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With MS should I be exercising
Q? With MS, should I be exercising?
I have gained quite a bit of weight (30 lbs.), since my accident back in July, last year.
In previous years, I would exercise, I have an "exercise bike", that I was doing 40 miles in an hour (and burning tons of calories). Then I had foot surgery and was unable to exercise.
So, again I wanted to lose weight, this time I went on the Mediterranean Diet (by Doctor's suggestion), watched my daily caloric intake, averaging about 1400 calories per day, and lost more than 50 lbs. (down to 190 lbs)
Now, I'm back up to 220 lbs. and I want to lose that weight.
I know that cutting my calories can do it, but now that my foot is healed, I could exercise again.
I know that exercise for people with MS can be a double-edged sword.
If I exercise, I will heat my body up and sweat, this will cause my MS symptoms to get much worse.
I mean, I don't have a lot of energy, fatigue, etc. (ya, ya, ya, MS symptoms)
So, if I want to lose weight, should I really be risking exercise?
-- Socrates
I have gained quite a bit of weight (30 lbs.), since my accident back in July, last year.
In previous years, I would exercise, I have an "exercise bike", that I was doing 40 miles in an hour (and burning tons of calories). Then I had foot surgery and was unable to exercise.
So, again I wanted to lose weight, this time I went on the Mediterranean Diet (by Doctor's suggestion), watched my daily caloric intake, averaging about 1400 calories per day, and lost more than 50 lbs. (down to 190 lbs)
Now, I'm back up to 220 lbs. and I want to lose that weight.
I know that cutting my calories can do it, but now that my foot is healed, I could exercise again.
I know that exercise for people with MS can be a double-edged sword.
If I exercise, I will heat my body up and sweat, this will cause my MS symptoms to get much worse.
I mean, I don't have a lot of energy, fatigue, etc. (ya, ya, ya, MS symptoms)
So, if I want to lose weight, should I really be risking exercise?
-- Socrates
I did came across this article with recommendations on exercise for people with MS at http://www.msforum.net/journal/download/20091605.pdf
The authors bemoan the paucity of research on exercise and MS, but they do say that there has been a shift in the last decade away from thinking that exercise is bad for people with MS because it exacerbates symptoms and uses up energy that could have been preserved for activities of daily living. However, they say that “Today it is known that well-organized physical exercise is a safe and efficient way to achieve physical improvements that have the potential to improve an MS patient’s quality of life” (5).
In general, people with MS have a lower level of daily activity than healthy people so some of our problems are due to inactivity. The authors think that these can be helped by exercise whereas the problems that are caused directly by MS are unlikely to be helped by exercise. Although the results of the studies on exercise are somewhat inconsistent and are often not as well-constructed (e.g., no controls, small sample sizes) or documented as they might be, the authors do think that they point to benefits for people with MS.
Better cardiovascular fitness in people with MS is “associated with better cerebrovascular function and cognition” and it is also possible that exercise might have a helpful anti-inflammatory effect that could even slow down the disease.
They find that resistance (strength) training has more positive effects on daily activities than aerobic exercise does, perhaps because these rely more on muscle strength than aerobic fitness. Strength training also seems to have a positive effect on fatigue.
Although there has not been much research on simultaneous strength and aerobic training in people with MS, the authors recommend that people do both. “While endurance [aerobic] training results in profound adaptations in the cardiorespiratory and neuromuscular systems, resistance [strength] training is known to increase muscle mass and to improve neural activation” (8).
They make the following general recommendation about MS for people with MS, as well as some more specific ones:
1. The following recommendations target MS patients with an EDSS score of less than 7 [defined as unable to walk beyond approximately five meters even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about in wheelchair some 12 hours a day; the authors give this caveat because of the lack of research and not because they think there’s some reason exercise wouldn’t be beneficial for people with a higher EDSS]
2. It is safe and beneficial for MS patients to participate in well-organized physical exercise.
3. The recommendations only serve as basic recommendations and an exercise programme should be designed and prescribed on an individual basis to ensure that individual capabilities and impairments, as well as environmental conditions, can be taken into account.
