Summary of Special Considerations Regarding Exercise Prescription and Persons with MS
| Heat Sensitivity | There is ample research documenting the presence of heat sensitivity in most persons with MS. The exact mechanism of how either external (e.g., environmental) or internal (e.g., metabolic) heat effects these individuals remains unknown. However, the resulting sequelae can include any one or all of the following: general or severe fatigue, loss of balance, foot drop, visual changes (e.g., blurred vision), speech changes (e.g., slurred speech), and muscle weakness and/or paralysis. Sweating has also been shown as being abnormal in as much as 50% of the population. The absence of sweating may contribute to a perception of being overheated as capillary skin blood flow increases in an effort to dissipate heat generated from exercising muscles. As such, the perception of overheating coupled with heat-related fatigue, may end the exercise session before the desired time. Use of fans, wet neck wraps, and spray bottles may help reduce the perception of overheating. Surface cooling has been shown to improve aerobic endurance slightly. Others have shown that pre-cooling before exercise also has a beneficial effect on performance. Exercise is also recommended to occur early in the day. This is when circadian body temperature is at its lowest. Subjective reports from most individuals with MS indicate that there is a decline in energy level during the afternoon hours with the occurrence of fatigue and other MS-related symptoms. |
| Bladder Dysfunction | Bladder dysfunction is an MS symptom that can indirectly effect exercise performance. Because of symptoms such as bladder urgency and exertional incontinence, MS clients may limit their daily intake of liquids. This is also a common practice observed during exercise. Recommendations for proper hydration prior to exercise and rehydration following should be addressed when working with this population. |
| Sensory Deficits | Subtle losses in tactile and proprioceptive sensation may make using some equipment difficult and even dangerous. Deficits may be reflected in an inability to grasp and control free weights, as well as to perceive muscle and joint position. Visual feedback by training in front of a mirror or performing rhythmic counting during repetitions can provide alternate forms of input to assure proper performance. When possible, the use of machines such as the LifeCycle Series is recommended since it reduces the amount of control and coordination needed by the client and provides visual feedback regarding range of motion and force produced for each repetition. |
| Incoordination | Safety is also an issue for persons that have coordination deficits. The presence of spasticity, ataxia and/or tremor may result in uncoordinated movement patterns in the effected extremities. Therefore, use of equipment that requires coordinated movement (i.e., free weights) is contraindicated. Use of synchronized arm/leg ergometers may improve exercise performance by allowing the arms to assist the less-coordinated legs. |
| Cognitive and Memory Deficits | Subtle cognitive changes and memory deficits may require a modified approach to instructing the MS client. This might include providing information in both written and diagrammatic format, and reminders of proper form, repetitions, and use of equipment. In addition, providing an easy form of recording exercises will eliminate the need for accurate recall. |