Column: One On One
The Special Populations Column in this issue discusses the epidemiology, management, exercise benefits and risks, and exercise goals for persons with multiple sclerosis (MS). This column will discuss exercise program recommendations for persons with MS.
Exercise professionals (EPs) should obtain medical clearance before exercise testing and training clients with MS. In addition, persons with MS who are unaccustomed to exercise should be screened by their physician for risks or presence of cardiovascular, respiratory or metabolic diseases (1). Persons with MS who are classified as “high risk” for medical complications during exercise should have a “thorough medical examination” with a physician-supervised exercise test before participating in an exercise program with EPs (1). The same recommendations apply to persons who are classified as “moderate risk” (asymptomatic men and women who have ≥2 risk factors for cardiovascular, pulmonary, and/or metabolic disease) engaging in “vigorous” intensity exercise (60% of maximal aerobic capacity [V̇o2max and/or 6 metabolic equivalents]) (1). The exercise test results can help EPs formulate an appropriate initial program (e.g., exercise heart rate and ratings of perceived exertion [RPE]). Clients with MS often experience daily fluctuations in their energy levels and symptoms. After obtaining medical clearance, EPs should select fitness tests to determine their client's cardiorespiratory and musculoskeletal fitness and neuromuscular/functional capacity (3-6,8,10). EPs should select fitness tests, which meet their client's goals and are well tolerated (4-6). Fitness tests should follow guidelines established by the American College of Sports Medicine (1). The 6-minute walk test requires minimal equipment, is validated for persons with MS, and is appropriate for persons using canes, walkers, and assistive devices (3). Other appropriate tests include leg, arm, or combined arm and leg cycle ergometry and recumbent stepping. Retesting outcomes can include the following:
- Ability to finish a 6-minute walk test if the client did not complete it before
- Greater distance walked
- Lower peak and submaximal exercise heart rate and blood pressure
- Lower exercise RPEs
- Greater peak exercise workloads if cycle or step ergometers are used.
Table 1 describes exercise testing recommendations for cardiorespiratory and musculoskeletal fitness and neuromuscular/functional capacity.
Daily exercise goals should reflect a client's current capabilities and energy level (4-6). Aerobic exercise (AE), resistance training (RT), and flexibility training (FT) are effective means of improving physical fitness and should be important components of an exercise program for persons with MS (2,4-6,9). Table 2 describes exercise program design recommendations for persons with MS.
Clients with MS are at an increased risk of sustaining exercise-related fatigue, heat intolerance, and falling (4-7). Body temperature is lower in the morning, thus morning may be a better time for persons with MS to exercise than later in the day (5). Clients with MS should be provided with equipment such as cooling fans, hand and foot straps, and a copy of the Borg (RPE) scale before they undergo exercise testing or participate in exercise sessions (2,4-6). Table 3 describes exercise precautions and safety recommendations for EPs to use with clients with MS. Clients should modify or stop their workouts if they experience symptom exacerbations and exercise intolerance.
MS can impair the person's ability to walk, perform activities of daily living, and lead a physically active life. A supervised exercise program consisting of AE, RT, FT, and balance activities can improve functional capacity, physical fitness, and quality of life in persons with MS.
1. American College of Sports Medicine. In: ACSM's Guidelines for Exercise Testing and Prescription
(8th ed.). Thompson WR, Gordon NF, and Pescatello LS, eds. Baltimore, MD: Lippincott Williams & Wilkins, 2009. pp. 18-39.
2. Dalgas U, Stenager E, and Ingemman-Hansen T. Multiple sclerosis and physical exercise, recommendations for the application of resistance, endurance and combined training. Mult Scler
14: 35-53, 2008.
3. Goldman MD, Marrie RA, and Cohen JA. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler
14: 383-390, 2008.
4. Jackson K and Mulcare J. Multiple sclerosis. In: ACSM's Resources for Clinical Exercise Physiology
(2nd ed.). Myers J and Nieman D, eds. Baltimore, MD: Lippincott Williams & Wilkins, 2009. pp. 34-43.
5. Jackson K and Mulchare J. Multiple sclerosis. In: ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities
(3rd ed.). Durstine JL, Moore GE, Painter PL, and Roberts SO, eds. Champaign, IL: Human kinetics, 2009. pp. 321-326.
6. LaFontaine T. Clients with spinal cord injury, multiple sclerosis, epilepsy and cerebral palsy. In: NSCA's Essentials of Personal Training
. Earle RW and Baechle TR, eds. Champaign, IL: Human Kinetics, 2004. pp. 565-568.
7. Mulchare JA, Webb P, Mathews T, and Gupta SC. Sweat response in persons with multiple sclerosis during submaximal aerobic exercise. Int J Mult Scler Care
3: 26-33, 2001.
8. Podsialdo D and Richardson S. The timed “up and go”. A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc
39: 142-148, 1991.
10. Whitney S, Wrisley D, Marchetti G, Gee M, Redfern M, and Furman J. Clinical measurement of sit-to stand performance in people with balance disorders: Validity of data for the five-times-sit-to-stand test. Phys Ther
85: 1034-1045, 2005.