4. MS patients should consult a rehabilitation expert (e.g. physician, physiotherapist or an exercise physiologist specialized in rehabilitation) before starting a new exercise programme.
5. It is recommended to follow a training schedule that includes both resistance [strength] and endurance [aerobic] training (combined training), because impairments are seen in both cardiovascular and strength-related parameters.
6. Potential exercise-induced exacerbations are a temporal phenomenon. [this is a little different from what we have heard on the forum where heat-induced exacerbations seem sometimes to lead to real relapses or permanent damage; the authors do recommend use of cooling strategies; they cite this article in support of their assertion: “Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis” http://www.ncbi.nlm.nih.gov/pubmed/16635637]
7. Factors affecting core temperature should always be considered and minimized, in order to make exercise as pleasant as possible for the thermosensitive patients.
They don’t say anything about dealing with spasticity or nerve-based muscle fatigue, but I suppose they expect that to be addressed on a case-by-case basis with the rehabilitation expert mentioned in point 4.
I would really like to be able to do some kind of aerobic exercise since it’s supposed to be so good for you, but I don’t seem to be able to move fast enough or long enough. I can’t walk so far and I am passed by all the little old ladies. I have to admit that I don’t like swimming. Anybody have ideas on this?
sho
The authors bemoan the paucity of research on exercise and MS, but they do say that there has been a shift in the last decade away from thinking that exercise is bad for people with MS because it exacerbates symptoms and uses up energy that could have been preserved for activities of daily living. However, they say that “Today it is known that well-organized physical exercise is a safe and efficient way to achieve physical improvements that have the potential to improve an MS patient’s quality of life” (5).
In general, people with MS have a lower level of daily activity than healthy people so some of our problems are due to inactivity. The authors think that these can be helped by exercise whereas the problems that are caused directly by MS are unlikely to be helped by exercise. Although the results of the studies on exercise are somewhat inconsistent and are often not as well-constructed (e.g., no controls, small sample sizes) or documented as they might be, the authors do think that they point to benefits for people with MS.
Better cardiovascular fitness in people with MS is “associated with better cerebrovascular function and cognition” and it is also possible that exercise might have a helpful anti-inflammatory effect that could even slow down the disease.
They find that resistance (strength) training has more positive effects on daily activities than aerobic exercise does, perhaps because these rely more on muscle strength than aerobic fitness. Strength training also seems to have a positive effect on fatigue.
Although there has not been much research on simultaneous strength and aerobic training in people with MS, the authors recommend that people do both. “While endurance [aerobic] training results in profound adaptations in the cardiorespiratory and neuromuscular systems, resistance [strength] training is known to increase muscle mass and to improve neural activation” (8).
They make the following general recommendation about MS for people with MS, as well as some more specific ones:
1. The following recommendations target MS patients with an EDSS score of less than 7 [defined as unable to walk beyond approximately five meters even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about in wheelchair some 12 hours a day; the authors give this caveat because of the lack of research and not because they think there’s some reason exercise wouldn’t be beneficial for people with a higher EDSS]
2. It is safe and beneficial for MS patients to participate in well-organized physical exercise.
3. The recommendations only serve as basic recommendations and an exercise programme should be designed and prescribed on an individual basis to ensure that individual capabilities and impairments, as well as environmental conditions, can be taken into account.
4. MS patients should consult a rehabilitation expert (e.g. physician, physiotherapist or an exercise physiologist specialized in rehabilitation) before starting a new exercise programme.
5. It is recommended to follow a training schedule that includes both resistance [strength] and endurance [aerobic] training (combined training), because impairments are seen in both cardiovascular and strength-related parameters.
6. Potential exercise-induced exacerbations are a temporal phenomenon. [this is a little different from what we have heard on the forum where heat-induced exacerbations seem sometimes to lead to real relapses or permanent damage; the authors do recommend use of cooling strategies; they cite this article in support of their assertion: “Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis” http://www.ncbi.nlm.nih.gov/pubmed/16635637]
7. Factors affecting core temperature should always be considered and minimized, in order to make exercise as pleasant as possible for the thermosensitive patients.
They don’t say anything about dealing with spasticity or nerve-based muscle fatigue, but I suppose they expect that to be addressed on a case-by-case basis with the rehabilitation expert mentioned in point 4.
I would really like to be able to do some kind of aerobic exercise since it’s supposed to be so good for you, but I don’t seem to be able to move fast enough or long enough. I can’t walk so far and I am passed by all the little old ladies. I have to admit that I don’t like swimming. Anybody have ideas on this?
sho
Thank you soooo much for helping out here! I am so not an expert in this and don't want to lead anyone astray.
We got such great members!
We got such great members!
I can help!
First of all, I really advocate for doing as much exercise and activity as each person feels comfortable and safe doing. MS makes exercising a little tricky, because the individual has to be able to closely monitor themselves for fatigue and heat tolerance. I'm a little bit biased, but the best thing to help you return to some sort of physical activity is to see an MS literate Physical Therapist. Walking into your local orthopedic PT may just frustrate you because many PTs may not see enough MS patients to really know and understand how to monitor you.
A good PT should be able to help with spaticity in a couple of different ways.
-Teach you positioning and movement tricks and sequencing that doesn't kick on extensor tone. Sometimes just foot placement when you go from sitting to standing can have a big affect of spasms.
-Use opposing muscles to help inhibit the spastic ones, so a specific strengthening program to address weaknesses.
-Stretches have to be held for at least 30 seconds and repeated 5 times to really calm down someone with neuro spasticity.
-Also, exercising a spastic muscle actually decreases spasticity (this is well researched especially in spinal cord injuries).
The problem with a treadmill and extensor tone is this: The treadmill does the extension part of the movement for you. So you are being forced into hip extension and plantarflexion without doing the muscle contraction yourself. Since I don't know how each person's balance is, and how bad their spasticity is I hate to even tell someone over the internet about this, but in the clinic, walking on a treadmill backwards can break the pattern of extensor tone, and then the person is usually more successful with walking forwards. Please don't try that alone or if you have balance issues.
I also cannot advocate for aquatic exercises enough. Exercising in a pool that is an appropriate temperature (not too warm) can support and challenge you.
First of all, I really advocate for doing as much exercise and activity as each person feels comfortable and safe doing. MS makes exercising a little tricky, because the individual has to be able to closely monitor themselves for fatigue and heat tolerance. I'm a little bit biased, but the best thing to help you return to some sort of physical activity is to see an MS literate Physical Therapist. Walking into your local orthopedic PT may just frustrate you because many PTs may not see enough MS patients to really know and understand how to monitor you.
A good PT should be able to help with spaticity in a couple of different ways.
-Teach you positioning and movement tricks and sequencing that doesn't kick on extensor tone. Sometimes just foot placement when you go from sitting to standing can have a big affect of spasms.
-Use opposing muscles to help inhibit the spastic ones, so a specific strengthening program to address weaknesses.
-Stretches have to be held for at least 30 seconds and repeated 5 times to really calm down someone with neuro spasticity.
-Also, exercising a spastic muscle actually decreases spasticity (this is well researched especially in spinal cord injuries).
The problem with a treadmill and extensor tone is this: The treadmill does the extension part of the movement for you. So you are being forced into hip extension and plantarflexion without doing the muscle contraction yourself. Since I don't know how each person's balance is, and how bad their spasticity is I hate to even tell someone over the internet about this, but in the clinic, walking on a treadmill backwards can break the pattern of extensor tone, and then the person is usually more successful with walking forwards. Please don't try that alone or if you have balance issues.
I also cannot advocate for aquatic exercises enough. Exercising in a pool that is an appropriate temperature (not too warm) can support and challenge you.
Hmmm..you present something of a dilemma. If your vision has dimmed - the classic Uhthoff Phenomenon - then you have already raised your core temp with the exercise. You are having a "pseudo-exacerbation" with regard to your vision.
You ask if this is okay as long as your vision returns to normal later. Well, at the time of dimming you don't know if it will return to normal or not. Waiting to see if it does it sort of too late. We do know that some episodes of warming can result in permanent worsening of a symptom.
I think you should discuss this with your neuro. My recommendation would be to cool before walking, wear some sort of cooling garment (vest, neck wrap, cooling headband) while walking, have a fan blowing on you to increase heat loss while walking and drink cold liquid throughout. Consider slowing your pace a bit. Take all the steps you can to minimize bringing on symptoms.
