Multiple SclerosisMultiple sclerosis is a chronic, inflammatory disease that affects the central nervous system and causes gradual destruction of myelin (demyelination) and transection of neuron axons patches throughout the brain and spinal cord . Myelin, the fatty material surrounding the nerves, is destroyed, leading to symptoms such as muscle weakness/paresis/paralysis, spasticity/tremor, and impaired balance, lack of coordination, heat sensitivity, and fatigue.

Importance of ExerciseIn addition to improving overall health, cardiovascular fitness, range of motion, and flexibility, exercise can help one increase energy, improve balance, manage spasticity, decrease muscle atrophy, and better perform activities of daily living.

Types of Training

Cardiovascular to increase stamina Strength to improve function, and to help prevent contractures, muscle imbalance, and atrophy Flexibility to increase range of motion and maintain joint flexibility Coordination and balance Cardiovascular Dysautonomia: Irregular function of the autonomic nervous system (ANS) leads to a blunted heart rate and decreased blood pressure in response to exercise. If this condition is present, heart rate and blood pressure must be monitored throughout the exercise program, and intensity might need to be decreased. Heat Sensitivity: This can include fatigue, loss of balance and visual changes. Create a cool environment with fans, air temperature between 72 and 76F, pool temperature between 80 and 85F, and if exercising outdoors, exercise during early morning or evening hours. Wear clothing that breathes (i.e., cotton), and use cooling aids as needed (i.e., cool vests, ice packs, cool baths at 84F or less, etc.). To counter dehydration, experiment with using sports drinks instead of water, depending on problems with incontinence. Incontinence: Loss of control of bowel/bladder. Void bladder before exercise and monitor urinary cycle. Try drinking sports drinks instead of water. Spasticity/Tremors: Choose supportive exercise modalities such as upright or recumbent bicycle instead of the treadmill, and use equipment such as toe clips and heel straps for foot stability. Avoid water temperatures below 80F and placing toes in a pointed position. When strength training, focus on areas of muscle imbalance, engage in gentle rhythmical/active flexibility exercises before exercise and in static flexibility movements after exercise that focus on increasing mobility and lengthening of tight areas (pelvis, chest, calf, and hip flexors). Balance and Coordination: As problems with balance and coordination can lead to dangerous falls, choose exercises providing maximum support (i.e., swimming, recumbent bicycle) and check with a physical health professional (i.e., clinical exercise specialist, kinesiologist, exercise physiologist, or other fitness/health professional trained

Important Considerations When Exercising

in exercise program design for individuals living with neurological conditions) to design a physical activity program that incorporates balance and coordination training. Medication: Be aware of side effects of medication you are taking and how this will affect your exercise program. Medication can affect energy level, muscle coordination and muscle strength. Set an exercise pace that is feels good to you. Rate your level of exertion by the Rate of Perceived Exertion scale (range of 6 to 20 where 6 = very, very light, and 20 = very, very hard). 12 to 14 is a good target zone. See the General Exercise Guidelines factsheet. Vary cardiovascular training to prevent boredom and avoid muscle imbalance by using a variety of machines (appropriate to level of ability). General cardiovascular exercise can be done daily and is recommended at least three to four days per week for 20 to 60 minutes per session. Swimming/aquatic fitness classes Stationary recumbent or upright bicycle Walking Begin strength training at 70% of a 10-repetition maximum. This is 70% of the weight that one can perform an exercise ten times. When this weight can be performed for 25 repetitions for two consecutive sessions, increase the weight 10%. Training should be performed two to three times per week, for three sets, eight to 12 repetitions per exercise, 10 to 15 minutes per session. Do not strength-train the same muscle groups on consecutive days.

General Cardiovascular Training Guidelines

Examples of Beneficial Cardiovascular Training

Strength Training Guidelines

A variety of equipment can be used, depending on the levels of balance/coordination, plasticity/tremor, strength, and/or fatigue:

Free weights Isokinetic machines Stretch band exercises Sandbag weights Water resistance exercises Stretching should be performed daily for at least 10 to 15 minutes. Stretching should be performed before and after every cardiovascular and strength workout (rhythmical/active flexibility training before exercise and static flexibility training after exercise). Every muscle group used in a workout should be thoroughly stretched before and after. Spend more time on tight muscle groups.

General Flexibility Training Guidelines

Stretches should be held for a minimum of 15 to 30 seconds for maximum benefit. Static stretches should be held for a minimum of 5 to 15 seconds for maximum benefit. Stretching should not be painful. Yoga Tai chi

Recommended Activities that Address Flexibility

NoteThe information provided here is offered as a service only. The National Center on Physical Activity and Disability, University of Illinois at Chicago, the National Center on Accessibility, and the Rehabilitation Institute of Chicago do not formally recommend or endorse the equipment listed. As with any products or services, consumers should investigate and determine on their own which equipment best fits their needs and budget.