Exercise and Multiple Sclerosis: Does It Help or Make It Worse?

Multiple sclerosis (MS) is the most common disabling disease of the central nervous system in young adults and is particularly common in young- to middle-aged female adults, right when they’re in their prime to excel at sports and when they need to get exercise to ensure healthy aging.

Key takeaways:
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    Exercise brings unique challenges in MS, however, is recommended.
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    Exercise can cause temporary worsening of symptoms in MS due to increases in body temperature, which typically go away after exercise ends.
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    Exercise can help improve depression, spasticity, cognition, and mobility in patients with MS.
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    Generally, pool-based activities are ideal, although most exercises, in moderation, should be OK. Exceptions are endurance exercises like marathons or road cycling.

Exercise and multiple sclerosis

Regular exercise has broad health benefits, while a sedentary lifestyle is associated with increased mortality – even more so than smoking and hypertension! Countless studies have demonstrated that sedentary individuals are three times more likely to have heart attacks or die compared to adults who exercise. Adults should aim for at least 150 minutes of moderate or 75 minutes of vigorous exercise weekly.

Pseudo attacks

When it comes to MS, exercise is a double-edged sword. Multiple sclerosis typically progresses with attacks and remits in the interim, however, a temporary worsening due to increased body temperature is common and is termed a “pseudo attack.”

Pseudo-attacks can be commonly caused by a fever secondary to an infectious process, or heat exposure. Exercise can also raise the core temperature and cause a pseudo attack, causing temporary worsening of the existing MS symptoms. These attacks are also called the Uhthoff phenomenon, and the most common symptoms in these cases are blurred vision and lazy eyes. Although these symptoms may be worrying, they typically resolve in 60–90 minutes after exercise ends and body temperature has normalized. These symptoms should not be considered a contraindication to exercise.

Benefits of exercise

Studies have consistently shown the benefits of exercise in MS. A meta-analysis (study reviewing other studies on a subject) has demonstrated that exercise was more effective in reducing the severity of fatigue in patients with MS when compared with the two most commonly prescribed fatigue medications, Amantadine and Modafinil.

Furthermore, a systematic review, published in the world-renowned Cochrane Database, has shown that exercise was beneficial for MS patients with spasticity, especially when used in conjunction with other interventions. As spasticity affects the majority of patients with MS and ultimately is responsible for impairing ambulation and interfering with activities of daily living, exercise would be a great addition to treat and prevent spasticity.

Depression is yet another common problem in MS that can benefit from exercise. Several randomized controlled studies have demonstrated that exercise can help ameliorate depressive symptoms in patients with MS, and thus help improve quality of life, strengthen interpersonal relationships, and ensure productivity in family and workspaces.

Finally, loss of walking mobility is both a hallmark of MS itself as well as an indicator of the advanced stages of the disease. Thus, interventions aimed at delaying this loss or improvement in walking mobility are of extreme value. Exercise helps improve walking outcomes in patients with MS. Several meta-analyses have demonstrated that walking was better in MS patients that regularly exercised.

Types of exercise in multiple sclerosis

Most of the exercises studied in the context of MS have been walking, yoga, or structured exercises. However, several studies have also shown benefits in climbing and aquatic training.

Aquatic training, swimming, water polo, and similar exercises that are conducted in a pool may be ideal for patients with MS, as the thermodynamic aspect of water may ensure appropriate heat transfer from the body and prevent increases in body temperature that may lead to worsening of MS symptoms.

From a strength training perspective, several studies have also demonstrated benefits in patients with MS, especially concerning walking mobility.

On the contrary, endurance exercises that are associated with rises in body temperature and undertaken for a long time, such as road cycling or marathons, would not be recommended in MS. As MS patients are susceptible to heat intolerance and exercise-related fatigue, these types of exercises may exacerbate MS symptoms.

Exercise is beneficial for all adults, and it may be particularly beneficial for those with MS. Exercise is associated with better outcomes for spasticity, walking, cognition, depression, and other MS symptoms, and will help ensure that the patients achieve the best quality of life they can, while reducing their risks of mortality and cardiovascular events.

However, exercise in the heat and exercise that may increase the core body temperature excessively should be avoided, and patients should increase their individualized exercise regimen progressively, ideally under the supervision of a clinician.

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