There are many possible exercise programs for people with MS. They may include stretching exercises, walking, running, swimming, and a range of other exercises that may be appropriate for all levels of physical functioning. In addition to these conventional methods, exercise may be obtained by unconventional approaches, such as yoga and t’ai chi.

The specific type of exercise program that is best depends on the individual. Each person with MS has specific strengths and weaknesses, and these must be taken into account when developing an exercise program. An exercise program for a person with MS is usually developed by a physical therapist.

The risks of exercise depend on the type of exercise. Increased body temperature with exercise may provoke neurologic symptoms in some people with MS. Musculoskeletal pain or injury may occur with overuse or trauma. The risk of exercise-induced injury is greater in those who are overweight, are older, or have had previous injuries. Finally, asthma may be provoked by exercise.

People with MS should develop an exercise program with the guidance of a physical therapist. This is especially important for those with significant physical disabilities or heart or lung conditions. Information on exercise is readily available from popular books and recreation centers. This information should not be used instead of consulting with a professional.

Exercise Builds Options
A Conversation With Timothy Vollmer, MD

In the past several years there has been an increased focus on the importance of exercise as a tool for managing MS. Why is that?

Dr. Vollmer: The brain is an organ that is constantly trying to repair itself. We now know that the majority of MS disease activity in the brain is clinically silent and that’s because the brain is pretty good at fixing the damage. The research is compelling that the brain repairs itself in MS mainly by shifting functioning from areas that are not working so well to areas that are working better. The ability of the brain to do this is improved by both cognitive and physical activity.

Cognitive reserve is the capacity of the brain to cope successfully with injury. The message about cognitive reserve is this: we are not talking about building more neurons. We are talking about having more connections between the neurons that already exist. It is those connections that allow the brain to move things around more easily. It is like having a city that has only one road in and out. If that one road gets closed, you are sunk. On the other hand, if you have a dozen roads coming in and out, if one gets plugged up, you can still get around. More connections between nerve cells help us get around damage and cope with injury.

Facilitating the development of cognitive reserve is really dependent on MS patients adopting lifestyles that help the brain develop these new connections. We have good evidence that exercise is beneficial. If you look at potential return on investment, exercise is right up there at the top. That’s why we are focusing on exercise.

Do you think of exercise as a sort of basic maintenance program for the brain or is it more than that?

Dr. Vollmer: There are three separate goals of exercise: good general health, maximizing your current functioning, and protecting your brain for the future, of course with the caveat that you still need to have effective immunological therapy. Exercise does not replace the immunological therapies.

What I don’t want people to assume is that exercise just maintains their current level of functioning. Because research suggests that it can actually improve your function. To take patients who have incurred significant disability as a result of MS and improve their futures you need to do two things. One is to prevent further injury by using the most effective anti-inflammatory treatment you have and the other is, in the context of a good normal healthy diet, to institute a program that is based on cognitive and physical exercise.

It is difficult to get people in general to stick with a regular exercise regimen. My experience is that it can be even harder when someone has a disease like MS.

Dr. Vollmer: The symptoms of MS themselves can make it hard to exercise so you need to design an exercise regimen that takes limitations into consideration. You need to start out with a lower intensity than you think is reasonable and you have got to go up slowly.

You need to assess what you realistically will be able to change. If an extremity is so weak that you cannot activate it, that does not mean you don’t try, but it does means that isn’t the only thing you do. If your legs are really weak, that probably should not be the focus of your exercise program. It is probably the rest of you that you need to be working on.

So, if you have lost the race in one area, do not just keep focusing on that: work on the rest of your body. You have to be explicit in telling patients who really have major problems with their legs that their arms are even more important to them.

The literature on what drives the brain to develop cognitive reserve, and the research on exercise, all suggest that change comes about when we really push the system. But we always encourage people with MS to be moderate, conserve energy, and stay within certain limits. What’s your opinion on this?

You can push yourself to exercise to the limit but it isn’t really necessary to push that hard every day. Professional athletes maintain pretty good function by doing a moderate exercise routine on a daily basis, but once a week completing a really intense workout. If patients really want to improve function, I suggest that they exercise daily, but at an intensity that allows them to recover within an hour or two. Once a week, they can push until they are so fatigued that they just want to go to bed. This is how people train to run marathons. They don’t run a marathon everyday but they do drive up their endurance once a week.