Resistance training for people with Multiple Sclerosis (MS)
By Lisa Meng, ARC Exercise Physiologist
Multiple Sclerosis (MS) is a chronic neurological condition where our immune system attacks the myelin sheaths, the protective covering around nerves. This causes damaged areas, known as ‘lesions’, which affect the signals sent to and from the brain, optic nerve and spinal cord.
Symptoms vary hugely amongst people with MS and can include muscle weakness, changes in sensation, and fatigue – which can all impact mobility, balance, cognition and quality of life. In addition, there can be other symptoms, including visual disturbances, bladder and bowel dysfunction, pain and many more.
Working with those who suffer from MS
As Exercise Physiologists (EP’s), we see clients referred to us who are newly diagnosed or living with MS for many years. We run exercise programs specific to addressing the common problems experienced in people with MS, including MS group, a circuit-based gym class or MS hydrotherapy groups. We are a mobile service too, and see many people with MS in their gyms close to home. We offer an ‘At Your Gym’ program, which focuses on supporting and building confidence for people to access exercise in a gym facility near them. We also offer educational resources for people to learn more about their condition and manage the symptoms they experience. The symptoms of MS manifest differently in all people, so while it is difficult to say what is the best type or how much exercise is suitable for each person, it is safe to say that exercise is critical for all people with MS and should be tailored to each person’s presentation.
One type of exercise that has been researched thoroughly in the literature is resistance training. While resistance training can sound simple, there are many variables or ways to set programs to get the desired result, whether that is muscle strength, muscle hypertrophy, muscular power or muscular endurance. This, again, will be very specific to the person’s needs and goals. When we think about MS, we know it affects muscle strength from direct damage to the nerves, but we also have to consider the other way people with MS lose strength over time – from long term dis-use, this is where you often hear the saying “use it or lose it”. When people with MS become less active due to the challenges of the symptoms of the disease, it causes them to move less and use less of their muscles, which then causes a cycle of strength loss. Unfortunately, research has confirmed that people with MS are less active compared to people of the same age living without MS.
It is challenging to maintain your activity levels when living with a chronic condition such as MS. The ‘invisible’ symptoms play a considerable part – fatigue, pain, and low mood can significantly impact our motivation. It is so important to access the help and support you need to exercise and, in turn, look after your health and daily wellbeing.
So how does resistance training work?
In a nutshell, resistance training at the correct intensity places muscle fibres under stress. This stress is a stimulus for the muscle to undergo adaptations that make the muscle stronger by increasing the size of muscle fibres. However, strength training doesn’t just build muscle, but it builds neural connections – here’s another saying, “what trains together, gains together”. When muscles are activated via nerve signals from the brain, we train that connection to become more robust and efficient. Together, stronger muscles and stronger connections will lead to improved muscle function. Improved muscle function for people with MS will mean many different things. It can improve walking distance, tolerance, intensity. It can improve the ability to lift, push and pull – movements needed for many everyday activities. It can also improve balance to reduce falls and increase endurance to lessen the impact of fatigue.
Exercise Physiologists create resistance training programs specific to the individual’s capacity and goals. We begin with repetition maximum testing to determine a person’s current maximal muscle strength and design programs so that a specific intensity is consistently reached. Resistance training programs need to be progressive so that once the muscles adapt, a new stimulus needs to be introduced – leading to further strength gains. Progressions can be as simple as increasing the weight, sets or repetitions – but what differentiates a good program from a great program is one that can progress static (closed chain) movements, for example, a leg press, to a more dynamic exercise (open chain) for example, a lunge. A great program also teaches the transfer of strength to function, e.g. lower limb strength transferring onto getting off the ground. Improvements in muscle strength and endurance can also help a person perform better during gait training and functional task practice – which are shared goals addressed through Physiotherapy and Occupational Therapy. Exercise Physiologists create resistance training programs that consider specific MS symptoms by:
- Factoring in hydration, heat sensitivity and the exercise environment
- Supporting the management of other symptoms such as spasticity, reduced sensation and pain
- Modifying program intensity after relapses or during infusions
- Ensuring correct rest breaks are taken between sets to ensure full recovery from each set so that working muscle groups can perform that same intensity
- Prescribing exercises that are specific to weak muscle groups or movement patterns
- Manipulating the load, sets, reps, modality, time in tension, and rest breaks to train specifically for the intended goal
- Including other exercises such as aerobic, functional and balance training
So, in a nutshell, resistance training forms a very important component of a specific exercise program for a person with MS. Exercise and the response to exercise need to be monitored closely, considering the many challenging symptoms people with MS face.