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Q) Should I recommend exercise to my patients living with MS?
Multiple sclerosis (MS) causes varied symptoms and functional impairment, depending on what part of the central nervous system is involved. Currently, many patients living with MS have sedentary lifestyles, which increases the risk for comorbidities such as cardiovascular disease, type 2 diabetes, and osteoporosis.1-3
Some MS symptoms—ambulatory difficulty, balance impairment, heat intolerance, muscle weakness, spasticity, visual impairment, and fatigue—act as obstacles to routine physical exercise; they also typically worsen over the course of the disease.2-5 In addition, psychosocial factors such as lower levels of education, single status, smoking, and depression or anxiety have been shown to increase the likelihood that a patient will not meet the World Health Organization’s recommendations on physical activity for health.1
For many years, MS patients were advised against physical activity out of concern that it would exacerbate symptoms.6 It is likely still true that patients who fear worsened symptoms or have higher levels of disability avoid physical activity.2-5 Unfortunately, for persons living with MS, this cycle of fear and reduced activity perpetuates itself, resulting in increased disability and decreased quality of life. Thankfully, many of the physical and social factors that prevent patients from exercising are modifiable.1,4
Many types of exercise have been studied in patients living with MS; those shown to be beneficial include regimens focused on cardiovascular fitness, resistance training, balance, and flexibility. Evidence supports the benefits of exercise training for improving overall fitness, muscle strength, ambulation, cognition, spasticity, fatigue, and anxiety and depression in patients with MS.2-4,6-9 Exercise with aerobic, anaerobic, or resistance training has been considered an important nonpharmacologic treatment for MS patients to improve quality of life without worsening disease symptoms.9 There is increasing evidence that engaging in more physical activity and improving physical fitness is an important modality to improve disease course and slow progression over time.
Any increase in symptoms related to exercise is transient, and there is no evidence of lasting harmful effects on overall day-to-day functioning or association with disease progression.6,10 Patient reports of the perceived benefits of exercise include maintenance of physical function, increased social involvement, and feelings of self-management and control.5 Thus, if patients can comply with an exercise regimen, much of the initial disability that limited their activity may be reduced.
More research is needed to fully elucidate what type of exercise is most beneficial for an individual patient.4,5,8,9 However, the benefits of exercise are clear: It can significantly improve quality of life by enhancing psychologic and physical functioning.1,3,5,6,8 Given this information, patients living with MS have incentives to exercise. Health care providers should endorse the benefits of exercise and work to help patients reduce barriers to physical activity.1-5—RR
Rebecca Rahn, MPA-C, MSCS
Augusta MS Center
Neurology Department, Augusta University, Georgia
1. Reider N, Salter AR, Cutter GR, et al. Potentially modifiable factors associated with physical activity in people living with multiple sclerosis. Res Nurs Health. 2017;40(2):143-152.
2. Sebastiao E, Learmonth YC, Motl RM. Lower physical activity in persons with multiple sclerosis at increased fall risk: a cross sectional study. Am J Phys Med Rehabil. 2017;96:357-361.
3. Vister E, Tijsma ME, Hoang PD, Lord SR. Fatigue, physical activity, quality of life, and fall risk in people with multiple sclerosis. Int J MS Care. 2017;19:91-98.
4. Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe disability: a systematic review and future research directions. Mult Scler Relat Disord. 2017;16:31-39.
5. Learmonth YC, Motl RW. Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences. Disabil Rehabil. 2016;38(13):1227-1242.
6. Paul L, Coote S, Crosbie J, et al. Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting. Mult Scler. 2014;20(12):1641-1650.
7. Sandroff BM, Motl RW, Scuddler MR, Deluca J. Systematic, evidence-based review of exercise, physical activity, and physical fitness effects on cognition in persons with multiple sclerosis. Neuropsychol Rev. 2016;26(3):271-294.
8. Hugos CL, Bourdette D, Chen YCZ, Cameron M. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: a randomized, controlled pilot trial. Mult Scler J Exp Transl Clin. 2017;3(1):1-11.
9. Alvarenga-Filho H, Sacramento PM, Ferreira TB, et al. Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators. J Neuroimmunol. 2016;293:91-99.
