September 2020
Written by: Jeffrey A Segal CSCS, NSCA-CPT, CPTS
Exercise is an essential component of the Multiple Sclerosis
patient’s treatment plan. Unfortunately, until the 1990’s, exercise was highly
regarded as contraindicated to MS patients. In 1993, the first medicine was
approved by the FDA for MS and in 1996; the first research showing the benefits
of exercise was published by the University of Utah. These were two major breakthroughs
which have given hope to a population consisting of the most common disabling
neurological disease of young adults (most common onset between ages 20 and 50).
Multiple Sclerosis is a neuroinflammatory autoimmune disease
of the central nervous system (CNS), consisting of the brain, spinal cord and
optic nerve. The immune system attacks
the myelin sheath of the nerves which insulates, protects as well as affects
the signal speed from the CNS to the affected body part. Presentation of
initial symptom of MS include optic nerve inflammation, poor balance (ataxia),
dizziness (vertigo), weakness, double vision (diplopia), bladder/bowel dysfunction,
pain, sensory loss, cognitive impairment, fatigue (most common) and a host of
others including but not limited to gait impairment, depression, tremors, thermo-regulatory dysfunction
(autonomic) and spasticity. Because many symptoms are invisible (not outwardly
visible), most notably fatigue, pain and cognitive impairment, they can affect
confidence, relationships, and discourage patients from seeking treatment or
help.
Currently, with roughly 20 FDA approved disease modifying
treatments, as well as exercise being greatly encouraged by health care
providers treating MS, the face of MS is changing for the better. While exercise
will not change the course of the disease progression, both aerobic and
anaerobic conditioning have greatly helped reduce secondary and tertiary
symptoms such as falls, injuries, anxiety/depression, impaired activities of
daily living (secondary) and increase self-esteem, and independence while reducing social isolation
and family disruption (tertiary).
The benefits of a safe, progressive/adaptive exercise program
are improved overall fitness, ability to perform activities of daily living,
moods, sense of well-being, strength while decreasing spasticity, fatigue and
may prevent a host of comorbidities. Because MS patients may be less mobile
and underweight/overweight, coupled with the possibility of side effects from
the use of corticosteroids, it increases the likelihood of developing
conditions such as osteoporosis and diabetes mellitus. This is an even a
greater reason those affected with MS should work with professionals who
understand the disease.
Although many patients are still hesitant to begin an
exercise program because of fear of exacerbating their condition, lack of
confidence or inability to find professionals skilled to work with them, now is
the best time in the history of MS treatment for both patients and professionals
to be on the same page. Exercise no longer has to be an activity of an MS
patient’s past. It is simply a must of the present and future.