Symptom Management

Research is clear that exercise can help people with MS. Persons with MS who engage in exercise programs will have better walking, balance, endurance, and physical performance in general than those who don’t exercise. Additionally, those who exercise have better moods, and less depression and anxiety than those who don’t. However, many people with MS do not exercise, or do not exercise correctly. Moreover, different types of exercise can serve different purposes. How do you know what kind of exercise is right for you?
   
Exercise can be divided into two broad categories: exercise for wellness and exercise for specific goals. Both are important, but each serves a slightly different purpose.
 
Exercise for wellness is based on the idea that any type of exercise will result in improved health and well-being, especially in persons who normally do not exercise. Because people with MS generally do not exercise as much as those who don’t have MS, exercise for wellness is a good idea because it will improve their overall health. Generally speaking, persons with MS who engage in a regular exercise program will have better health than those who do not. Therefore, they will be less affected by the disease itself. MS is an illness that almost always leads to decreased movement. A sedentary lifestyle is almost certain to make the course of the disease worse, and therefore exercise of any type can decrease the chance of that happening.
 
However, the limitation of exercise for wellness is that it does not target any specific area, while people with MS may require exercises that target very specific symptoms. For example, if a person with MS has very tight or weak leg muscles limiting their ability to walk, then exercise for their arms will not improve their walking; it will improve their arm strength, and that’s a good thing, but it will have little or no effect on their walking.  To improve specific activities that are affected by MS, specific exercises must be done. This brings us to the second type of exercise, which we can call specific exercise.
 
Specific exercise refers to exercise that is done for a specific reason, to address a specific problem. In the same way that a physician gives you specific medications to address specific symptoms (penicillin for infections, aspirin for a headache), exercise for persons with MS must be specific to the problem they are experiencing.
 
For an example, let’s look at foot drop a common problem people with MS have with walking. In foot drop, the muscles of the calf get extremely tight, and the muscles in the front of the ankle that lifts the toes up get weak. This results in the front of the foot catching on the floor when you walk, resulting in loss of balance and falls, and eventually walking less and less. Exercises can help with this, but only specific ones. In particular, exercises that slowly and carefully stretch the calf muscles, while strengthening the muscles that lift the toes will help to reduce the effects of foot drop and improve walking. On the other hand, if a person with foot drop strengthened their arms, or rode a stationary bicycle, their foot drop would not improve. They would become fitter and healthier, but their problems with walking would persist.
   
All exercise is not the same. Just as each medication has a different purpose and goal, each exercise does too. Everyone with MS should look for a physical therapist that is knowledgeable about the disease. Work with the physical therapist to improve any mobility problems, or address other concerns that affect their physical abilities. In my 25 years of experience in working with persons with MS, I have always seen that the people who do the best are those who are involved in a serious and specific exercise program.
 
The new year is here, and as everyone knows, that’s a time to make resolutions. I hope that all persons with MS make a resolution to not just exercise more, but also exercise better. Find out from a physical therapist who specializes in MS what specific types of exercises you should do to help you with your MS and start doing them.