BENEFITS OF PHYSICAL ACTIVITY FOR THOSE LIVING WITH MULTIPLE SCLEROSIS

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a condition where the body’s immune system attacks myelin in the central nervous system. Myelin is a tissue that surrounds and protects nerve fibres. Without myelin, nerve impulses to and from the brain cannot travel as well. MS causes scar tissue to develop around the nerve fibres which can affect many bodily functions.

As recently as a generation ago, medical researchers thought that even light physical activity might worsen the effects of MS as well as many other chronic lifestyle diseases. However, that started to shift with the U.S. Surgeon General’s 1996 Report on Physical Activity and Health [1] which highlighted ways that significant health benefits could result from even moderate levels of exercise.

A study published by researchers at the University of Utah in 1996 [2] was one of the first to demonstrate the benefits of exercise for people with multiple sclerosis. Exercise and physical activity are cited as a substantial contributor to healthy lifestyle interventions but often it is reserved for sometime in the future ‘when we feel better and can make the time’, rather than movement being utilised as an essential medicine in the present.

Multiple Sclerosis and Exercise What's The Evidence?

LESS FATIGUE

The researchers measured factors like maximal aerobic capacity (VO2 max), isometric strength, body composition and blood lipids. As expected there were significant gains in all physical areas but also mental health and quality of life improvements such as social interaction and better home management too. [2]

The current thinking is that regular cardio workouts that raise the target heart rate and resistance training can help to influence and slow the progression of the disease. [5] Exercise increases the volume and number of mitochondria and thus the body’s ability to produce energy and reduce fatigue. The more intense the exercise, based on very short duration activities, the more significant the effect.

One meta-analysis published in 2020 looked at 31 clinical trial studies between 1996 and 2019 and found that exercise significantly reduced fatigue in people living with MS. Patients reported increased fitness, strength and endurance, reduced body fatigue, improved morale and better daily function. By participating in exercise, the oxidation capacity of the muscles is improved, leading to an increased amount of oxygen uptake in the body. [27]

IMPROVED BALANCE, WALKING SPEED AND GAIT.

It is commonly acknowledged that the majority of persons with multiple sclerosis experience walking limitations at some point in the course of their disease. [14] Also, abnormal gait patterns and decreased mobility can lead to (comorbidity) one or more additional diseases or disorders coexisting with multiple sclerosis such as osteoporosis, musculoskeletal pain, osteoarthritis, cardiovascular disease and injury from falls. [15]

Walking limitations are mainly the result of damage to the central nervous system. Patterns of gait dysfunction in MS include decreased walking speed, decreased step and stride length, increased energy expenditure and loss of balance; this can occur even early in multiple sclerosis. [16]

A study published in 2004 in the journal Neurology [8] found that weekly aerobic sessions had the impact of reducing secondary measures of fatigue, including loss of balance and coordination. The study concluded that walking speed improved in this randomised study, that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.

In general, medical practitioners now advise a program of movement that emphasises mobility and a full range of motion for muscles and joints. This can help to decrease the severity of MS symptoms, improve balance and walking gait. [6][7]

BETTER BONE DENSITY

Another potential benefit of physical activity for persons with MS is the ability to increase bone mineral density. Increased bone density and its association with exercise was supported by a December 2010 study published in Neurology Reviews which highlights that maintaining or increasing bone density is another potential benefit of movement for persons with MS. [9][12]

With multiple sclerosis, your chance of developing osteoporosis, a disease in which bones lose density and become brittle and fragile, increases. Osteoporosis inflates your risk for bone fractures if you fall or bump into objects, but fractures in the spine can occur with commonplace movements such as twisting or sneezing too.

