Do You Need to Exercise if you have Multiple Sclerosis?

Q.  Is exercise really that important for MS, and why? I hate exercising, and when I feel tired and crampy I feel more like resting than torturing my body even more.

A.  First, let me provide you with the reasons that exercise is important for people with MS and then let me address your specific concerns. The overall answer is that exercise is probably the most important therapy for MS and serves as the platform for all other treatment modalities.

1. Exercise is the only treatment known to improve function in MS patients
2. Exercise preserves neuronal reserve and provides a buffer against disease progression
3. Exercise improves well being and mood
4. Exercise improves overall health and protects you from other conditions (e.g. cardiovascular disease , diabetes etc) that will worsen your MS and your quality of life. 
5. Exercise serves as a deterrent to other bad health behaviors; you don't see a lot of smokers who regularly exercise
6. Exercise will help prevent other MS related complications even in the absence of other medical problems. For instance, exercise will help preserve bone density in more disabled patients and limit the development of chronic pain syndromes

This being said, some people have difficulty initiating and continuing exercise programs for reasons both related and unrelated to their MS. Since the perceived barriers to exercise are almost too numerous to list, I find it far easier to list some core principles to follow:

1. Just do it  is the maxim you must always follow; Try to exercise 5 days a week and never let yourself fall below 3 days a week unless you are significantly ill or injured. Even an MS relapse should not take you away from exercise for long. You must find the time to fit this into your life and make sure those around you understand exercise is as important as anything else you need to do. This will require you to make some life choices and possibly some sacrifices at the beginning. I guarentee you will not consider exercising a sacrifice after the first 6 months, if not sooner.
2. Start low and go slow. Some individuals are unable to perform aerobic exercise programs or even progressive resistance training for more than 5 minutes at the beginning. This could be due to other health conditions or just MS related fatigue. If this is the case, begin at 5 or 10 minutes and gradually increase on a weekly basis even if only by 1 minute at week. Eventually you will reach at least 30 minutes of exercise.  You should feel moderately but no severely tired after completing and exercise routine. As the Buddhist proverbs states, " A journey of a thousand miles begins with a single step."
3. Do exercise that you enjoy or find a way to enjoy it.   The types of exercise programs are almost too numerous to mention; some are individual and some involve groups; some can be done without leaving your home. Many incorporate games or other social activities. Be creative. Despite the many options some people tell me they hate all exercise and would prefer to just watch TV. I say fine, watch TV while walking on a treadmill or using an exercise bike. If you exercise every time you watched TV, you would probably exercise 4 hours a day !
4. If heat intolerant use methods to keep your body temperature down : This is particularly true of MS patients and the main reason that many patients prefer swimming or pool walking for exercise. Immersion in the water during and after exercise,  moderates any increase in core body temperature. Other methods of cooling include air-conditioning, fans and cooling collars or hats.
5. Always include a combination of stretching, aerobics and progressive resistance (weight training)
6. Get help if you need it from a physical therapist or a trainer
7. If you fall off the wagon or have a setback, just start over again
8. Make sure everyone in your family or close to you understands the importance of exercise and participates. If you haven't noticed already socialized behavior is reinforcing. Those who continue to smoke tend to hang out with smokers and those who regularly exercise tend to hand out with those who exercise. In each case the social interaction is supportive and reinforces the behavior. Recent evidence suggests that even overweight people tend to hang out with other overweight individuals.  To effect change in yourself often requires a change in those around you.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego