Tangible and Non-Tangible Aspects of Exercise

We all know that exercise is important. Researchers are finding increased specific benefits related to multiple sclerosis. Studies indicate that exercise may have a neuroprotective effect that can promote an insulin-like growth factor that appears to act as an agent for neuroprotection in MS. In addition, physical activity increases Brain-Derived Neuropathic Factor, which may help lessen the decline in cognitive function in MS. (White, LJ, Castellano V, “Exercise and Brain Health implications for MS: Part 1-neuronoal growth factors,” 2008).

Beyond the scientific terminology, Can Do MS believes, quite simply, that exercise will help you in all facets of your life, and these benefits are achievable to everyone. However, all exercise is not created equal. A well-balanced fitness program needs a number of components - some tangible, some not so tangible.

Individual exercise recommendations can be broken down into four tangible categories: Strengthening, stretching, balance and coordination, and cardiovascular activities. Your exercise goals should encompass each of these categories.

Strengthening is important for everyone, particularly for persons with MS. You must maintain or increase current muscle strength since we tend to lose 10% of strength and muscle mass every decade. Areas that are weak need to be strengthened, if possible. Strengthening is also a calorie burner. Muscles at rest burn twice the calories versus fat. As you increase strength (and hopefully decrease fat) calorie consumption will increase even at rest!

When thinking about your strengthening, make sure to include all areas of the body, particularly the core (trunk, abdominals, and back muscles). This can be done with free weights, resistive bands, weight machines, kettle weights, yoga, Pilates, Tai Chi, swimming, and much more. In particular, I would recommend some form of yoga, which strengthens by using body weight to maintain a pose. In addition, Pilates and Tai Chi incorporate similar factors.

Keep in mind that strengthening depends greatly on each individual’s ability to carry out proper neurotransmission throughout the body. If strengthening to a certain muscle or muscle group is not feasible, one may need to concentrate on other areas to allow for compensation to weak areas. With any strengthening activity, you should first consult a PT to help identify weak areas and gain knowledge of whether strengthening is possible or if neurotransmission is a factor.

Stretching improves flexibility and range of motion (ROM), which are also essential to keeping the body healthy and maximizing function. Inactivity, weakness, immobility and gait problems may lessen normal daily movement. In turn, this may decrease ROM. This can be detrimental to balance and gait. With prolonged lack of ROM, contractures (permanent shortening of muscles and tendons) may also occur.

Balance and coordination are very important areas, as well. Weakness, muscle imbalances, decreased sensation, dizziness and visual disturbances can lead to increased falls. With the help of a physical therapist, balance and coordination deficits may be identified and improved through a variety of measures, including aquatic exercises, gait training, Swiss Ball activities, yoga, Tai Chi, and Pilates. A PT can also work with you to help conserve energy, ensure safety, and identify assistive devices and/or braces, if needed.

Finally, cardiovascular exercise is important for heart health and helps with burning calories. In MS, it can also improve with fatigue and other symptoms. However, we are learning more about similar benefits in “non-cardio” exercises. Non-cardiovascular exercise can encompass many forms of activity. Many include elements of the “tangible” categories covered above. Swimming activities are wonderful, even if you are a non-swimmer. Water can help you stay upright when it may be difficult on land. It can help keep your core body temperature down (water temperature must be appropriate), can offer strength training due to the resistance of the water, and can assist with balance and coordination. Therapy such as WATSU (combination of Water-Shiatsu) can also be very relaxing.

As mentioned above, yoga can be extremely beneficial and may take many adaptable forms. From “hot” yoga (NOT recommended for MS), to strength or iron yoga, wheelchair yoga, and now even paddleboard yoga, there is something for every ability, skill level, and challenge goals. Try letting yoga be one of your easier activities in your “day off” routine. As Dr. Allen Bowling noted in his 2014 publication, “Optimal Health with MS-Demos,” yoga “is inexpensive, generally safe and may improve MS symptoms including fatigue.”

Pilates is a dynamic form of exercise that also offers many benefits. Pilates works on “elongating” muscles by shortening and increasing muscle mass like traditional weight lifting. They can be done in the form of mat Pilates or using a reformer table (more specialized and costlier). In addition, Tai Chi traditionally works on balance, but also incorporates all areas that assist with the success of your wellness. Swiss Balls also touch on the four exercise categories while accommodating every level of ability and skill level. Swiss Ball exercises can also improve posture… and can be very fun!

Finally, there is growing research on the health benefits of ballroom dancing. Throughout the country, there are classes for persons with MS. These can be a great form of exercise, as well as an excellent social opportunity. Also look into ballroom dancing on Wii and other computer game programs. They have been shown to have positive effects on physical activity in persons with MS.

In closing, strengthening, stretching, balance and coordination, as well as cardiovascular and non-cardiovascular activities are important tangible aspects of a comprehensive and beneficial exercise program. You should also keep in mind other factors that may be less tangible. These factors are equally as important as the actual substance of the activities.

• Is the activity something that you can do daily or frequently?
• Does it involve transportation to a gym or community center, or can it be done at home?
• Will you adhere to the program and sustain it over time?
• Can modifications occur as needed?
• And perhaps most importantly: Do you like it? Exercise should be fun!

When searching for an appropriate class, program, DVD, etc., ask yourself these non-tangible questions. You may have to try a number of sources before getting it just right. Talk to others in a support group, seek community activities, consult Can Do MS and the National MS Society, and gather suggestions from your healthcare team. Every activity offers varying levels and accommodations, but they all can- particularly with yoga- offer fun opportunities to help you physically, while decreasing stress and increasing relaxation. Greatly needed qualities for sure!