Benefits of Therapeutic Exercise for Multiple Sclerosis
Physical therapy exercise interventions can help reduce and manage symptoms of multiple sclerosis, restore function and mobility, and boost quality of life at all stages of the disease. Research has shown that exercise is a safe and effective method to improve symptoms of multiple sclerosis and reduce disease progression. Multiple sclerosis is a progressive disease of the central nervous system that can lead to fatigue, pain, and impaired coordination and mobility. Therapeutic exercise is a safe and effective treatment to help patients manage the disease from onset through relapse and remission to maintain overall fitness and function.
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a progressive disease of the central nervous system in which the immune system attacks myelin, the protective covering of nerves. Myelin allows electrical signals to move quickly through nerves; when damaged, it forms scar tissue which not only disrupts signals to the brain, but also leads to symptoms like fatigue, pain, and impaired coordination and mobility.
In the last two decades, there has been a 10% increase in the global prevalence of multiple sclerosis with 2.8 million people suffering from MS globally and one million adults in the United States alone. Multiple sclerosis is often diagnosed between the ages of 20-40 years old and affects women more than men (female to male sex distribution of nearly 3:1).
Symptoms of multiple sclerosis vary from person to person in type, duration, and intensity depending on which part of the nervous system is affected and how far the disease has progressed. Common symptoms include fatigue, pain, difficulty walking, impaired coordination, cognitive and mood changes, numbness or weakness in one or more limbs, sensory loss, bladder and bowel dysfunction, vision problems, dizziness, spasticity (muscles feel stiff), and muscle spasms (sudden stiffening of the muscle that can cause the limb to kick out or jerk towards the body).
Multiple sclerosis is often treated with disease-modifying therapies that target immunologic signaling proteins to reduce relapse rates and slow disability progression by reducing inflammatory activity. However, one key aspect of multiple sclerosis management is therapeutic exercise under the supervision of a physical therapist.
Benefits of Therapeutic Exercise for Multiple Sclerosis
Physical therapy plays a key role in rehabilitating and conserving functional abilities, preventing symptoms, and strengthening the body of those with multiple sclerosis, particularly through targeted therapeutic exercise. Research suggests that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis.
A 2021 review in Lancet Neurology noted that exercise can help reduce and manage symptoms of MS, restore function, improve general wellness, increase activity levels, and boost quality of life. A review of 54 clinical trials over a 10-year period reveals that for those with MS, exercise was associated with positive effects on walking, mobility, neurologic disability, pain, cardiorespiratory fitness, muscular strength and endurance, body weight, balance, mental health, and quality of life.
In each of these studies, exercise interventions involved cardiovascular aerobic exercise to increase aerobic power, neuromuscular training such as gait training and targeted muscle strengthening, and balance training. Clinical guidelines suggest that for those with moderate MS, engaging in 30 minutes of moderate-intensity activity twice a week and strength training twice a week to start should yield fitness benefits, reduced fatigue, and improved mobility. Over time, as the patient can tolerate it, exercise intensity and duration can be increased.
Exercise has been shown to be safe and effective for improving symptoms of multiple sclerosis and reducing disease progression. Growing research indicates a neuroprotective role of exercise against stroke, Parkinson’s, and Multiple Sclerosis. With MS, exercise can decrease neurodegeneration and can be effective in stimulating neuroplasticity as overall exercise increases neurological functioning. Research has also indicated that exercise has been associated with a reduced incidence of relapses and slowed disability progression.
Physical therapy exercise interventions can be applied at nearly any stage of multiple sclerosis from the first onset of symptoms to highly impaired patients and can help patients regain function and mobility gradually and safely. At the time of diagnosis, the therapist performs a physical examination to establish a baseline of the patient’s fitness levels and identify areas of improvement to create a customized exercise program to improve function and mobility.
When MS is stable (in remission), the physical therapist checks in with the patient every few months to ensure maintained strength and physical function. During and after a relapse, the therapist works with the patient to regain as much function as possible and a physical exam is done to assess where the patient is at in comparison to the baseline exam. Even with advanced MS, a therapist can help the patient maintain range of motion in joints and a strong core.
As a patient engages in aerobic and resistance training, the therapist carefully monitors the patient for heat tolerance and sensitivity to allow the patient to exercise without triggering the onset or exacerbation of symptoms and uses cold packs and other cooling devices to ensure the patient’s temperature remains steady.
If you or a loved one are currently living with multiple sclerosis, consider working with a physical therapist to manage symptoms and regain function and mobility safely through targeted therapeutic exercise!