10. Smith RM, Adeney-Steel M, Fulcher G, Longley WA. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil. 2006;87(5):723-727.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month's responses were authored by Stacey Panasci, MSPAS, PA-C, who practices at Springfield Neurology Associates, LLC, in Massachusetts, and Rebecca Rahn, MPA-C, MSCS, who is Associate Director of the Augusta MS Center in the Neurology Department of Augusta University in Georgia.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month's responses were authored by Stacey Panasci, MSPAS, PA-C, who practices at Springfield Neurology Associates, LLC, in Massachusetts, and Rebecca Rahn, MPA-C, MSCS, who is Associate Director of the Augusta MS Center in the Neurology Department of Augusta University in Georgia.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month's responses were authored by Stacey Panasci, MSPAS, PA-C, who practices at Springfield Neurology Associates, LLC, in Massachusetts, and Rebecca Rahn, MPA-C, MSCS, who is Associate Director of the Augusta MS Center in the Neurology Department of Augusta University in Georgia.
Q) Should I recommend exercise to my patients living with MS?
Multiple sclerosis (MS) causes varied symptoms and functional impairment, depending on what part of the central nervous system is involved. Currently, many patients living with MS have sedentary lifestyles, which increases the risk for comorbidities such as cardiovascular disease, type 2 diabetes, and osteoporosis.1-3
Some MS symptoms—ambulatory difficulty, balance impairment, heat intolerance, muscle weakness, spasticity, visual impairment, and fatigue—act as obstacles to routine physical exercise; they also typically worsen over the course of the disease.2-5 In addition, psychosocial factors such as lower levels of education, single status, smoking, and depression or anxiety have been shown to increase the likelihood that a patient will not meet the World Health Organization’s recommendations on physical activity for health.1
For many years, MS patients were advised against physical activity out of concern that it would exacerbate symptoms.6 It is likely still true that patients who fear worsened symptoms or have higher levels of disability avoid physical activity.2-5 Unfortunately, for persons living with MS, this cycle of fear and reduced activity perpetuates itself, resulting in increased disability and decreased quality of life. Thankfully, many of the physical and social factors that prevent patients from exercising are modifiable.1,4
Many types of exercise have been studied in patients living with MS; those shown to be beneficial include regimens focused on cardiovascular fitness, resistance training, balance, and flexibility. Evidence supports the benefits of exercise training for improving overall fitness, muscle strength, ambulation, cognition, spasticity, fatigue, and anxiety and depression in patients with MS.2-4,6-9 Exercise with aerobic, anaerobic, or resistance training has been considered an important nonpharmacologic treatment for MS patients to improve quality of life without worsening disease symptoms.9 There is increasing evidence that engaging in more physical activity and improving physical fitness is an important modality to improve disease course and slow progression over time.
Any increase in symptoms related to exercise is transient, and there is no evidence of lasting harmful effects on overall day-to-day functioning or association with disease progression.6,10 Patient reports of the perceived benefits of exercise include maintenance of physical function, increased social involvement, and feelings of self-management and control.5 Thus, if patients can comply with an exercise regimen, much of the initial disability that limited their activity may be reduced.
More research is needed to fully elucidate what type of exercise is most beneficial for an individual patient.4,5,8,9 However, the benefits of exercise are clear: It can significantly improve quality of life by enhancing psychologic and physical functioning.1,3,5,6,8 Given this information, patients living with MS have incentives to exercise. Health care providers should endorse the benefits of exercise and work to help patients reduce barriers to physical activity.1-5—RR
Rebecca Rahn, MPA-C, MSCS
Augusta MS Center
Neurology Department, Augusta University, Georgia
Q) Should I recommend exercise to my patients living with MS?
Multiple sclerosis (MS) causes varied symptoms and functional impairment, depending on what part of the central nervous system is involved. Currently, many patients living with MS have sedentary lifestyles, which increases the risk for comorbidities such as cardiovascular disease, type 2 diabetes, and osteoporosis.1-3
Some MS symptoms—ambulatory difficulty, balance impairment, heat intolerance, muscle weakness, spasticity, visual impairment, and fatigue—act as obstacles to routine physical exercise; they also typically worsen over the course of the disease.2-5 In addition, psychosocial factors such as lower levels of education, single status, smoking, and depression or anxiety have been shown to increase the likelihood that a patient will not meet the World Health Organization’s recommendations on physical activity for health.1
For many years, MS patients were advised against physical activity out of concern that it would exacerbate symptoms.6 It is likely still true that patients who fear worsened symptoms or have higher levels of disability avoid physical activity.2-5 Unfortunately, for persons living with MS, this cycle of fear and reduced activity perpetuates itself, resulting in increased disability and decreased quality of life. Thankfully, many of the physical and social factors that prevent patients from exercising are modifiable.1,4
Many types of exercise have been studied in patients living with MS; those shown to be beneficial include regimens focused on cardiovascular fitness, resistance training, balance, and flexibility. Evidence supports the benefits of exercise training for improving overall fitness, muscle strength, ambulation, cognition, spasticity, fatigue, and anxiety and depression in patients with MS.2-4,6-9 Exercise with aerobic, anaerobic, or resistance training has been considered an important nonpharmacologic treatment for MS patients to improve quality of life without worsening disease symptoms.9 There is increasing evidence that engaging in more physical activity and improving physical fitness is an important modality to improve disease course and slow progression over time.
