exercises (Land-Based) for MS Clients

Cardiorespiratory Training

Cardiorespiratory fitness is critical for all populations, and can be a major factor in overall health and daily activities. The department of labor reports that the participation of cardiovascular activities among adults with chronic or autoimmune diseases was 12% from 2009 – 2015 (8). Some common forms of cardiorespiratory exercises, such as jogging and dancing, have high-impact effect on joints, which can cause discomfort in MS clients. However, research supports the inclusion of cardiorespiratory exercise for those with MS. Specifically, a review of studies has shown that cardiorespiratory exercise at low- or moderate-intensity have positive effects on both physiological and psychological factors among people with MS (2).

ACSM recommends participation of 150 min of moderate cardiovascular exercise (40 – 60% heart rate reserve [HRR]) or 75 min of vigorous exercise (60 – 85% HRR) each week. This prescription can be challenging for some MS clients. Implementation of low-impact, and possibly low-intensity, cardio exercises with sufficient recovery time before the next cardio day is critical for those with MS. Initially, utilizing hydrotherapy as the environment for cardio exercises may be most beneficial for maximum adaptation and minimum discomfort. Once the client does not have any residual pain or discomfort from cardio exercises in hydrotherapy, incorporate land-based cardio, staying mindful of needed modifications to meet impact, intensity, or balance concerns. Table 3 provides a sample of low-impact cardio exercises and potential modifications.

Table 3. Sample Cardiorespiratory Exercises for MS Clients

Table 4. Sample Program Design for MS Clients

Weekly Program Design

Once a foundation of the exercise intensity and impact is implemented, designing a program for MS clients can have several options. Table 4 provides a sample eight-week program for MS clients with a specific focus for each week.

Conclusions

MS patients should also be encouraged to complete a variety of exercise types for many benefits related to symptoms and side-effects of the disease. MS clients may best benefit from an initial hydrotherapy program, then moving to land-based resistance, flexibility, and cardiorespiratory exercises. Combining these therapies will allow persons living with MS the opportunity to attain health benefits; increased muscular strength, ROM, and flexibility; and potentially decrease fatigue, pain, and risk of injury.

This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »