It’s no secret it’s important to keep your body fit. But what about your brain? You may be surprised to learn how physical activity can impact your brain and your MS. Exercise is an important part of general health and wellness. That’s no secret, it’s a fact we’re reminded of on TV, social media, and just about everywhere else we turn these days. There’s no shortage of advice — fitness routines, workout guides, and exercise programs are available at most of our fingertips. There are even late-night commercials for programs and devices promising to be the one secret ingredient to your personal fitness, weight loss, strength and more.
In a perfect world, according to what seems to be common thought these days, our daily routine should start with jogging five miles, then heading straight to the weight room for a lifting session, and “cooling down” with an hour of hot yoga.
Realistically, there are very few of us that can maintain extreme or even moderate exercise routines. While we generally understand regular exercise is important, there are countless factors at play when trying to set aside time dedicated to exercise. Sometimes there just aren’t enough hours in the day. Sometimes, even with no shortage of information and resources, we simply don’t know where to start. We know we need exercise, but life simply gets in the way.
For the average person, so many factors can make regular exercise daunting proposition. When you start to think about adding exercise to a routine that’s already been altered by MS, the prospect can seem downright impossible.
But does that have to be the case?
In this issue, we’ll review some of the basic benefits of exercise, then talk about how those various benefits are amplified when you’re living with MS.
We’ll also delve into a benefit of exercise that’s often overlooked — the cognitive and neuroprotective benefits exercise has on the brain, and how that can impact those living with MS.
Finally, we’ll talk about some truly practical applications, and how to incorporate more exercise into your life. Spoiler alert, it’s a whole lot easier than our exercise-crazy culture might lead you to believe.
EXERCISE IS GREAT FOR THE BODY AND GENERAL HEALTH
First, for the review. We’ve talked about the benefits of exercise in recent issues of InforMS, and as mentioned earlier, there’s no shortage of unsolicited advice out there. Exercise is good, we should all do it, most everyone knows that. But do you really know why?
WEIGHT: Most obviously, we know that exercise can help control your weight. When you eat, you consume calories. When you’re active and moving, you’re burning those calories. This is a bit of an oversimplification, but the calories you don’t burn get stored in your body, and that storage equals increased weight.
ILLNESSES: We also know that exercise can help fight countless health conditions, including high blood pressure, type 2 diabetes, arthritis, and even certain types of cancer.
MOOD: It’s also been proven that exercise can improve mood, fight depression and quell anxiety. Physical activity stimulates a collection of brain chemicals — endorphins —that can leave you feeling less stressed, more relaxed, and happier.
ENERGY: Physical activity conditions your body, improves muscle strength, and builds endurance. Put those together, and over time you’re going to have more energy to do the things you need to do (or even increase your levels of exercise).
SLEEP: Regular exercise can have a great effect on regulating your sleep patterns. Whether you have trouble falling asleep or staying asleep through the night, physical activity throughout the day has been proven to help people achieve some consistency in their sleep patterns.
OKAY, EXERCISE IS IMPORTANT, BUT WHAT DOES IT DO FOR MS?
Nothing in that last section should come as much of a surprise — we’re all exposed enough to the benefits of exercise. What’s really worth examining, though, is how those relatively simple benefits can become much more important when you’re living with MS.
WEIGHT: Our weight can effect so many other parts of our health and our lives that it can really have a cascading effect on a chronic illness like MS. Being overweight can make you more suceptible to other illnesses, can rob you of energy, and compound feelings of fatigue. It can also contribute to mood problems and depression, and complicate your mobility which can disrupt your ability to be physically active in the first place. Controlling and maintaining weight is closely related to each of these exercise benefits, especially when MS is in the picture. Also, weight related illnesses such as type II diabetes and hypertension increase the level of disability due to MS because these illnesses also damage the brain which magnifies the impact of MS lesions.
ILLNESSES: Some of the most difficult complications that can occur with MS patients is when they’re also fighting another serious health issue or additional chronic illnesses. These “comorbidities,” as doctors call them, can create some serious issues for you and your neurologist to work through. Complications can arise from conflicts between drugs you may be prescribed for MS and another illness, symptomatic problems that can compound and get worse, or even from things as simple as managing your care with multiple different medical specialists and the appointments you may need with each of them. But, most importantly, other illnesses stress the nervous system increasing the impact of MS on neurologic function. Physical activity is proven to reduce your risk of developing many of these comorbidities.
MOOD: Endorphins released during exercise have been shown to have a number of effects, from acting as analgesics (pain relief) to producing feelings of euphoria (commonly called the “runner’s high”). Together, these effects can reduce stress and anxiety, which in turn can ward off feelings of depression. A number of studies have shown that depression is the second most common symptom of MS, just behind fatigue. Around 50% of MS patients are taking anti-depression medications as part of their medical treatment for MS. While regular exercise surely isn’t a cure for depression, it can be an important part of helping treat the condition.
ENERGY: One of the most common and most difficult symptoms reported by MS patients is fatigue. When you’re living with MS, you know that fatigue isn’t just feeling a little tired from time to time — it’s a profound lack of energy that can make even the simplest of daily tasks nearly impossible. It’s also probably the most common “invisible” symptom, very difficult to explain to those around us.
Exercise as a means of fighting fatigue sounds counter-intuitive… if you’re tired, you should rest, not exercise, right? But it may actually be one of the most effective ways to deal with fatigue over time, and forgoing exercise because of fatigue may have a snowball effect. In “Exercise in Multiple Sclerosis,” published in the EPMA Journal in 2011, authors declared: “MS patients end up in a vicious circle: out of a wish to reduce fatigue they decrease physical activity which over time reduces endurance, muscle strength, and quality of life and may enhance fatigue, which then thus in turn further limits physical activity and social life.”
Interestingly, the complicating factor with exercising to help fatigue is fatigue itself — if you’re exhausted, it’s not just difficult to get up and get moving, but can also become unsafe. Make sure you start slow, build slowly, and always be safe (more on that later).
SLEEP: Like weight, sleep can have a cascading effect on many other issues. If you’re not getting the sleep you need, your body and brain are constantly fighting an uphill battle. Your body needs to recharge itself regularly — and that’s not just a matter of resting time, it’s also good, quality, uninterrupted sleep. Quality sleep helps your immune system fight off other illnesses, can improve your mood and stave off depression, and can contribute to increased energy.
EXERCISE YOUR BODY, BENEFIT YOUR BRAIN
Exercise doesn’t just benefit the obvious parts of your body — muscles, heart, lungs, etc. Research shows that even small amounts of physical activity can have an impact on cognition, cognitive decline, and neuroplasticity (the brain’s ability to adapt).
We’ll dig deeper in a moment, but let’s do a quick review of the concept of maximizing lifelong brain health.
“We’ve been thinking about maximizing lifelong brain health for six or seven years,” said Dr. Timothy Vollmer, Medical Director of the RMMSC, “based on our increasing understanding of loss of neurons in MS and how important this is in leading to disability.”
The brain has a built-in capacity to compensate for injury or damage, including the damage caused by MS. When an area of the brain is compromised, this “neurological reserve” essentially acts as a buffer, working to make up the difference. This concept of neurological reserve is a key component in our understanding of brain health.
Neurological reserve is closely related to overall brain volume. As we get older, we all lose brain volume – that’s just a natural part of the aging process called brain atrophy. Our brains get smaller as we age, and as that happens we’re also losing the neurological reserve that protects our brains from injury.
In people with MS, neurological reserve compensates for the effects of the disease, leaving them with less neurological reserve as they age. Less neurological reserve means less ability to compensate for the next bout of disease activity, which can lead to a worsening of MS symptoms, or to an increased risk for disability. Loss of neurological reserve can also unmask the effect of normal aging on brain leading to early onset of age-related changes in neurological function.
MS is treated with disease modifying therapies to slow disease progression, which in turn saves neurological reserve over time.
But here’s the thing: physical activity has been shown to increase the brain’s ability to protect itself, as well. That’s right, the neurological reserve we’re concerned with protecting in our efforts to maximize lifelong brain health is also increased when we engage in physical exercise. (More on neurogenesis — growing new brain cells — in Dr. Hebert’s interview.)
YOUR BRAIN DOES MORE THAN THINK
We tend to view the brain as a “thinking” organ, and we work it out with common brain exercises like reading, brain teasers, memory games, even working out our fine motor skills. All of those are great for preserving brain volume and fighting atrophy over time.
But the brain is doing a lot more than that — it’s also controlling every aspect of movement, taking in information from our senses, and processing the world around us, all in addition to the automated functions of breathing, pumping blood and more.
When we exercise, there’s not always a lot of “thinking” going on, so we don’t always consider how deeply our brain is involved with those functions. But it turns out we should: physical activity is as important to our brain as it is to the rest of our body.
“The regions (of the brain) that benefit from physical activity are also those that seem more vulnerable to aging, leading to a decline in a broad array of cognitive processes,” say the authors of “Neuroprotective Effects of Physical Activity,” published in the journal Frontiers in Neurology in 2017.
Exercise isn’t simply a means of staying physically fit — it’s also complementary to an overall MS treatment plan aimed at maximizing the health of the brain over your lifetime.
Hopefully we’ve convinced you that exercise is more than just getting physically fit, and its benefits are a lot more important than just toning muscles and burning calories.
Now, let’s look at what “exercise” really means.
We’re not all marathon runners, and spending hours-on-end in the gym isn’t in the cards for many of us. In the MS community, things are more complicated for many of us due to physical limitations that may have been brought on by the disease. Also, you don’t have to do all your exercise routine at one time. Doing four 5-minute episodes of exercise can be just as effective as doing one 20-minute exercise routine. The majority of health benefits come from a moderate exercise program, so intense exercise is not necessary to improve health in general, and brain health in particular.
But none of that should be a barrier to increasing your physical activity. Getting started can be as simple as taking the stairs instead of the escalator, or parking a little further away from the front of the store when you’re grocery shopping. If you use an assistive device for walking, or a chair or scooter to get around, there’s still plenty you can do to increase your level of activity.
If you’re behind a desk at work all day, get up and walk around once in a while. If you’re enjoying a quiet evening streaming your favorite TV show, stand up and walk around the house between episodes.
Exercise doesn’t have to be many hours of strenuous working out five nights a week — it just needs to be an increase over doing nothing. The key is finding what’s right for you, what suits your interests, what fits your lifestyle and schedule, and what you can make stick.
Read our interview with Dr. Jeffrey Hebert, who expands on what it means to incorporate exercise in your life.