Exercise and Multiple Sclerosis
Lucinda Hugos, MS, PT
Question
I have mild MS. I occasionally get very tired after short walks or brief activities. I have nearly fallen a couple times and once was very embarrassed because I knocked a bag of groceries out of a fellow shopper’s hands when I tripped. How can I decrease my fatigue and improve my walking? Jim R., age 43
Answer
First of all, Jim should be congratulated for taking an active approach to managing his MS symptoms. Learning the best way to exercise after developing a life-changing disease like MS can be challenging, but important. The first step to finding solutions is to seek information.
Jim describes two different but often related MS symptoms - weakness and fatigue. Leg weakness usually means that you are using more energy to walk and do everyday activities. Using more energy to move around just doing everyday activities often contributes to a feeling of fatigue.
Regular exercise is one of several steps needed to help manage fatigue. However, the difficulty walking that Jim describes means that running, walking, or working out on a treadmill are not the best exercise choices. A safe exercise program would be using an exercise bicycle or water exercising in a pool. Jim may also do well using an elliptical trainer - machines where the foot is not lifted with each cycle of the foot pedals.
It is generally recommended that people should exercise aerobically three to five times a week. This includes people with MS. The duration of exercise should be twenty minutes or more each day. Because Jim suffers from fatigue, starting out exercising twenty minutes per day may not be very realistic or possible. He should start with what he can do, build on his success, and then slowly increase his exercise time. His plan should be to start with three to four minutes, next increase from four to five minutes, and then from five to seven minutes, etc. Jim can remain at those periods for as long as he needs to until he’s ready to go up to the next level. An alternate approach would be to do two five to ten minute sessions.
Jim may wonder how hard he should exercise. The “gold standard” is for him to monitor his heart rate, but this does not always work for people with MS. Jim may find that MS causes numbness and tingling in his fingers and it is hard to feel a heart rate. If this is an issue, it’s recommended that he exercise to a level where a conversation can be held while still exercising. He should be cautious of overheating and keeping a water spray bottle handy to spritz himself or exercising in a cool room is recommended.
Once Jim gets the right kind of exercise program, he should look for ways to decrease the amount of energy he uses in daily activities. Separating exercise from daily functional activities is an important step in reducing fatigue. It is important for Jim to closely look at all his daily activities and become more efficient by learning how to modify them to decrease the amount of energy they require. Many people have found an activity diary to be a very useful tool. If Jim kept an activity diary for three to four days in a row, he may start to see patterns of what he is doing. Once he sees these patterns, he can change his activities so during times of energy, he can do activities that require energy and during low energy times, he can do things that do not take a lot of energy.
If Jim has difficulty identifying how to change activities to be more efficient or finding the right exercise program, he could talk to his doctor about referrals to physical and occupational therapists. Physical therapists are experts at identifying causes and solutions for walking problems and helping people find the right exercise program. Occupational therapists are experts at modifying everyday activities to increase safety and efficiency.
The VA has a wonderful system of health care providers that are available. Talk with your health care provider about seeing therapists that can help you live fully and meaningfully with MS.
