Health & Fit The Best Exercises for MS to Keep Yourself Mobile
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Staying active can help you manage your multiple sclerosis. And creating a workout routine that includes specific exercises for MS can help you avoid injury and achieve the benefits of physical fitness.
Multiple sclerosis is a progressive condition that affects the brain and spinal cord (the central nervous system). In MS, the immune system misfires, attacking the protective coating around your nerve fibers. When this coating, called myelin, is damaged, impulses to your brain can be affected, causing physical symptoms including muscle weakness and numbness, difficulty walking, fatigue, and vision problems may occur.
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Most people with MS, because most people with the condition have relapsing-remitting MS, which means there are periods of time where they are relatively unaffected by the disease. However, because MS is a degenerative condition, these physical symptoms often eventually get worse over time. Medications aim to help reduce the frequency of relapses, as well as stop the progression of the disease. But medication is only one piece of the treatment puzzle. Incorporating exercises for MS into your routine can be very helpful in managing your symptoms and keeping your body functioning as best as possible.
MS treatment | Exercise for MS | Exercise benefits | Aerobic exercise | Resistance training | Upper-body strengthening | Lower-body strengthening | Progressive strength training | Functional movement | Stretching for MS | Water aerobics | Yoga | Balance training | Tai Chi | At-home workouts | Adapting exercise for MS | Physical therapy for MS
In general, MS treatment is highly dependent on your specific case. For example, there is only one FDA-approved medication to treat primary-progressive MS (a form of the condition with no remission periods), while there are many medications to treat relapsing-remitting MS. Medically, MS is usually managed with disease-modifying therapy (DMT) or drugs that suppress the immune system to reduce the attacks on the myelin. DMTs can be given along with symptom-specific medications, like muscle relaxants if you have a lot of muscle spasms, stiffness, or spasticity (an involuntary contracting/shortening of muscle tissue). When your doctor develops your treatment plan, they’ll likely take into account how advanced your MS is, any potential plans you have to get pregnant (some drugs are not safe for pregnancy or breastfeeding), and your history of taking MS medications, among other factors.
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Exercise is a less obvious but vital part of MS treatment, according to Patricia Bobryk14, a physical therapist at the UCHealth Yampa Valley Medical Center in Steamboat Springs, Colorado, and multiple sclerosis certified specialist. “This is a lifelong disease. We don’t have a cure for it yet. So, exercise is part of that overall treatment approach,” Bobryk tells SELF. Physical activity can help maintain motor function in patients with MS, and may even prevent MS from getting worse.
Exercise for MS
Of course, exercise is beneficial for many people, and individuals with MS are no exception. For years, there was a myth that exercise could make MS itself worse, but there is now good evidence indicating this is untrue. Many people with MS can find a form of exercise that works for them, even those with very advanced cases of MS. “You could have someone who’s not ambulatory anymore, but maybe they can do chair yoga,” Christina Burke13, D.P.T., a clinical specialist in neurologic physical therapy, MS certified specialist, and clinical associate professor of physical therapy at Stonybrook University, tells SELF.
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Exercises for MS should revolve around four main areas, according to Dr. Burke and Bobryk: aerobic exercise, strength/resistance training, stretching/flexibility exercises, and balance exercises. (We’ll cover these in the following sections.) The National Center on Physical Activity and Disability3(NCHPAD) recommends being physically active 30 minutes a day (total—it’s okay to break it up!) on most days, with stretching incorporated daily.
It’s safest to work with a physical therapist who can help you create an individualized program that suits your abilities and addresses your goals, e.g., improved strength and coordination.
There are numerous benefits to working out, but continued mobility is one of the reasons experts recommend physical activity for people with MS. “There is some evidence to support that exercise is not only helpful to maintain function, but to improve functions,” Bobryk says. “We can also find some evidence that exercise can help reduce inflammation in the central nervous system. We’re learning that exercise really has a positive impact on the disease,” she explains. While it’s worth noting that physical activity may feel more difficult if you have MS, exercising to the best of your ability can still be beneficial. Among other things, research shows that people with MS felt less fatigued and improved their mood after doing resistance training, according to a 2010 study published in Multiple Sclerosis Journal4. (Keep in mind that results don’t happen overnight, and following a consistent schedule is important to experience any potential benefits of exercises for MS.)
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Aerobic exercise, which is any exercise that provides cardiovascular conditioning5 and is also referred to as cardio, is important generally for cardiovascular health. The NCHPAD recommends doing cardio three days each week for 30 minutes each time. (Alternatively, you can do three 10-minute sessions if 30 minutes is too difficult to maintain.)
If you have MS, you may want to consider low-impact aerobic exercise (activities like walking, bicycling, or using an elliptical machine).
You may think walking isn’t strenuous enough to be considered cardio, but Dr. Burke and Bobryk say it’s great for people with MS. Plus, you canby experimenting with pace, elevation, and other tweaks. (If it’s too hot to walk outside, Dr. Burke suggests walking in an air-conditioned space like a mall early in the morning to avoid crowds if you’re comfortable with indoor spaces.)
