A relapse is a scary experience. For me, I lost my ability to walk properly without falling over, hearing in my right ear, and strength in my right arm. I thought it was permanent. After about a month those symptoms abated and I could hear, lift and carry my son, open things, and walk again. Not simply walk, but I could run again. It took time to feel confident in the movement, just as it took time with bouldering to feel that my arm would support my weight as it once did. That relapse was a reminder to me that the strength, flexibility and overall fitness of our bodies should be something we strive for, not only for the obvious physical benefits but for the deeper biological benefits as well. For people with MS, it can reduce the severity of relapses, improve quality of life, and help regain control and movement and thereby maintain independence for the rest of your life.
As multiple sclerosis impacts the brain and spinal cord, those impacts can result in significant mental and physical symptoms. Often due to these impacts people give up exercising, for fear it will make their symptoms worse and trigger a relapse, they feel too fatigued, or because they don’t know how to exercise with the new functionality their MS has presented them with. What is known is that continued fitness and regular exercise is essential for long-term health of anyone, and can be especially beneficial in people with MS.
This is the most extensively studied area of exercise in relation to patients with MS. As a result, we have a huge body of work that details the evidence of why getting moving with your body is good for your MS (and your health in general).
Cardiovascular fitness includes any kind of aerobic training, probably familiar to you as cardio (e.g. swimming, running, cycling, brisk walking), that raises your heart rate and your breathing. It can be low to high intensity, and the benefits are not only to your health and body performance, but also there are neurobiological benefits as well.
In terms of your general health, aerobic exercise can strengthen you lungs, diaphragm, and heart, improving your ability to breath and pump blood efficiently around your body. It can reduce stress and lower depression. Your risk of developing diabetes and death due to cardiovascular problems also decreases, and you can stimulate bone growth, reducing the risk of osteoporosis – a serious issue as we age.
When we move on to body performance, our bodies become more capable of withstanding the exercise we put it through, recovering quicker the more we exercise. We are also able to utilise the energy stores in our body more efficiently, often seen as the positive side effect of some weight loss as the energy in fats are used up before our carbohydrate stores. We are also able to endure more, which is important if you have a busy lifestyle and are always on the go – if our bodies are getting regular aerobic exercise, we are able to handle more day to day activities and end up less tired than we would without the exercise.
Lastly the neurobiological impacts are incredibly important and relevant to everyone. With regular aerobic exercise there is evidence of improvement in the structural connections of the brain and new neuron growth, as well as an increase in the gray matter density. This may help explain the related improvements shown in cognitive function and the improvement in overall mental health. One large study goes so far as to suggest that being physically fit makes you smarter and more successful.
The impacts get even more specific and beneficial for people with MS. Aerobic exercise of low to moderate intensity can improve cardiovascular fitness, your quality of life and mental health, and can reduce stress. Regular aerobic exercise can also reduce fatigue, and not only in people with MS, but for anyone. It seems the best way to handle feeling tired is to go out and get some more exercise – as counter intuitive as that sounds, it works.
The neurobiological benefits were also found to be specific in people with MS. One study has shown that exercise is associated with preserved gray matter and better white matter integrity, that is the neurons are better connected in our brains which means a reduction in long-term disability. This is fantastic! When I read these results I wanted to throw down my computer and head out into the park for the longest run I could manage, all the while thinking about how my brain was adapting and recovering from the damage my MS had caused.
People with MS tend to be less physically active and weaker than other adults. Whilst some of this may be down to the impact of their condition, it has been shown that people with MS can improve their strength with resistance training (also known as weight training), essentially undoing some of the impact MS has had on your strength. Weight training is often shied away from in women, who make up two thirds of those impacted by multiple sclerosis. Yet there are many benefits of resistance training that unless you’re taking anabolic steroids, you won’t “bulk up”.
In general, strengthening your muscles through weight training will help protect your joints from injury, improve your posture and balance, and prevent you from becoming frail as you age (when we age we naturally lose muscle mass leading to the picture of frailty we imagine of the elderly). As with cardiovascular fitness, weight training can help to prevent osteoporosis and decrease the incidence of falls. Now whilst this is aimed at older people (in their 70s) the benefits and relevance hold true to younger people as well; we don’t simply start falling over when we reach 70, it’s a progressive loss of muscle mass and stability that leads to this result that starts in your 30s. In the MS population there is often decreased leg strength that coupled with impaired balance increases the incidence of falls; this can be mitigated by resistance training.
