It is important to have some flexibility in modifying the federal exercise guidelines slightly to allow for more of an individualized plan, such as exercising for shorter periods, planning rest breaks to allow for faster recovery from exercise bouts, and keeping core temperatures as cool as possible while raising your heart rate are all simple considerations that can make exercise more easily tolerated. The primary thing I suggest to my patients is that they should do whatever type of exercise they enjoy, the theory is that if you enjoy it you are more likely to prioritize it in your busy schedule. Since we don’t know exactly what types of exercise are most helpful to someone with MS, combining some aerobic and some strengthening exercise is ideal. Individuals with the progressive forms of MS should be given more guidance on how to maximize their current energy levels and should seek out professionals such as occupational therapists (OT) who can provide concrete steps for managing or modifying daily tasks that have become more difficult. It is also important to consider the addition of technology, such as functional electrical stimulation, for strengthening the lower extremities or at least preventing further loss of muscle strength, and focusing more on the upper extremities for aerobic benefits, much of this can be learned from a good physical therapist (PT).
The health benefits gained from regular exercise are well known, from improving cardiovascular health, to bone density, strength, cognition and emotional well being, to name a few. All of these should be a priority for people with MS but a primary problem still lies in convincing people to exercise, and to do it on a regular basis. Any ideas on how to do this would be a great addition to this blog, and I would appreciate learning more along those lines myself. For now, keep in mind that the evidence supports the idea that individuals with MS should be getting regular daily exercise, and the extent of what that means for each person varies considerably. I wish you all a happy new year and encourage you to make exercise goals for the year that are attainable and enticing to follow.
*Dr. Zackowski is currently an Assistant Professor in the Department of Physical Medicine and Rehabilitation and Neurology at the Kennedy Krieger Institute/Johns Hopkins School of Medicine. She is certified as a Multiple Sclerosis (MS) Specialist and works as the sole Occupational Therapist at the Johns Hopkins MS Center. Dr. Zackowski’s research interests are to investigate the mechanisms that underlie sensorimotor impairments and disability resulting from damage to the central nervous system so as to improve disability. To this point her studies have focused on the motor control problems that occur as a result of neurodegenerative disease processes such as multiple sclerosis. Dr. Zackowski’s current studies investigate the extent that nerve fiber changes in the brain and spinal cord are associated with changes in walking and physical impairments such as strength and sensation, in the context of an exercise strengthening program.