Exercise and Multiple Sclerosis

As a fitness instructor it is important to remember that each student you teach comes with a unique history of health, wellness & fitness.  Many fitness instructors are well versed in how to help a student modify for common temporary musculoskeletal aches and pains but may be left wondering what to do for students with a more complex systemic disease.  Multiple Sclerosis presents an even bigger challenge for fitness teachers since the disease presentation and progress is very unique for each individual with MS.  The good news is that studies have shown that exercise can help with symptom management and quality of life for those living with MS. 

What is MS?

MS is an autoimmune disease in which the immune system attacks the central nervous system (the brain and spinal cord). 

The nerve fibers in the central nervous system are called axons.  Surrounding each axon is a fatty sheath called myelin.  You can think of myelin as the insulation that surrounds an electrical wire.  In MS this myelin sheath is attacked, resulting in bare spots and scarring along the nerves.  

Smooth electrical conduction and communication between the central and peripheral nervous systems is important to everything we do as humans.  Our brain and spinal cord are constantly sending and receiving information from the peripheral nervous system to help us move, feel, see, even breathe.  When the myelin sheath is disrupted (called demyelination) the signals can get crossed or missed and the smooth conversation between our brain and our muscles can become choppy or silent.

There are four different types of MS:

• Relapsing-remitting MS (RRMS):  this is the most common type of MS (more than 80% of those with MS begin with relapsing-remitting MS).  With this type of MS symptoms come and go.  Symptom free periods (remission) can last from days to months.
•  Primary Progressive MS (PPMS):  this type of MS occurs in about 15% of people with MS.  Symptoms progress slowly and steadily for people with PPMS with no remission     
• Secondary Progressive MS (SPMS):  this type of MS often eventually develops in people with RRMS.  Periods of remission are replaced with periods of partial recovery.  Symptoms progressively get worse and result in greater disability over time.
• Progressive Relapsing MS (PRMS):  this type of MS is relatively rare.  People with PRMS experience a progressive worsening of symptoms and experience attacks or flare-ups during periods of remission.

Some common symptoms of MS are:

• Fatigue
• Numbness
• Problems with balance and coordination
•  Vision problems
• Dizziness
• Pain
• Spasticity (can be as mild as muscle tightness to severe pain and involuntary muscle spasms)
• Bowel and bladder dysfunction
• Emotional changes or depression

How can exercise help?

Exercise has been shown to decrease symptoms in MS including bowel and bladder dysfunction, muscle weakness, immobility and fatigue as well as improving mood and preventing secondary complications such as heart & lung disease.

What type of exercise is best?

Many different types of exercise have been shown to have a positive impact for those living with MS.

• Endurance activities improve cardiovascular health and help to reduce symptoms of fatigue in MS (walking, swimming etc.)
• Strength training activities improve muscle strength and bone density and help to reduce fatigue symptoms, improve mobility and prevent secondary complications such as bone fractures from falls (weight lifting and/or exercises that use your own body weight for strengthening such as planks, push ups, squats, lunges, etc.)
• Stretching helps to improve flexibility and mobility and prevent the muscle spasticity that can cause permanent shortening of the muscles in MS.

Perhaps most importantly a fitness routine should be something enjoyable.  Sticking to a fitness plan and being consistent is the key to long-term success. In those living with MS, exercise has been shown to reduce depression, increase participation in social activities and help people maintain and improve independence.

Are there any exercises that should be avoided for those with MS?

Choice of exercise should be based on each individual’s specific symptoms on a given day.  Exercise should be fun, challenging and safe.  It is imperative that those living with MS are encouraged to listen to their bodies and make small adjustments to their fitness routine as needed to ensure safety.

Heat has been shown to exacerbate the symptoms of MS.  When exercising outdoors, plan workouts to avoid the hottest times of the day.  Avoid activities performed in a heated room.

Consider the pros and cons of group fitness versus personal training.  For many, group fitness can be more motivating, uplifting and affordable.  Many group fitness studios will offer private instruction as well to get you started and give you the confidence you need to feel great in a group class.

www.msactivesource.com is a great online resource for more specific exercise tips and tricks include short videos as well as free exercise DVDs.

The most enjoyable and rewarding part of writing this particular post was having the opportunity to speak to some of the true MS experts -- the brave and strong men and women living with this disease every day.  I’m so fortunate as a The Dailey Method studio owner to have a worldwide community of owners and teachers to reach out to and learn from.  The testimonials, tips and tricks below come from the amazing students this community serves.  If you are a fitness teacher I hope you will be a student for the moment and allow these stories to guide and inspire you in serving your community.  If you are living with MS, I think these stories will serve as continued motivation to be in the present and live your best life.  I’d also love to hear any of your own personal tips & tricks in the comments section below.