Any cardio activity builds a stronger heart, but weight-bearing and resistance exercise also produce healthier bones. Weight-bearing activities are those that force you to work against gravity, such as walking, or even marching in place while holding onto something. This is especially important for sedentary individuals who may have reduced bone density. [10]

In addition to weight-bearing activity, other lifestyle factors that support healthy bones include:

foods rich in calcium and vitamin D such as cruciferous leafy greens, oily fish (for example, salmon, sardines and mackerel), eggs and liver;
Giving up smoking;
Reducing alcohol consumption;

Inadequate vitamin D levels can contribute to osteoporosis and the bone fractures that often go with it, but low vitamin D levels are also associated with more MS disease activity, based on the formation of new lesions in the brain, according to research published in 2012 in Annals of Neurology [11]

An April 2015 study in the European Journal of Neurology showed that steroid therapy was associated with a higher rate of fractures. Steroids can affect how the body metabolises calcium and vitamin D so speak to your doctor to see if an alternative medication can be offered if you are taking steroids regularly. [13]

BETTER BLADDER AND BOWEL CONTROL

According to the National Multiple Sclerosis Society (US), an estimated 80 per cent of people with MS experience some degree of bladder dysfunction. This occurs if the immune response to MS affects the transmission of nerve signals in areas of the central nervous system that travel to the bowel or bladder and some of these can cause incontinence. [18]

Pelvic floor physical therapy otherwise known as Kegel exercises can be beneficial. These pelvic floor exercises help strengthen the muscles that are responsible for bowel and bladder function. [17]

BETTER MOOD AND WELLBEING

About 50 per cent of people with MS experience depression at some point and many others can experience periods of low mood. This can be the result of dealing with MS but can also be a symptom caused by multiple sclerosis if there is a lesion in an area of the brain involved in mood.

Light-to-moderate intensity physical activity can result in a better mood and increased social interaction.[2] This has been supported by numerous studies showing the link between physical activity and improved mood. A review published in the European Journal of Neurology in 2015 of 15 randomised controlled trial studies suggests that exercise has the potential to improve mood in people with MS, by preventing and reducing depressive symptoms. [22] The studies included resistance training, endurance training and combined (resistance and cardio) exercise types.

WHAT ABOUT DEALING WITH PAIN?

A review of the effect of exercise vs passive control on pain found evidence that exercise can reduce pain for those living with MS. Exercise helps due to “neuroplasticity and neuro-regeneration”. This regeneration is the brain’s ability to re-route nerve signals around areas of damage and repair or re-grow previously damaged nerve cells.

Exercise may also improve other factors involved in pain, such as reducing the levels of pro-inflammatory signals in the body, endorphins, synovial fluid around the joints, improving muscle strength, posture and mood. [28]

The mood hormones released by the brain during exercise have a significant role here too, especially when it is play-based. Researchers have found that the play state, especially with companions, helps to produce powerful feel-good hormones – endorphins, oxytocin, dopamine and serotonin.

STAY SAFE

As always it is best to chat with your doctor or health care professional before starting a routine. Find a fitness professional familiar with MS that can help create a routine that fits your capabilities and addresses issues such as balance, poor gait, body temperature, spasticity and fatigue. They can also ensure you don’t over do out with a progressive program to work with how you feel for a given session.

IN SUMMARY

Based on the medical and research evidence, a steady regimen of physical activity can go a long way toward reducing MS symptom severity. It is known that physical exercise does not lead to relapse or a faster disease progression but decreases fatigue, improves physical function, mental health and quality of life. [2][20] [23][24] even for those with severe mobility disability. [25]

For many people with MS, training a few times a week can lead to a drastic improvement in the overall quality of life. The Canadian Physical Activity Guidelines for adults with MS evidence review suggests a minimum of 2 x 30-minute sessions of moderate-intensity aerobic activity and 2 x resistance sessions per week. [26] For others, a more precise exercise prescription taking into account individual issues are necessary.

If you are not sure how to exercise on your own, have difficulties with mobility, or would like advice on other lifestyle modifications such as nutritional support - try working with a Wahls Protocol Health Professional and movement coach such as Darryl Edwards to develop a program you can do that works within your range of ability and not to overdo it.

