More on Exercise and Rehabilitation

It’s getting clearer that exercise and rehabilitation can help many levels of function and quality of life for people living with MS. This year, ECTRIMS is being held in conjunction with the 18th Annual Conference of Rehabilitation in MS, and I’ve been impressed by the extent to which researchers are applying creative strategies to study and maximize the potential benefits of rehab and exercise to address MS.
 
Some of these strategies were described by Dr. Dalgas (Aarhus, Denmark), who reminded the audience that for many years people with MS were advised against exercising because it seemed to make fatigue and other symptoms worse. Thanks to research, we now know that this worsening is usually temporary and outweighed by the benefits.
 
It seems like new benefits of exercise and rehab are being discovered every year. There have been hints that exercise can fight depression and improve cognition, and possibly even modify disease activity. The extent of these benefits and the optimal type of exercise for these benefits need further study.
 
One report by Dr. L. Prosperini and colleagues from Rome might be particularly motivating to keep active. They had already reported that an intensive home-based training program using the Nintendo Wii balance board improved standing balance and inhibited swaying in people with MS. Finding a way to improve balance can, for one thing, prevent falls. Falling, and the fear of falling, can dramatically impact a person’s quality of life.
 
To find out why it helped, they did advanced brain imaging in 21 people before and after a 12-week training period with the Wii board. After the training, differences in the imaging suggested that myelin in some parts of the brain had gotten thicker, particularly in the part of the brain that controls movement and balance (cerebellum). More work is needed, but it’s really exciting to think that we can take action to physically change our brains, and possibly to recover function.  
 
There were many other presentations related to benefits of specific rehab and exercise programs, such as Pilates to improve core stability, climbing to improve strength and balance, and tai chi for balance and other functions. One I was particularly interested in was a novel approach called kaatsu resistance training. It’s based on the idea that people who are already weak may have a hard time exercising with enough vigor to see positive changes in strength or growth in muscle mass.
 
Dr. Y. Learmonth and other rehabilitation researchers in Urbana, Illinois presented preliminary results of kaatsu training, in which blood flow to the muscles is partially blocked by a device similar to a blood pressure cuff, while performing lower limb exercises such as leg presses and curls. This may simulate extra resistance so that the exerciser needs to use less force to achieve gains. Eight people did these exercises 3 times a week for 6 weeks – 4 with the kaatsu cuff and 4 without. This was a small study, but they found it to be safe and also found hints that those using the cuff showed more signs of improved strength than the control group who didn’t use the cuff.  National MS Society has just committed to funding a small pilot study to further explore its potential, so we will keep you posted on progress in this area in the future.
 
Anyone who has ever tried to stick with an exercise routine knows that there are always things that can get in the way, making it challenging to maintain. As we continue to learn more about how exercise can really help people with MS, researchers are also looking at those barriers, too – what are they, and how can people best be motivated to stick with programs that can have such positive results.  
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Nicholas

Nicholas LaRocca, PhD

Dr. Nicholas LaRocca is a clinical psychologist who has worked in the field of MS for over 30 years. He was an associate professor at Albert Einstein College of Medicine and New York Medical College before joining the Society in 1997. He currently serves as Vice President of Health Care Delivery and Policy Research in the Research Programs Department of the Society. In this role he has responsibility for Society funding of research to address the symptoms of MS, rehabilitation, epidemiology, psychosocial aspects of MS as well as health policy studies.