Deb - a few little stretches may not be enough for the tightness of spasticity. The stretches need to be firm enough and held long enough to make the muscle uncomfortable. Experiment to see what kind of stretching works the best to prevent the nighttime pain.
Quix
You ask if this is okay as long as your vision returns to normal later. Well, at the time of dimming you don't know if it will return to normal or not. Waiting to see if it does it sort of too late. We do know that some episodes of warming can result in permanent worsening of a symptom.
I think you should discuss this with your neuro. My recommendation would be to cool before walking, wear some sort of cooling garment (vest, neck wrap, cooling headband) while walking, have a fan blowing on you to increase heat loss while walking and drink cold liquid throughout. Consider slowing your pace a bit. Take all the steps you can to minimize bringing on symptoms.
Deb - a few little stretches may not be enough for the tightness of spasticity. The stretches need to be firm enough and held long enough to make the muscle uncomfortable. Experiment to see what kind of stretching works the best to prevent the nighttime pain.
Quix
I've not been doing a cool down because I've been practically collapsing onto the bed afterwards. I will do a few little stretches when I'm on the bed.
Thanks, Quix!
Deb
Thanks, Quix!
Deb
I agree . . . this is a great topic and quite timely for me. I've actually been getting on the treadmill for the last few weeks and have noticed my vision blurs while I'm walking. Is this okay if it returns to "normal" after I cool off?
I'm not an exercise expert, by any means, but I do know that the effect of exercise is the contract muscles and that they are tighter after doing it. That is why the stretching is such an integral part of conditioning.
If your spasticity is more painful after exercising then yes, it would make sense that it is caused by the exercise. Perhaps you should have a cool down then a good long stretch session afterward.
Anyone know?
Good question for a PT/Physio knowledgeable in MS.
Quix
If your spasticity is more painful after exercising then yes, it would make sense that it is caused by the exercise. Perhaps you should have a cool down then a good long stretch session afterward.
Anyone know?
Good question for a PT/Physio knowledgeable in MS.
Quix
I wonder about exercising when we're feeling spasticity at night . . . With the exercising I'm doing as of late (treadmill), I have some pain at night. I don't know if this would have happened with or without the exercising.
I also wonder if I should stop exercising because I'm feeling spasticity.
Great topic!
I also wonder if I should stop exercising because I'm feeling spasticity.
Great topic!
Great topic!
Yes, we should all be moving/exercising within our limits and as, Dragonflies says, very slowly pushing our limits. We may need a PT/Physio eval to help guide the kind of movement that is best.
Not getting overheated is of paramount importance. If we are able to do real aerobic work, then we should pre-cool our bodies - cool shower, wear cooling garments, move in front of a shower - whatever. At the first sign of fatiguing we have probably overdone it so we should learn other signs. We do not want to "feel the burn".
The examples already given are great.
Alex mentioned an important one. Many of the machine aerobic apparatuses selectively strengthen certain muscle groups. One in particular to be aware of is the quadriceps. Machines like StairSteppers really work them. In extensor spasticity of the legs, the quads already are hypertonic. The leg wants to straighten out. If we strengthen this muscle it can worsen our spasticity.
In people with functional drop foot - we actually "can" bring our toes up, but during walking they pull down anyway and we trip or drag our toes. Exercises that strengthen the calves will make this toe drop worse.
If you have spasticity you will want some guidance about how to formulate your exercise and which things you should avoid.
Also PT/Physio can give you suggestions about strengthening muscle groups to aid the weakened muscles.
Learning what is overdoing and what is safe is a personal exploration. And we won't always get it right. Some days just doing what was okay two days ago might be a problem for a variety of reasons. But, we do not want to go anywhere near that "wall" or that muscle burn.
The better shape we are in the easier all things will be to do.
However, also remember that a muscle that is weakened will stay weak even if you strengthen it. huh? I am climbing stairs as often as I can. I have significantly strengthened my ability to lift my right leg to the next step. Lifting my bulk up the step is not much of a problem, because I do have extensor spasticity and the quad works pretty well. But, once I fatigue for the day, I completely lose the ability to lift my right leg up. Once that muscle signal fatigues and disappears, it doesn't matter how strong I have made that hip flexor - I revert to just as weak as I was before strengthening. Very frustrating.
