On Saturday, March 6^th, JKFITNESS took part in a local 5K walk that kicked off a national “MS Awareness Week” sponsored by the National Multiple Sclerosis (MS) Society.  As many of you know, our fitness studio is shared with a group dedicated to helping MS patients regain functional ability through physical therapy regimens.  The Neurological Institute of San Antonio (NISA) and JKFITNESS literally place MS rehab and exercise hand-in-hand.  Working along side of the NISA professionals, we have learned an immense amount about how exercise can help MS patients and how it can help restore independence by maintaining functional strength.  In honor of last week’s “MS Awareness Week”, this blog will focus specifically on proper exercise prescription for MS patients.

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system that more commonly affects women between the ages of 20 and 40 years old.  Symptoms of MS vary greatly among each patient, but common side effects include sensory disturbances, weakness in the extremities, optic nerve dysfunction, impaired balance, fatigue and heat insensitivity.  These symptoms are also very specific to exercise programming for patients with MS.  The primary goal of exercise is to restore functional ability for MS patients.  Exercise program design should specifically address the patient’s unique limitations and have transferability to daily tasks.  Realistic goal setting, with emphasis on short-term goals, should be encouraged for MS patients.  Successful short-term goal setting will ultimately lead to long-term consistency and success.

Due to the unique and varied limitations MS patients present, there are several exercise guidelines that should be considered with exercise program design.  First and foremost, it is recognized that exercise consistency is more important than exercise intensity.  An MS patient should not exercise to exhaustion or adopt a “no pain, no gain” attitude.  Extreme exercise intensity is not safe for most MS patients due to heat insensitivity issues.  Additionally, the energy level of MS patients can vary greatly from day to day, so it is critical to gauge exercise intensity each day and simply “do what you can”.  This will help to create exercise consistency and this will yield greater long-term success.  Next, as mentioned above, restoring functional ability should be the main goal for MS patients.  Every exercise that is performed should mirror daily activities or tasks.  In other words, the exercises should be transferable outside of the exercise environment.

Overall exercise program objectives should include emphasis on balance training, flexibility and strength training to improve function.  Flexibility and strength training should be seen as a continuum, rather than mutually exclusive as traditionally viewed.  A person that has tight muscles usually has a corresponding muscle weakness.  Strength training promotes muscle flexibility naturally and should be used to increase overall functionality.  For example, as you are performing an exercise to strengthen the quadriceps muscle, the muscle will contract or shorten.  The opposing muscle, the hamstring, will consequently lengthen.  Therefore it is important for MS patients to utilize exercises to not only increase strength, but to promote flexibility as well.  Gait analysis and subsequent “walking training” is also an important part of exercise programs for MS patients.  Due to weakness and sensory disturbances in the extremities, focus should be placed on maintaining a proper walking gait.  Emphasizing a “heel, ball, toe” gait will help to avoid drop foot problems which can contribute to balance issues.  Emphasis should also be placed on making walking be a “conscious” movement and being aware of total body movement and the recruitment of muscles throughout the process.  Furthermore, for MS patients actively rehabilitating, reliance on braces or canes should be minimized.  Instead, focusing on core strengthening exercises will teach the MS patient to maintain good posture and rely on their own body structure for support, rather than devices.  Many times, focusing on core strengthening is a great starting point for MS patients.  Strength training exercise selection should begin with more stable exercises and then gradually progress to less stable methods.

Keys to a successful exercise program for MS patients boils down to this:  safe exercise = effective exercise.  So long as exercise is creating a positive effect on the overall functionality of the patient and is creating long-term consistency, it should be considered successful!