As a personal trainer, you may recognize this scenario:
“Mary” is a fictional 30-year-old woman who was diagnosed with multiple sclerosis soon after her 21st birthday. She is often tired in the morning, even when she gets a full night’s worth of restful sleep, which is rare. The fatigue is unpredictable, gets worse throughout the day and tends to be triggered easily. Muscle spasms and weakness in her legs make it difficult for her to walk long distances.
Weakness and fatigue made Mary less able to do her job, forcing her to quit. She has a hard time focusing for very long on tasks that require thought and attention, and she suffers from depressive episodes. As she accustoms herself to her condition over time, she may feel a little healthier emotionally and socially, but she may still have problems with her physical health.
Though our Mary is not real, these symptoms are an everyday reality for those who suffer from MS. Traditionally, caretakers have recommended that people with MS avoid physical activity and save their energy for functional daily living, but studies in the past decade have documented the benefits of exercise for MS sufferers (Dalgas, Stenager & Ingemann-Hansen 2008), so exercise professionals are becoming more essential in helping people deal with the effects of this condition.
Background on Multiple Sclerosis
The Multiple Sclerosis Association of America says MS was first recognized in 1868, when neurologist Jean-Martin Charcot lectured on the disease (MSAA 2013b). MSAA estimates that 400,000 Americans (twice as many women as men) have MS (MSAA 2013a; NMSS 2013), as do an estimated 2 million-plus worldwide (NMSS 2013).
MS is often diagnosed in young adults who have a wide range of symptoms like those described above and listed in Figure 1. Summarizing the existing research, Dalgas, Stenager & Ingemann-Hansen (2008) state that MS patients have a higher incidence of osteoporosis, owing to reduced bone mineral density; more depression and fatigue; and an increased risk of death from cardiovascular diseases compared with those without MS. The financial impact of MS can be severe: Managing the symptoms can cost a patient anywhere from $6,603 to $77,938, depending on the condition’s severity (Manouchehrinia & Constantinescu 2012).
Physiology of Multiple Sclerosis
The axon (i.e., slender projection) of a nerve cell has a protective myelin sheath made of fatty tissue (see Figure 2). In MS, the body’s immune system periodically attacks this fatty-cell covering. Myelin damage creates a buildup of scar tissue—a condition called sclerosis (hence the name multiple sclerosis)—that interrupts nerve signal messaging and leads to
a host of neurological problems with serious health consequences. Although a precise cause of this disease has yet to be identified, some scientists believe it may be a slow-acting virus (inactive for many years), along with some unknown factor
in a person’s genetic make-up.
Cardiovascular Exercise for MS Patients
Fatigue plays a large role in an MS patient’s suffering, but regular exercise can reduce fatigue. A survey conducted by Stroud & Minahan (2009) indicated that MS patients who were classified as exercisers (participating at least twice a week for 30 minutes) experienced less fatigue, less depression and a higher quality of life than those who did not exercise as much.
It appears that any kind of common exercise can produce these benefits. For example, McCullagh et al. (2008) tested
a 40-minute station-based aerobic regimen composed of 10-minute sessions that varied between treadmill walking/ running, cycling, stair climbing, volleyball and outdoor walking, including steps and slopes (11–13 on the rating-of-
perceived-exertion scale, or fairly light
to somewhat hard). McCullagh and colleagues found that reductions in fatigue and improvements in quality of life were evident and remained apparent for 6 months after the intervention, though fitness levels did drop as expected when people stopped exercising.
Exercise professionals are encouraged to determine which modes of exercise their MS clients enjoy, as multiple investigations indicate that the benefits spring primarily from the cardiovascular nature of the exercises. McCullagh et al. emphasize that MS sufferers have a hard time sticking with a program, so exercise professionals need to be cautious about progressing duration and intensity.
Resistance Exercise for MS Patients
Resistance training has proved to be just as effective as aerobic exercise in producing benefits for MS symptoms (Sabapathy et al. 2011). Interventions can range in intensity from fairly light to moderate. Dalgas et al. (2010) recruited subjects (exercise group = 16; control group = 15) for a 12-week periodized resistance training program; sessions consisted of lower-body exercises and took place twice weekly (Monday and Thursday) in a supervised setting. After a 5-minute warm-up on a stationary bicycle, participants performed ﬁve exercises: leg press, knee extension, hip ﬂexion, hamstring curl and hip extension.
Subjects performed each exercise with a fast concentric phase and a slower eccentric phase. By the end of the training, they had progressed from a 15-repetition maximum to an 8-RM (of 3–4 sets per exercise). Study results showed significant improvements in fatigue, mood and quality of life.
MS, Exercise and Gait Improvements
Snook and Motl (2009) used a meta-analytic statistical technique (which reviews existing studies and summarizes the overall findings) to examine the effects of exercise training on walking mobility among persons with multiple sclerosis. Results indicated that exercise training of all types could bring about small but important improvements in mobility with MS patients.
Exercise Design Applications for MS Patients
Clients with MS will generally tolerate a combination exercise program quite well if it consists of equal parts resistance exercise and aerobic exercise—2 days per week of each, with at least 1 day of rest between similar sessions (Dalgas, Stenager & Ingemann-Hansen 2008). Below are some other suggestions:
- Pay attention to form. Gait abnormalities may cause a client to have improper form during aerobic exercise. Be sure to monitor form.
- Take it slow. MS clients are likely to be deconditioned and may not tolerate moderate-to-hard exercise well. Start them off slowly (fairly light) and build up gradually (progressing to somewhat hard). >>
- Allow for flare-ups. MS symptoms may be more pronounced following an exercise bout, but they will most likely return to normal within 30 minutes (Dalgas, Stenager & Ingemann-Hansen 2008).
- Listen. Listen carefully to client feedback on exercise programming, structure and progression.
- Have options. Be flexible in designing the exercise program. Many different modes of exercise are therapeutic for this population.
- Go low. Focus resistance exercises on the major muscle groups of the lower body, as research shows that muscular deficits in people with MS are more pronounced in the lower body (Dalgas, Stenager & Ingemann-Hansen 2008).