Soc, you are right, sorta. Exercise is a two -edged sword, but one side is duller than the other. We need to keep moving and to keep as flexible as possible.
Quix
Yes, we should all be moving/exercising within our limits and as, Dragonflies says, very slowly pushing our limits. We may need a PT/Physio eval to help guide the kind of movement that is best.
Not getting overheated is of paramount importance. If we are able to do real aerobic work, then we should pre-cool our bodies - cool shower, wear cooling garments, move in front of a shower - whatever. At the first sign of fatiguing we have probably overdone it so we should learn other signs. We do not want to "feel the burn".
The examples already given are great.
Alex mentioned an important one. Many of the machine aerobic apparatuses selectively strengthen certain muscle groups. One in particular to be aware of is the quadriceps. Machines like StairSteppers really work them. In extensor spasticity of the legs, the quads already are hypertonic. The leg wants to straighten out. If we strengthen this muscle it can worsen our spasticity.
In people with functional drop foot - we actually "can" bring our toes up, but during walking they pull down anyway and we trip or drag our toes. Exercises that strengthen the calves will make this toe drop worse.
If you have spasticity you will want some guidance about how to formulate your exercise and which things you should avoid.
Also PT/Physio can give you suggestions about strengthening muscle groups to aid the weakened muscles.
Learning what is overdoing and what is safe is a personal exploration. And we won't always get it right. Some days just doing what was okay two days ago might be a problem for a variety of reasons. But, we do not want to go anywhere near that "wall" or that muscle burn.
The better shape we are in the easier all things will be to do.
However, also remember that a muscle that is weakened will stay weak even if you strengthen it. huh? I am climbing stairs as often as I can. I have significantly strengthened my ability to lift my right leg to the next step. Lifting my bulk up the step is not much of a problem, because I do have extensor spasticity and the quad works pretty well. But, once I fatigue for the day, I completely lose the ability to lift my right leg up. Once that muscle signal fatigues and disappears, it doesn't matter how strong I have made that hip flexor - I revert to just as weak as I was before strengthening. Very frustrating.
Soc, you are right, sorta. Exercise is a two -edged sword, but one side is duller than the other. We need to keep moving and to keep as flexible as possible.
Quix
I've been lifting weights since the fall of this year. I started out just doing the arm motions, without weights in my hand, because I just wasn't strong enough to lift anything at all. I worked my way through the various ones, and now I'm up to 15 lbs per arm! I just started really, really slow, and I only do it for about 15 minutes a day, gently, which is short enough so that I don't get overheated or worn out.
The upside is that if you have stronger muscles, you can do other things more easily. So now I don't get overheated and worn out nearly as quickly when I'm walking, biking, doing housework, etc.
I also do yoga stretches occasionally (usually in my own home, not in a class). I keep planning to swim, but I never manage to get my act together and go to the pool. I am generally pretty active in terms of walking, biking, etc. during the spring, fall, and winter, but I'm a bit worried that I'll have trouble in the summer with biking outside. Some years I do, some years I don't.
The upside is that if you have stronger muscles, you can do other things more easily. So now I don't get overheated and worn out nearly as quickly when I'm walking, biking, doing housework, etc.
I also do yoga stretches occasionally (usually in my own home, not in a class). I keep planning to swim, but I never manage to get my act together and go to the pool. I am generally pretty active in terms of walking, biking, etc. during the spring, fall, and winter, but I'm a bit worried that I'll have trouble in the summer with biking outside. Some years I do, some years I don't.
I should add to my post that although I walk an hour a day (treadmill, in A/C), I do it in 2 parts -- 1/2 hr in the AM, 1/2 hr PM.
Works for me -- with MS it's not good to go to the point of exhaustion.
I should also add that I have no spasicity, pain etc -- my only symptom has been sensory.
So each of us has to find the fitness/exercise that fits our specific situation.
Hope you find the one that works for you -- it is really important!