“Even walking can be a taxing activity for somebody if you don’t have the aerobic capacity to sustain it,” Bobryk says. And the best way to condition yourself to walk is by doing it more often. “We call that specificity of training,” Dr. Burke says. “If you want to get better at walking, you have to practice walking!”
Bicycling is another good option because it can help reduce spasticity in the legs. Clip-in cycling can be particularly helpful for people with MS6, since numbness and muscle spasms can make it difficult to keep your feet on the pedals, Dr. Burke explains.
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Practicing these moves will pay off with power, better posture, and more comfort on the road. The static position of the upper body and the range of motion needed from your lower half requires mobility of the shoulders, hips, and spine, in order to both keep you strong on the bike and without aches when you’re off it. “Cycling is very much in the sagittal plane,” Rena Eleázar, D.P.T., C.S.C.S., co-founder of Match Fit Performance in New York City, tells Bicycling. That means you’re moving front to back.
If you prefer group fitness classes, opt for low-impact choices like water aerobics.
Resistance training, also known as, requires your muscles to work against a weight or exterior force. You can do this by using your own body weight, working with dumbbells or barbells, trying resistance bands, and using weightlifting machines. For people with MS, resistance training can help retain muscle mass, which is important in maintaining function. “We can always be stronger, but [in MS] weakness comes not only from the disease but from deconditioning. So if someone has a lot of fatigue, then they’re resting more. They’re more sedentary. Their muscles become deconditioned,” Bobryk explains. To counter this, the NCHPAD recommends planning for three to four days of strength training per week.
Moves that target your upper body are great for strengthening these muscles so you can do things like carry groceries. Generally, upper-body strengthening exercises include bicep curls, rows, pull-downs, chest presses, bench presses, and shoulder presses.
One thing to note: If your MS tends to cause numbness, tingling, or other sensory problems in your upper body, free weights may not be safe because you could drop them or lift them incorrectly and injure yourself. If that’s the case, you may want to start by using elastic bands, weight machines, or doing bodyweight exercises.
Exercises that target the muscles in your lower body can be particularly helpful for people with multiple sclerosis since the disease can affect the lower limbs7. Lunges, squats, leg presses, and deadlifts are all moves you can do to strengthen your lower body. Even though you may be working on lower-body moves, the guidance on doinginstead of holding free weights remains true if you have upper body sensory problems due to your MS, since you’ll need to use your upper body to hold the weights.
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Progressive strength training
Progressive strength training is very similar to resistance training, except thatover time as you become stronger. This can be done by using heavier dumbbells or barbells, adding to the weight stack, or using less stretchy resistance bands, depending on your comfort level. Studies show that progressive strength training may help people with MS improve their physical ability8 by doing things like walking more quickly or getting out of a chair faster.
Dr. Burke has her patients with MS lift the heaviest weights possible during an exercise session to help them build muscle. “You want to overload the muscle to get it stronger, and if you’re not challenging the muscle, it won't get stronger,” Dr. Burke says. By slowly adding weight until you hit your max, you can find out where that max actually is and work to improve it.
For example, if you can do six reps of a move with a 10-pound weight before you get tired, Dr. Burke recommends trying just three reps with a 20-pound weight. Then, take a break and do another three reps.
You can do progressive strength training any time you would strength train, and the guidance about avoiding free weights if you’re prone to upper body symptoms also applies. To start, you might want to consider working with a physical therapist so you can learn proper form and minimize your risk for injuries.
are exercises that recruit multiple muscle groups at the same time (for example, a push-up, which uses your core, chest, and back muscles). Another benefit of functional movement is that some of the exercises, like squats, mimic motions we do in our daily lives9 (like standing up from or sitting down in a chair). Functional movement can be very helpful, then, for people with MS, because it trains the muscles to continue performing daily tasks effectively. You can perform functional movements with or without weights, and they can be incorporated into a strength/resistance routine easily (most strength moves are, in fact, functional movements). Other examples of functional movements include standing rows, squats, and multidirectional lunges.
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Stretching for MS
Daily stretching can be really beneficial when you have MS since it increases range of motion, improves flexibility, and decreases spasticity, according to NCHPAD. Aim to stretch for 10 to 15 minutes per day, focusing on spastic muscles. Move slowly to give your muscles time to respond to the stretch and hold each exercise for 20 to 60 seconds, if possible. Stretching shouldn’t be painful, so if it is, you may need to decrease your range of motion. Yoga and Tai Chi, which we’ll discuss later, are two great forms of stretching.
Water aerobics fall somewhere in between resistance and aerobic exercise: You are getting your heart rate up due to constant motion from moves like jumping and moving your arms, but the water is a force for you to work against, providing resistance. For these reasons, water aerobics is one of the best exercises you can do if you have MS. “It’s a great mode of exercise because of the buoyancy, which makes it easier for you to move,” Bobryk says. “You can get a great strength workout in the water and you get a great aerobic workout.”
Finding a cool pool is essential for water aerobics since a warm or hot pool may cause people with MS to overheat.