More specifically, for people with MS resistance training has been reported to reduce the rate of relapse, improve fatigue levels, decrease disability scores, as well as increases in strength and overall functional capacity thereby helping you maintain independence long into your old age. Further, it decreases depression, increases quality of life, and reduces the risk of other conditions, such as diabetes and cardiovascular disease.
Flexibility & stability
Tied in ever so tightly to cardio and weight training is flexibility and stability. As your cardiovascular fitness improves and your muscles get stronger, your overall stability will improve. What can often happen though is you lose flexibility. This is a natural part of ageing, but can also be more obvious as you start to exercise more, especially if you don’t stretch, stretch too much, or don’t take the time to focus on your flexibility and stability alone.
Flexibility varies greatly between individuals, however it can be increased to some extent through exercise and stretching. For anyone looking to increase their range of motion there are some great benefits, such as preventing injuries (important if you’re going to undertake cardio and weight training for your health as talked about earlier), preventing back pain, and increasing balance. If your muscles can move freely and utilise it’s full range of motion, not only do you see better athletic performance, but every day tasks become easier, such as bending and reaching. As a side note, it’s no longer recommended to stretch before exercise, instead you should start your workout with a sport-specific warm-up, such as a gentle walk, or serving some tennis balls, or a few light reps of a weight lifting movement to get blood and oxygen to your muscles. Once your muscles are warm and soft then it’s a good time to stretch.
For MS, little research has been done in this area, however it is thought that flexibility exercises can diminish spasticity and prevent future painful contractions. However, whilst looking at flexibility and mobility routines to incorporate into my workout routine I came across Dana. She has had MS since 2006 and is challenging her body to maintain and regain functionality. Dana has been following a particular flexibility and mobility program and has seen a dramatic improvement in her spasticity, her functionality, and her flexibility. As you search the web more, you will find more examples of people with MS increasing their flexibility, stability, and overall functionality, thereby improving their quality of life and in my opinion taking control of their disease to gain back part of their life.
Things to consider
There are many factors that can complicate getting a workout routine going in your life. These include your level of fatigue, spasticity, balance, heat sensitivity, and disease activity. However, most of these can be improved by exercise, and whilst you should be mindful of how tired you are before you start a workout, you should also be careful that you don’t start using it as an excuse to not do it. It is incredibly common and easy to fall into the “I’ll do it later” camp, yet it is so important to persist and dedicate yourself to your health, the long-term benefits are immeasurable.
If you are new to exercising you need to consult with your doctor and get a program that is suited to you. If your main issue is poor balance, your focus should be improving that balance before moving on to something like endurance.
Exercising is known to decrease the risk of many health conditions, from diabetes and high blood pressure to cancer, osteoporosis, and cardiovascular diseases. When you add MS into the mix you’re looking at a population of people who tend to be less active and weaker, who also may present with any of these conditions on top of their MS. This is known as a comorbid health condition and they have an adverse effect on people with MS. People with MS and comorbid health conditions often see a more rapid disability progression, poorer mental health, and a lower quality of life. It is very common for someone with MS to have another health condition, as it is for anyone with a chronic condition in the first place. This highlights the importance of taking control of the aspects of your health that you can control, and with the numerous positive impacts and risk reducing behaviours exercise provides, it’s essential that it becomes part of your forever lifestyle, not to lose weight and get that summer bod – that should be the added bonus!
One thing that I really want to stress is that exercise in seen as a rehabilitation tool for MS, that is, it is seen as a way of recovering from our condition, and doesn’t recovery from MS sound like a great idea? As with diet, exercise is something we have control over. Whilst the activity of our MS may change how we can exercise, there is always a way around the limitations we are facing. Getting in touch with a good physiotherapist or finding a great trainer who appreciates and understands MS is a good start if you’re unsure how to incorporate exercise with your current abilities.
Feel free to get in touch and I’m more than happy to discuss ideas for how to get and stay active, focusing on your cardiovascular fitness, weight training, and flexibility and stability.