Testimonials, tips & tricks:

Kris:

Kris is a 44-year old mother of two (ages 9 and 6) who has been living with MS for 9 years.  Previously a competitive gymnast and an active all around athlete, Kris seeks the emotional high of a great workout, but has sought and continues to seek a “new normal” for herself when it comes to fitness.  The number one MS symptom that has required an adjustment to her personal fitness routines is lack of balance.  Kris has found a home at The Dailey Method La Grange in La Grange, IL.  The low-impact yet results orientated nature of The Dailey Method has allowed Kris to stay fit while at the same time feeling safe in the environment and able to modify and adjust for her needs on any given day.  Here are Kris’s top tips for staying fit while listening to her body to ensure that her workouts leave her energized and inspired rather than frustrated and wiped out.

• Talk openly to your fitness teachers about MS.  It is an ongoing conversation as opposed to a one-time notification.
• Seek out less crowded class times or make sure to get to class early enough to find a spot in the room where you will have some space and something to hold on to when necessary
•  Know that if a certain exercise is not working for you on a given day it is OK to modify.  Frustration can set off a downward spiral and leave you feeling worn out and unsuccessful.  A great teacher will help you modify and listen to your body – ask for help.
• Set realistic goals for yourself.  It can be tempting to look around at other fit and healthy bodies and think, “I used to be that.  I want that.”  Look forward, not back – find your “new normal”.  
• Celebrate and be proud of little successes.  Feel good about yourself when you can let go of the barre for a few more seconds, can get deeper in a certain pose or hold a stretch a little longer.  It all means you are working towards your goal and it feels great!

Judith:

I have remitting-relapsing MS.; three years ago I was slammed with what was called a relapse, even though I didn’t know I had MS at the time.

Apparently I had had MS for many years, symptomatic at a low level.   But when my attack hit in 2010, I was devastated.   I could not walk across the campus where I taught. The disability cart carried me to and fro.  My husband drove me to the university and often I would pour myself into the car at the end of the day and sob.

I rehearse this story to provide a context for what I will say next:  I have slowly climbed back to a state in which most activities--physical, cognitive or spiritual--are not problematic.  And much of my recovery in the last year has been due to my regular participation in The Dailey Method classes at The Dailey Method Reno (Reno, NV).  Of this I feel sure.  Specifically, The Dailey Method has helped with many of the typical MS problems:  mood (I feel elevated by the mental and physical concentration the classes require – my anxieties are dispelled); neuropathy and limited movement  (my neuropathy and spasticity is often greatly improved by taking The Dailey Method classes and it is never made worse); my strength and balance are building “dailey”; and perhaps most interesting, I am now able to get muscles to fire that would not for the first year and a half after my attack – my brain and body connection has been reestablished.

I believe that the ways in which The Dailey Method targets small muscles, movement and awareness has been key for me.   Also, helpful are wonderful teachers who have encouraged me, a total type A person, to participate at 85% when necessary, recognizing that MS symptoms, including fatigue, come and go. In terms of my goals of maintaining strength, flexibility and endurance, I hope to be able to continue with The Dailey Method for a long time.  

Judith Rodby, Ph.D

Professor Emeritus, California State University

Reno, Nevada

Anne:

I started at The Dailey Method more than a year ago, soon after I wad diagnosed by the neurologist I was seeing at the time. I was scared and hesitant to try any kind of demanding exercise, especially anything involving heat (my doctor specifically warned me against hot yoga, which he felt could trigger a relapse of symptoms). However, I was also just tired of feeling bad all the time. I felt it was worth the risk.

Right away I could see that I was in good hands at the The Dailey Method Mission-Castro (San Francisco, CA). All the instructors were very sensitive to what I needed -- pointing out the "cool spots" in the room and helping me manage discomfort. They showed me how to adapt exercises to pain or numbness by working higher on the barre, and described how breathing could pull me through tough moments. In time, I figured out that neutral spine work helps me focus on everything else; I also use a towel to cushion my neck in floor work. 

I feel stronger and happier. I've also noticed less numbness in my extremities after and between workouts. More important, my primary care doctor noticed that the practice makes a huge difference in my stress level. My mood has improved over the 16 months I've been a member, and I can anticipate how I will feel the next day in a way I haven't been able to in years. I feel like I can actually make and keep commitments, because I can count on my body to work for me. That's priceless. 

I've had barely any symptoms at all for more than a year now. Very recently, my doctor told me about Clinically Isolated Syndrome, which he thinks might be a more accurate diagnosis. I am beyond thrilled, but not really surprised: I feel like this has been the year I got my body back. :)

I don't think that The Dailey Method can cure all that ails people, but it's done so much for me. The costs of a relapse can be really high, both financially and physically; I'm in better shape to fend them off thanks to The Dailey Method. It's the best choice I've made in years.

I want to give the biggest THANK YOU and giant virtual hugs to these amazing women for sharing their stories with me.  You are why I love what I do! Xoxo

Kerry