Yoga is an ancient practice that is primarily of Indian origin10. It combines breath and movement, and can be very gentle (like restorative yoga) or very physically challenging (like power yoga). For the purposes of an MS exercise regimen, yoga is considered a stretching routine, according to the NCHPAD. They recommend doing some form of yoga daily to improve balance, help with muscle spasms, and increase your range of motion. Yoga can even be adapted for people with MS who can no longer walk, by doing a style called chair yoga, explains Dr. Burke.
“If someone has spasticity or abnormal tightness in their muscles, a stretching program is a really good remedy,” says Bobryk.
There are many styles of yoga, andchannels so you can practice at home.
Balance training involves performing exercises that focus on controlling your posture so you can control your body mass more stably. Many balance exercises involve standing on one leg at a time and then challenging your balance by performing another movement. For example, standing on one leg while doing a bicep curl or balancing in tree pose during yoga are all examples of balance training exercises. Practicing balance exercises is crucial because they can help reduce falls for people who have MS.
But, on that note, one challenge for balance exercises is that you might fall when doing them on your own. “In therapy, I can make sure you won’t fall, but I have to be careful giving patients exercises to do on their own, because I don’t want them to fall, but I do want them to challenge themselves,” Dr. Burke says. “One thing we have really found that helps with balance is increasing your core strength. A lot of our patients go through a Pilates program because it challenges your core, and there’s a balance component [but it’s done safely on the floor]. People have found that if they get their core stronger, their balance improves,” she says.
Dr. Burke recommends trying to do some sort of balance exercise every day. This could include doing a Pilates video or even practice standing on one leg. If you struggle with balance, consider doing exercises with a chair or counter nearby for support or ask a friend to exercise with you, Bobryk says.
Tai Chi is an ancient Chinese practice that combines breath and movement. With Tai Chi, you move slowly (and at your own pace) from each posture into the next without pausing. Similar to yoga, there are various styles of Tai Chi, according to the Mayo Clinic11. The practice can be done nearly anywhere, requires no equipment, and may improve your mood and flexibility.
Doing Tai Chi helps you with balance training because the slow movements stress posture control12. In fact, numerous studies have shown that older adults who practiced Tai Chi decreased their risk of falling. If you’re new to Tai Chi and want instruction, you can look for classes in your area using the database on thewebsite.
Nearly all of these workouts can be effectively done at home. “You don’t need a lot of equipment for these things,” Bobryk says. If you’re able to, walking can be a low-cost form of cardio that doesn’t require a lot of equipment. If you’re seated, you can search YouTube for videos focusing on chair workouts. (Theand YouTube channels offer a wide variety of chair workouts.) Bobryk recommends using your own body weight or household objects like soup cans to do strength training. Flexibility and balance training movements generally require no equipment unless you need to make certain adaptations to do the exercises safely.
Adapting exercise for MS
If you have MS and now have a hard time doing exercises you once loved, consider talking to your doctor or a physical therapist about how you can make the routine work for you.
Sometimes, buying support devices or making other small tweaks can help you get back to doing what you enjoy. For instance, one of Bobryk’s clients noticed that his foot dragged while walking. Now, he wears a brace to help support his foot and is able to walk for much longer, she says.
There are a few precautions that can help make exercising with MS safer. These include:
- Keep yourself cool: People with MS can be sensitive to heat and potentially experience symptoms because of it, so Dr. Burke recommends keeping your core body temperature down. You can help keep your temperature down by using cooling vests, cold towels, or exercising in a cold room. That doesn’t mean sweating is unsafe, though! “There’s a myth that if you’re sweating, then you’re working too hard. And that's absolutely false!” says Bobryk. “Sweating is a mechanism for our bodies to cool ourselves down. And you want to cool yourself down while you’re exercising with MS.”
- Break up your exercise if you need to: “People with MS may feel this overwhelming sense of fatigue even though there might not be a real reason for it,” Bobryk explains. “Research shows that light to moderate exercise actually can help improve fatigue levels. So to help manage fatigue we use an intermittent exercise philosophy,” Bobryk says. With intermittent exercise, you might do, say, three minutes of walking on a treadmill, take a three-minute break while wearing a cooling device, and then walk on the treadmill again.
- Allow your body to rest if you need it: With fatigue or other mild symptoms, you can work out safely. But there are times you should take a break. For example, people with MS can have “pseudo-relapses” where they experience MS symptoms in addition to a fever. Exercising when you’re not feeling well or while you have specific could leave you susceptible to injury.
Physical therapy for MS
Oftentimes, neurologists refer people with MS to a physical therapist at the time of diagnosis. If this happens, and you’re not experiencing a lot of symptoms, then you may just have a consultation and receive a home program of exercises for MS, according to Bobryk. Then, you might have regular check-ins with your therapist every few months to monitor your progress. If you have a relapse with new symptoms or a significant decline in function, you would go back for another evaluation, and perhaps in-person sessions, Bobryk explains. If you’ve never seen a physical therapist and would like to, Dr. Burke recommends using thedatabase to find a clinician in your area. When reaching out to practices, ask whether the physical therapist has experience working with individuals who have multiple sclerosis to get the best care.
While MS is a lifelong condition, finding an exercise routine that suits your abilities can help you be more consistent with your training, and ultimately help you move and feel better.
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