Health & Wellness

What is New in Exercise Research?

By Mike Zervas, PT, DPT, NCS, Herb Karpatkin, PT, DSC, NCS, MSCS
Exercise has been well established as one of the best ways of treating and managing the deficits caused by multiple sclerosis. Regardless of disability severity, exercise has been shown to improve function, fitness, and health in persons with MS. As physical therapists who specialize in working with patients with MS, one of the most common questions we are asked is “What is the best exercise for my MS?” This is never an easy question to answer because MS affects each person differently, requiring that treatment plans should be individualized. Additionally, there is a large amount of new research that is continuing to try to address questions about MS and exercise. While there are already various types of exercises persons with MS are participating in, the primary purpose of this article is to review some of the latest MS exercise research, and propose how it might best be utilized by persons dealing with MS now.

PTs are very passionate about exercise, and for good reason. It has a tremendous number of benefits, including improving walking, balance, strength, flexibility, and endurance, as well as reducing your feelings of fatigue, pain, and stiffness. Most importantly, however, is that recent evidence suggests you do not have to do only one specific type of exercise to reap some of the above benefits. There are several ways to exercise that can help improve how well you move and feel. Below are a few newer trends being researched by PTs with findings that apply directly to the unique needs of persons with MS. It is important to note these exercises should be performed under the direct supervision of a PT initially to ensure safety and for progression of your exercise program.

High-intensity interval training: HIIT is defined in its name. Exercises or specific movements are performed at a high intensity for short bouts or repetitions with rest breaks between sets. The goal is to essentially work as hard as you safely can, then rest, recover, and repeat. HIIT has been examined extensively in persons without MS – ranging from adolescents up to professional athletes – and found to be safe and effective. A systematic review examined the safety and benefits of HIIT in MS and found it to not only be safe and well-tolerated, but could help improve physical fitness for those with mild, nonprogressive MS. What is unique about this exercise mode is it can avoid the onset of debilitating fatigue despite the high intensity because periods of work are interspersed with periods of rest and recovery. Many patients with MS have difficulty exercising continuously because of fatigue, but in HIIT you are doing short bursts of activity with rest breaks, allowing fatigue to be more easily controlled.

Body weight supported treadmill training: This is a type of walking practice where you are suspended from a harness over a moving treadmill. The harness serves two purposes: First, it decreases your body weight while walking, therefore making walking less fatiguing and allowing a greater amount of walking to be done. Second, the harness protects you from falling, so you are not limited by fear. Difficulty or decreased walking ability is extremely common in persons with MS. An important rehabilitation goal is to practice what is difficult in order to improve one’s ability to perform that activity. The saying ‘practice makes perfect’ applies. For walking, that means practicing walking will help improve your walking. One way to overcome the difficulties of walking for those who fatigue easily or require an assistive device to walk is to wear a harness that supports your body and prevents you from falling, while at the same time practicing walking on the treadmill. This is a popular exercise that PTs use that has evidence supporting improving walking capacity, fatigue, independence in activities of daily living, and overall quality of life for persons with MS. An advantage to BWSTT is it can be used for those with mild to more severe MS, but it does need to be performed under the direct supervision of a PT.

Aerobic and resistance training for pain reduction: Many persons with MS suffer from pain, which can be extremely debilitating and only worsen other MS-related issues, such as walking and fatigue. Waiting for pain to go away on its own with rest or medication alone is not always the best strategy. Pain is a product of your nervous system and MS can directly affect that part of your nervous system. A systematic review examined several different studies that looked at aerobic exercise and resistance training in MS, all with different examples for what device to use and how hard to exercise. However, regardless of what was used, the reported pain levels went down. The
take-home message is movement can help change your nervous system for the better, and therefore reduce your reported pain.

As we hope we have shown in this brief article, exercise is extremely important for persons with MS for several reasons. It not only can make you move better but feel better. There are lots of ways you can incorporate exercise into your regular routine, and different exercises that you can perform with your PT.

One of the most important messages PTs can pass along to our patients is you should find an activity or exercise you like, and stick with it. If you like what you do, you are much more likely to continue it and make lifestyle changes. Whether it is HIIT, increasing your walking, or using weights, some form of exercise is always better than no exercise. Just make sure to speak to a PT trained in working with persons with MS before starting a new exercise program to help get you started and make sure you stay safe.