Exercise

Exercise is not always considered a form of complementary and alternative medicine (CAM). Sometimes it is classified as conventional medicine or merely as part of one’s lifestyle. Although it is not always discussed during a conventional medical visit, exercise has significant implications for the health of people with MS.

Previously, exercise was not recommended for people with MS. However, research now indicates that regular exercise produces multiple beneficial effects.

Treatment Approach

Many variations of exercise programs exist for people with MS, from simple stretching and walking to running and other activities. Such a wide variety allows for the accommodation of all levels of physical functioning. Aquatic therapy, or hydrotherapy, is a term used for exercising in water. Hydrotherapy eliminates the risk of injuries from falling. Also, cool water helps dissipate body heat. This is an added benefit because body warming can exacerbate MS-associated symptoms. Less conventional forms of exercise, including t’ai chi and yoga (see sections on T’ai Chi and Yoga), may also be beneficial.

Specific exercise programs should be tailored to the individual, as each person with MS has personal strengths and weaknesses. Physical therapists are excellent resources for people with MS who are looking to develop appropriate exercise regimens.

Evaluation in MS and Other Conditions

A variety of health benefits can be attributed to regular exercise. One study involving 54 people with MS, conducted at the University of Utah, examined the effects of aerobic exercise for 40 minutes, three times a week. After 15 weeks, weakness, fatigue, depression, anger, and bowel and bladder function all responded positively to exercise. Other studies suggest that walking ability and overall level of disability respond to exercise. Furthermore stiffness and spasticity may respond well to stretching.

More than one thousand studies have been conducted looking at exercise and depression. These studies have generally found that exercise has antidepressant effects. Many studies have found that longer courses of exercise—longer than four months—are needed to be definitely effective. It also appears that exercise may be more effective than relaxation techniques or the pursuit of enjoyable activities for overcoming depression. Exercise is more effective when combined with psychotherapy.

Anxiety appears to respond to exercise immediately, with noticeable results in exercise sessions as short as five minutes. By decreasing anxiety levels and possibly other processes, exercise may be beneficial for insomnia.

Exercise can produce many other health benefits. Regular exercise may prevent the decrease in bone density (osteoporosis) that may occur in those with MS. Low back pain also appears to respond to exercise. Exercise also decreases the death rate by up to 30 percent and decreases the risk of heart disease and stroke. Exercise may also help prevent diabetes, mildly decrease blood pressure, decrease the risk of some forms of cancer, and improve the symptoms of premenstrual syndrome (PMS).

Adverse Effects

Exercise is generally well tolerated. Exercise that produces an increase in body temperature may exacerbate MS-associated symptoms. Overexertion, repetitive use, and trauma may cause musculoskeletal pain or injury. Exercise may provoke asthma in susceptible people. People who are older, overweight, or who have had previous injuries are at greater risk of exercise-induced injury.

Summary

Exercise may produce many health benefits. Furthermore, it is inexpensive and generally safe. Beyond general health benefits, exercise may specifically improve many MS-associated symptoms, such as anxiety, anger, depression, fatigue, bowel and bladder problems, lower back pain, osteoporosis, spasticity, weakness, and walking difficulties.

References and Additional Reading

Books

Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos Medical Publishing, 2007, pp. 110-114.

Ernst E, ed. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. Edinburgh: Mosby, 2001.

Fugh-Berman A. Alternative Medicine: What Works. Baltimore: Williams & Wilkins, 1997: 94–100.

Journal Articles

Adlard PA, Perreau VM, Engesser-Cesar C, et al. The time course of induction of brain-derived neurotrophic factor mRNA and protein in the rat hippocampus following voluntary exercise. Neurosci Lett 2004;363:43–48.

Brown TR, Kraft GH. Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehab Clin N Am 2005;16:513–555.

Chen H, Zhang SM, Schwarzschild MA, et al. Physical activity and the risk of Parkinson disease. Neurology 2005;64:664–669.

Ernst E, Rand JI, Stevinson C. Complementary therapies for depression: An overview. Arch Gen Psych 1998;55:1026–1032.

Karpatkin HI. Multiple sclerosis and exercise: a review of the evidence. Int J MS Care 2005;7:36–41.

Petajan JH, Gappmaier E, White AT, et al. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996;39:432–441.

Rietberg MB, Brooks D, Uitdehaag BM, et al. Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev 2005;1:CD003980.

Romberg A, Virtanen A, Ruutiainen J, et al. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Neurology 2004; 63:2034–2038.

Scully D, Kremer J, Meade MM, et al. Physical exercise and psychological well being: a critical review. Br J Sports Med 1998;32:111–120.

Solari A, Filippini G, Gasco P, et al. Physical rehabilitation has a positive effect on disability in multiple sclerosis patients. Neurology 1999;52:57–62.

 

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