    15 Comments

  • LAURIE GARVIN   Oct 4, 2013 9:53 AM
    I would love to exercise more but the therapist only allows fifteen minutes. I am thankful that I do not have a problem with fatigue.
  • Maureen Kenney   Oct 4, 2013 10:06 AM
    I am a 50 yr old mother of six diagnosed in 2002. Prior to diagnosis I was a marathon runner, and had to stop. In June of this year I decided I would start running again. I am now up to 3 miles 3x per week and walking an additional 20 miles per week. I have dropped 46 lbs. I had a small relapse end of Aug and for first time exercised through the steroids (5 gms) with my Dr's blessing.....Never had such an easy time through a relapse, my energy level did not drop and I am convinced the running helped my recovery.
  • Cathy Van Engen   Oct 4, 2013 10:06 AM
    I began going to pool 3x a week. I start slow, work out with a variety of swim exercises . I just am on my own and I can just do what I feel works for whatever I feel I can handle and try to challenge myself when I feel I can. I can walk or do my own water aerobic moves. It is so nice I don't have to follow a routine because my body handles different activities on different days. My day is so much better on those days.
  • Danyelle Portillo   Oct 4, 2013 10:12 AM
    I wish I could be more motivated to work out fatigue gets the best of me all the time its my biggest issue
  • Jerilyn Maruzzella   Oct 4, 2013 10:25 AM
    I have been exercising since being diagnosed with MS in 2/2012. I started with just at home stuff. Doing light core and balance workouts. That lasted several months. I changed it up, adding weights and elliptical workouts. My balance definately improved. I had slipped twice in that time frame and was totally amazed that I didn't completely do a face plant. I kept my balance on my way down and recovered gracefully from the fall. I also noticed that my body did not get injured. I again became bored and decided to try pilates. I had heard it was great for people with MS. I now do pilates once a week and have also started doing crossfit 2x a week. I continue to do at home exercise and elliptical also. Yes there are days that I don't have the energy, but I push through. I do believe this has helped me tremendously. My 2nd MRI did not show any new lesions.
  • Dawn Carter   Oct 4, 2013 10:28 AM
    Diagnosed in Nov 2001. I feel terrible because I tried physical therapy a few years ago, had insurance problems. Had an exercise bike used it for a while, but sometimes my fatigue is so bad I don't have the strength to push through. I'm 47 years old, and I have two sons. Is it too late for me to start back exercising? Also I can barely walk, my lower legs are so heavy that I can't lift them good enough to run.
  • Dawn Carter   Oct 4, 2013 10:42 AM
    Danyelle, I agree with you. I know exactly what you mean
  • Melissa Jones   Oct 4, 2013 10:44 AM
    I had lost my job over a year ago and realized how sedentary I had become. I decided to join a gym. I was set up with a personal trainer who had other clients with MS. The right side of my body is affected so he set up a routine to strengthen my legs and arms..but only three times a week. Wish I could go more!
  • Linda Clark   Oct 4, 2013 11:19 AM
    Exercising 3-4 days a week really helps keep you going with every thing else in life.I personally go to the local indoor pool and walk and exercise in the water it is not as stressful.I can still go home and due what I need to do the rest of the day.
  • Catherine   Oct 4, 2013 12:24 PM
    Diagnosed 2000. Currently managing significant balance and gait issues. Have been attending PT for years, as needed, and am a huge proponent to be as strong as I can possibly be. PT educates, makes recommendations and provides tools for me to accomplish just that based on my specific capabilities. I value her!!! In fact, she recommended I try a new tool, BalanceWear Weighted Vest! She was so right. Helping to improve my balance. Advancements, hope for me. I want to be ready for whatever comes from those pipelines! Never giving up!
  • Darcy Gagnon   Oct 4, 2013 2:57 PM
    I was never offered physical therapy for MS. My fatigue was so severe (I am "labeled" SPMS and had given up on the DMD that I had self injected for years, all the ABCs. They did nothing to help me). I kept sliding further and further downhill until I had lost all hope, even though I always had a positive attitude, because I could barely move, drive, brush my sleep, cook, clean, and barely bothered to drag myself upstairs to sleep and shower. I lived on the couch. It was no life, and while I wasn't suicidal, I really just wanted my life to be over.

    Then about 20 months ago, my daughter urged me to look into yet another diet, because she knew my low fat, whole grain diet wasn't working for me. I had nothing left to try, and for her I did exactly that, out of desperation. It changed my life within a few days.

    Now I am strict Paleo, driving and walking again, without a wheelchair, strollator or even a cane. I am going to the gym every day, and about 4 months ago hired some amazing personal trainers, who also changed my life even more. I am motivated, I work hard every day, and my life is amazing. It is expensive, and I am extremely grateful I can afford it.
  • Cheryl Venables   Oct 4, 2013 4:59 PM
    I would love to exercise more but I don't have that energy anymore, previously being a gym junkie, it's too exhausting. Some days I'm flat out getting up and out for work. I'm now no longer working 5 days but down to 3 which is working well, so now I can do the housework and still work part time & have a bit of a life on my days off.
  • Susan Acquilla   Oct 4, 2013 9:13 PM
    I was diagnosed with MS in April of 2002. I currently still work for UPS as a package car driver. I have 23 years down & 7 to go for retirement. I strongly agree with keeping busy. I think it is, what keeps me going. I just turned 50 this past August & started to add walking & jogging in to my routine. I love the feeling I get after a 2 1/2 mile walk /jog before my work day begins. I have more energy that lasts all day. Just going to continue to keep active. I may have MS, but it does not have me...
  • Becca Guess   Oct 17, 2013 12:29 PM
    I was doing Crossfit for 6 months when I was diagnosed. I really thought I would never been able to go back to it. But, I started it back up, modified of course because I have balance issues and don't want to take anyone else out. But besides making me stronger, I feel so much better about myself and feel that I am not letting my MS control me! Plus, I would dream about CrossFit all the time so I knew I had to go back.
    I played golf in college for one of the top teams in the country and that is my next goal. I need to re-train myself to play golf...And I will!
  • Avatar
    rega_strong  Oct 17, 2013 7:19 PM
    I was diagnosed 9/30/13 - and I feel like I've never been healthier in my life. I quickly began a whole new routine, a complete 360 of my lifestyle. Concise of what I eat and began an exercise/strengthening program. I've been awaken to healthy living and I love it. Not that I didn't take care of myself before but, probably not as well as I should of. I truly believe this disease is about removing the toxins in your body and staying positive. Since MS is such a complex disease and affects everyone differently - personalized treatment is a must. I believe what your body is made of is how it started and how it will affect you....your chemical makeup - my body didn't agree with the way I was treating it so..I got MS.
    This may be the steroid treatments talking but I feel like I'm beating this thing already. I prepare on reversing over 20 years of toxins so, I know it will take a while and a lot of hard work, can't wait.
    I'm supposed to start the DMA Gilenya in the coming weeks, still on the fence about it. Was actually considering taking a more holistic approach with vitamins and supplements - if you could provide some feedback on the benefits of IGF-1 or Deer Antler Velvet, I'd appreciate it...heard conflicting reports.
    Either way, I'm staying strong and living a healthy life - MS AIN'T GOT NOTHIN' ON ME!