Excerpts from Living with MS a Wellness Approach by: George H. Kraft, M.D. & Marci Catanzaro, R.N., Ph.D.

How can someone who has a chronic illness like multiple sclerosis also be healthy? The answer is by choosing behaviors that promote health. The World Health Organization views health as the optimal level of unction and well-being within the possible limitations imposed by a physical or mental impairment. As multiple sclerosis fluctuates or even progresses, the overall physical and emotional capacity can be nurtured, and improvement achieved within realistic goals. This broad and positive approach to health is also conceptualized as "wellness," with emphasis on those areas within our control, those opportunities to make thoughtful and informed choices to enhance our function, attitudes, and general sense or well-being. This approach not only has implications for the present, but can also impact long-term health. Cardiovascular fitness feels good today, but also reduces risk of heart attacks and stroke in later years. In order to choose wisely, it is necessary to be informed of the ramifications of various behaviors and activities.

There are very few sources of information available on the topic of wellness management. In general it could be said that issues of empowerment, taking responsibility for our own health and maintaining a stay of wellness have not been adequately researched.  In general, research has demonstrated that people who take charge of their lives and take responsibility for their behavior do far better than those who assume a passive stance. Individuals with Multiple Sclerosis need to make a determination that they care about their health and make it their highest priority.

Exercises are important to maintaining wellness. They are not only a scientifically valid means of increasing strength in people with weakness and a means of stretching tight muscles and preserving range of motion of contracted joints, but they also help give a sense of well-being to the person who exercises. Recent studies on MS have shown that exercises of various types-stretching/range of motion, resistive/strength building, and aerobic/cardiovascular all have important roles in the management of MS.

The type of exercise that is best for someone with MS depends on the severity and extent of the disease process, as well as on age and other health characteristics. For example, a young, newly diagnosed person with MS who s otherwise healthy may have essentially no limitations on physical activity and would benefit from the same type of exercises as anyone without MS. In a more severe situation, in which MS has progressed and weakness is a problem, the best type of exercise might be range of motion, in which the joints are taken through the full range and the muscles are stretched, possibly along with specific resistive exercises for certain weakened muscles. Of course, concomitant diseases such as arthritis might produce other restrictions on physical activity.

Aerobic exercises are conditioning exercises for the cardiovascular system. A person with MS who has the physical capacity to participate in an aerobic exercise program will certainly benefit. However, some people may be limited by fatigue. Aerobic exercise will not alter the course of MS, but it may improve general health.

Weight bearing exercises have a positive effect on bone metabolism. Standing in parallel bars can decrease osteoporosis and improve heart, lung, and kidney function. It is also good psychologically to be able to stand yp and face people at eye level. One disadvantage of exercising in water is that the buoyancy of the water does not provide the benefit of weight bearing, although, hydrotherapy can be excellent for maintaining joint range of motion.

Exercises that involve lifting a weight or pushing against resistance can produce muscular fatigue. In fact, in healthy subjects the most effective way to strenghten a muscle is to exercise it to the point of fatigue. The problem in someone with MS is that another type of fatigue-central fatigue- can occur and possibly interfere with the stregthening, this is called--muscle fatigue. Also, the level of force that can be generated in weak muscles in people with MS is reduced, so exercise may not be efficient. It is not uncommon, for example , for someone with MS to be able to walk a short distance without difficulty. However, walking a long distance may result in foot drop. It is important for the person with MS to get an expert opinion as to whether exercise, the adjustment of medicine to reduce spasticity , or the use of ambulation aids and ankle foot orthoses (braces) to protect muscles that fatigue easily is indicated.

People who are barely ambulatory can benefit from range of motion exercises. Moving the joint through their full range of motion only once a day prevents the development of contractures that interfere with joint movement and impair the ability to perform activities of daily living. Any resistance exercise, that is, moving a limb against a resistance or weight might help or hinder. A physiatrist or physical therapist can determine the most appropriate exercise.

Streneous exercise should not cause harm to people with MS. The question to be asked is how long the degree of fatigue that results from the exercise lasts. If the fatigue from strenuous exercise continues into the next day, cutting back on the exercise would be appropriate. Otherwise, it is good to continue exercise at the maximum level possible. A good rule of thumb is that it should not take much longer to recover that it took to become fatigue.

Consistent exercise is required to obtain beneficial effects. Ideally, aerobic exercises should be done for at least twenty minutes three times a week. The time of the day that someone exercises should correspond with the times when they have the most energy. Normal body temperature tends to be lowest in the morning and gradually rises to be a peak in the late afternoon. Exercising in the morning when the body temperature is lowest helps to prevent heat-induced fatigue.

The National Multiple Sclerosis Society has funded some studies on exercise and MS. We know that exercise in someone without MS builds stregth. It also increases core body temperature, which may temporarily worsen some symptoms of MS in certain susceptible people.This worsening of symptoms will resolve reasonably soon after the activity is stopped and body temperature returns to normal. Exercise in general does not appear to precipitate an exacerbation of MS. However, it appears to be helpful for many people with Multiple Sclerosis.