Works for me -- with MS it's not good to go to the point of exhaustion.
I should also add that I have no spasicity, pain etc -- my only symptom has been sensory.
So each of us has to find the fitness/exercise that fits our specific situation.
Hope you find the one that works for you -- it is really important!
Hey Soc,
Yes, do keep moving as much as you can. Like Wobbly says, w/gait, among other issues, it's really difficult to do this. We all hate what happens to us when we get hot, so we avoid it at all costs - I sooo understand this. I do it too.
Stretch, and walk during off hours (early a.m. or late p.m.) if you are able. When you are tired and can only sit or lay, stretch those muscles out while you lay there.
It's so very important --but oh so hard to get started no matter the cause.
Maybe we should do something each morning on the forum w/each other, ha/ha
1...2...3.... now sit, stand, reach over your head.., sit, 1...2...3...
Seriously, good important topic.
ttys,
shell
Yes, do keep moving as much as you can. Like Wobbly says, w/gait, among other issues, it's really difficult to do this. We all hate what happens to us when we get hot, so we avoid it at all costs - I sooo understand this. I do it too.
Stretch, and walk during off hours (early a.m. or late p.m.) if you are able. When you are tired and can only sit or lay, stretch those muscles out while you lay there.
It's so very important --but oh so hard to get started no matter the cause.
Maybe we should do something each morning on the forum w/each other, ha/ha
1...2...3.... now sit, stand, reach over your head.., sit, 1...2...3...
Seriously, good important topic.
ttys,
shell
Since I was told I might have MS in 2007 I have done everything I can to be as healthy as I can. I eat well and have been gradually losing weight. It is hard. You do need to speak to a doctor before exercising because some exercises can cause problems with spasticity.
I mostly walk but it is not easy. I have friends or my husband who walk with me which makes it easier. Walking has also helped my back. I also do a lot of stretching and core exercises I learned in physical therapy.
The key to all of it is start small.
Alex
I mostly walk but it is not easy. I have friends or my husband who walk with me which makes it easier. Walking has also helped my back. I also do a lot of stretching and core exercises I learned in physical therapy.
The key to all of it is start small.
Alex
When I was first diagnosed & freaking out, my PCP said this:
In his experience, healthy people do better with MS than unhealthy people.
So MS-ers need to do all the things needed to stay healthy, including a good diet, exercise, weight control, etc.
I can't take the heat, so I walk an hour a day in air conditioning -- you can safely stay cool on treadmill, bike, swim, WiiFit, even mall-walking --choose whatever you enjoy & will do faithfully.
In his experience, healthy people do better with MS than unhealthy people.
So MS-ers need to do all the things needed to stay healthy, including a good diet, exercise, weight control, etc.
I can't take the heat, so I walk an hour a day in air conditioning -- you can safely stay cool on treadmill, bike, swim, WiiFit, even mall-walking --choose whatever you enjoy & will do faithfully.
Hi there...I haven't been able to excercise in a few years because of balance and tiredness etc etc... and put on 25lbs or so..
I started in jan.. my hubby and I got the WII game..fitness Plus.. first time I used a game at all on the TV.. I use it for yoga and different things that I feel comfortable on.
at first it was hard, and now I find it easier all the time. I have watch my portions.. I don't like to diet...did that for years and it just comes back. So I just eat what I want, but very little portions.. and add yougart? fruit, V8 juice..low sodium.. rice cakes .. popcorn..no butter...etc..etc..
I'm down about 15 lbs...like to go down another 15... slowly but it's getting there..
good luck and always let your Dr know what you are planning to do. OK..
wobbly
dx
I started in jan.. my hubby and I got the WII game..fitness Plus.. first time I used a game at all on the TV.. I use it for yoga and different things that I feel comfortable on.
at first it was hard, and now I find it easier all the time. I have watch my portions.. I don't like to diet...did that for years and it just comes back. So I just eat what I want, but very little portions.. and add yougart? fruit, V8 juice..low sodium.. rice cakes .. popcorn..no butter...etc..etc..
I'm down about 15 lbs...like to go down another 15... slowly but it's getting there..
good luck and always let your Dr know what you are planning to do. OK..
wobbly
dx
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