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References:

[1] US Department of Health and Human Services., "Physical activity and health: a report of the Surgeon General." Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, 1996.  
[2] Petajan JH et al., "Impact of aerobic training on fitness and quality of life in multiple sclerosis.", Ann Neurol. 1996 Apr;39(4):432-41.  
[4] Ponichtera-Mulcare JA, Mathews T, Barrett PJ, Gupta SC., "Change in aerobic fitness of patients with multiple sclerosis during a 6-month training program.", Sports Med Train Rehabil 1997;7:265–272.  
[5] Mostert S, Kesselring J., "Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis", Mult Scler 2002;8:161–168.  
[6] Gehlsen G, Beekman K, Assman N, Winant D, Seidle M, Carter A. "Gait characteristics in multiple sclerosis: progressive changes and effects of exercise on parameters", Arch Phys Med Rehabil 1986;67:536 –539.  
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[9] Steffensen LH et al., "Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis"., J Neurol. 2010;257(3):410-418.  
[10] Terzi T et al., "Changes in bone mineral density and bone metabolism markers in premenopausal women with multiple sclerosis and the relationship to clinical variables.", J Clin Neurosci. 2010;17(10):1260-1264.  
[11]  Ellen M Mowry et al., "Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis.", ANN NEUROL 2012;72:234–240.  
[12] Ozgocmen S, Bulut S, Ilhan N, et al., "Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity.", J Bone Miner Metab. 2005;23(4):309-313.  
[13] Tyblova M et al., "Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis.", Eur J Neurol. 2015 Apr;22(4):624-32. doi: 10.1111/ene.12479. Epub 2014 Jun 16.  
[14] Swingler RJ, Compston DA., "The morbidity of multiple sclerosis.", Q J Med. 1992;83:325-337.  
[15] Marrie RA, Horwitz RI, Cutter G, Tyry T, Vollmer T., "Association between comorbidity and clinical characteristics of MS.", Acta Neurol Scand. 2010 Sep 29  
[16] Martin CL, Phillips BA, Kilpatrick TJ, et al., "Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.", Mult Scler. 2006;12:620-628.  
[17] Incontinence, https://www.mstrust.org.uk/health-professionals/practice-resources/bladder-practical-guide/what-bladder-and-bowel-problems-can, accessed 21 August 2018  
[18] Bladder Problems, https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Bladder-Dysfunction, accessed 21 August 2018  
[19] Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW, "Impact of aerobic training on fitness and quality of life in multiple sclerosis.", Ann Neurol. 1996 Apr; 39(4):432-41.  
[20] Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A, "Physical training and multiple sclerosis.", Ann Readapt Med Phys. 2007 Jul; 50(6):373-6, 369-72.  
[21] Dalgas U, Stenager E, Ingemann-Hansen T., "Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training.", Mult Scler. 2008 Jan; 14(1):35-53.  
[22] Dalgas U, Stenager E, Sloth M, et al., "The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature.", Eur J Neurol. 2014 Oct 18.   
[23] Reynolds, Eric, R et al., "Multiple Sclerosis and Exercise: A Literature Review", Current Sports Medicine Reports: January 2018 - Volume 17 - Issue 1 - p 31–35  
[24] Pilutti LA et al., "The safety of exercise training in multiple sclerosis: a systematic review.", J Neurol Sci. 2014 Aug 15;343(1-2):3-7. doi: 10.1016/j.jns.2014.05.016.   
[25] Edwards T et al.,"The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions.", Mult Scler Relat Disord. 2017 Aug;16:31-39. doi: 10.1016/j.msard.2017.06.003. Epub 2017 Jun 12.  
[26] Canadian Physical Activity Guidelines for Adults with MS, https://mssociety.ca/support-services/programs-and-services/recreation-and-social-programs/physical-activity/the-guidelines, accessed 21 August 2018.
[27] Razazian N, Kazeminia M, Moayedi H, et al. "The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis." BMC Neurol. 2020;20 (93). doi: 10.1186/s12883-020-01654-y.
[28] Demaneuf, Thibaut, et al. “Effectiveness of Exercise Interventions for Pain Reduction in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” Archives of Physical Medicine and Rehabilitation, vol. 100, no. 1, Jan. 2019, pp. 128–139, www.archives-pmr.org/article/S0003-9993(18)31191-2/fulltext, 10.1016/j.apmr.2018.08.178. Accessed 23 Apr. 2019.