Any increase in symptoms related to exercise is transient, and there is no evidence of lasting harmful effects on overall day-to-day functioning or association with disease progression.6,10 Patient reports of the perceived benefits of exercise include maintenance of physical function, increased social involvement, and feelings of self-management and control.5 Thus, if patients can comply with an exercise regimen, much of the initial disability that limited their activity may be reduced.
More research is needed to fully elucidate what type of exercise is most beneficial for an individual patient.4,5,8,9 However, the benefits of exercise are clear: It can significantly improve quality of life by enhancing psychologic and physical functioning.1,3,5,6,8 Given this information, patients living with MS have incentives to exercise. Health care providers should endorse the benefits of exercise and work to help patients reduce barriers to physical activity.1-5—RR
Rebecca Rahn, MPA-C, MSCS
Augusta MS Center
Neurology Department, Augusta University, Georgia
1. Reider N, Salter AR, Cutter GR, et al. Potentially modifiable factors associated with physical activity in people living with multiple sclerosis. Res Nurs Health. 2017;40(2):143-152.
2. Sebastiao E, Learmonth YC, Motl RM. Lower physical activity in persons with multiple sclerosis at increased fall risk: a cross sectional study. Am J Phys Med Rehabil. 2017;96:357-361.
3. Vister E, Tijsma ME, Hoang PD, Lord SR. Fatigue, physical activity, quality of life, and fall risk in people with multiple sclerosis. Int J MS Care. 2017;19:91-98.
4. Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe disability: a systematic review and future research directions. Mult Scler Relat Disord. 2017;16:31-39.
5. Learmonth YC, Motl RW. Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences. Disabil Rehabil. 2016;38(13):1227-1242.
6. Paul L, Coote S, Crosbie J, et al. Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting. Mult Scler. 2014;20(12):1641-1650.
7. Sandroff BM, Motl RW, Scuddler MR, Deluca J. Systematic, evidence-based review of exercise, physical activity, and physical fitness effects on cognition in persons with multiple sclerosis. Neuropsychol Rev. 2016;26(3):271-294.
8. Hugos CL, Bourdette D, Chen YCZ, Cameron M. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: a randomized, controlled pilot trial. Mult Scler J Exp Transl Clin. 2017;3(1):1-11.
9. Alvarenga-Filho H, Sacramento PM, Ferreira TB, et al. Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators. J Neuroimmunol. 2016;293:91-99.
10. Smith RM, Adeney-Steel M, Fulcher G, Longley WA. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil. 2006;87(5):723-727.
1. Reider N, Salter AR, Cutter GR, et al. Potentially modifiable factors associated with physical activity in people living with multiple sclerosis. Res Nurs Health. 2017;40(2):143-152.
2. Sebastiao E, Learmonth YC, Motl RM. Lower physical activity in persons with multiple sclerosis at increased fall risk: a cross sectional study. Am J Phys Med Rehabil. 2017;96:357-361.
3. Vister E, Tijsma ME, Hoang PD, Lord SR. Fatigue, physical activity, quality of life, and fall risk in people with multiple sclerosis. Int J MS Care. 2017;19:91-98.
4. Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe disability: a systematic review and future research directions. Mult Scler Relat Disord. 2017;16:31-39.
5. Learmonth YC, Motl RW. Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences. Disabil Rehabil. 2016;38(13):1227-1242.
6. Paul L, Coote S, Crosbie J, et al. Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting. Mult Scler. 2014;20(12):1641-1650.
7. Sandroff BM, Motl RW, Scuddler MR, Deluca J. Systematic, evidence-based review of exercise, physical activity, and physical fitness effects on cognition in persons with multiple sclerosis. Neuropsychol Rev. 2016;26(3):271-294.
8. Hugos CL, Bourdette D, Chen YCZ, Cameron M. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: a randomized, controlled pilot trial. Mult Scler J Exp Transl Clin. 2017;3(1):1-11.
9. Alvarenga-Filho H, Sacramento PM, Ferreira TB, et al. Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators. J Neuroimmunol. 2016;293:91-99.
10. Smith RM, Adeney-Steel M, Fulcher G, Longley WA. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil. 2006;87(5):723-727.
