If you have multiple sclerosis (MS), exercise can help retain flexibility and balance, promote cardiovascular fitness and a sense of well-being, and prevent complications from inactivity. Exercise also helps regulate appetite, bowel movements and sleep patterns.
Jogging, walking and aerobic exercises are helpful when strength and coordination are not affected. Stationary bicycle riding may be more practical if walking or balance is impaired. Swimming is helpful for stretching and cardiovascular fitness. Yoga and Tai Chi are most useful for stretching and promoting a sense of well-being. Your physical and occupational therapists will assist you in selecting the best exercise program for you to follow.
Although stress cannot be totally eliminated from our lives, we can learn to manage it more effectively. Any reduction in stress will be associated with an improved sense of well-being and increased energy. A psychologist or social worker may be helpful in developing a stress management program that is tailored to your needs. The following are some useful stress reduction techniques:
- Identify causes of stress in your life and share your thoughts and feelings.
- Simplify your responsibilities by setting priorities.
- Try relaxation and meditation exercises.
- Manage your time and conserve your energy.
- Ask for help when needed.
- Set both short-term and life goals for yourself.
- Keep as active as possible both physically and mentally.
- Recognize the things that you cannot change and don't waste your time trying.
- Make time for fun activities and maintain your sense of humor.
Good nutrition maximizes your energy, general sense of well-being and healing capacities. A dietary routine also contributes to regular bowel habits. Although no specific diet has been demonstrated to conclusively improve the natural history of MS, most people do report an improved sense of well-being when following a carefully planned diet. Several published diets are healthful and easy to follow. Others are more restrictive and less practical.
Vitamin and Mineral Supplements
Unless there is a specific vitamin deficiency found by your doctor there is no scientific proof that supplementary doses of vitamins or minerals, alone or in combination, favorably affect the course of the disease. Be careful not to take excessive doses of vitamin B6 because excessive doses of this vitamin can produce sensory symptoms similar to those seen in MS. High doses of vitamin A and D are toxic.
Oleic and Linoleic Acids
These fatty acids have been reported to be deficient in MS patients. There is an unconfirmed suggestion that supplementary feeding of these fatty acids may slightly reduce the frequency of MS attacks. These fatty acids are contained in sunflower seed oil and primrose oil. The former is much cheaper and readily available in grocery stores. Two tablespoons of sunflower seed oil each day will provide you with these fatty acids and give you the added benefit of a laxative.
If you have problems with mobility, muscle contractures or are confined to a wheelchair, you should check your skin regularly for sores, pressure spots, infections and abrasions. Regular skin care will minimize the chances of skin breakdown and help you to avoid complications such as a decubitus ulcer. Be sure to check the pressure points on your body including your heels, knees, hips, buttocks and elbows. Remember to protect against skin cancer by wearing sunscreen and protective clothing when outdoors, whether it is sunny or not. Get familiar with your skin and examine it frequently.
Urinary Tract Infections
Vitamin C helps to acidify the urine and prevent the growth of bacteria. Orange juice or vitamin C tablets are both useful. Cranberry juice also will acidify the urine and is available as a sugar free juice for those who count calories. If you develop new urinary frequency, burning when you urinate or have difficulty passing your urine, you should call your doctor and be seen for the possibility of a urinary tract infection.
There has traditionally been a concern that immunizations could worsen MS by stimulating the immune system. With the exception of transient worsening associated with fever or rare neurological complications known to be associated with certain vaccines, there is no convincing evidence that immunizations make MS patients worse. If immunizations are recommended by a doctor, they can probably be undertaken safely. In general, immunizations should be delayed if the person is experiencing an acute MS attack. However, in some circumstances, such as when urgent vaccinations for tetanus or rabies are required, immunizations should be given immediately. If questions arise, you should discuss them further with your neurologist.
Physical Therapy (PT) focuses on ways to preserve or improve safety and independence with functional mobility. This may be accomplished through a variety of approaches including:
- Mobility technique training
- Home exercise programs
- Caregiver training
- Effective use of adaptive equipment
The following are examples of PT therapeutic strategies that help everyday management of mobility-related symptoms.
You and a physical therapist should develop an individualized exercise program that is based on your current needs and future goals. This may include yoga, exercises in a gym, tai chi or Feldenkrais, as well as traditional forms of exercise such as running, walking, biking, swimming or water aerobics. In some cases, exercises can be carried out independently, with or without modification. In other instances, certain more challenging exercises may require some assistance.
Frequently, persons with MS have spasticity, especially in their lower extremities. This can cause the legs to stiffen if a regular stretching program is not incorporated into the daily routine of activities. Stretching exercises help to maintain or improve muscle length to allow greater flexibility.
Coordination exercises are done to improve balance and ease of purposeful movement. The degree of skill required to perform the exercises varies. An appropriate program will be discussed with the individual MS patient.
Strengthening exercises are designed to build weakened muscles to aid in moving and walking. While being beneficial, discretion is advised when carrying out a strengthening program. For instance, if one has undergone a vigorous session of exercising but is too tired to prepare dinner or do chores that ordinarily can be done without difficulty, it may be necessary to modify the program or space the activity more evenly throughout the day.
Upper Body ExercisesThese simple exercises are designed to promote flexibility and muscle balance as well as to enhance upper extremity function. If done correctly, they are appropriate for all stages of MS. Stretches are to be done slowly, generally being held for approximately five to 10 seconds. These exercises can be performed either seated or lying on your back. Repeat each exercise five to 10 times on each side as tolerated. You can do one side at a time or both sides at the same time.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
Multiple Sclerosis Center
1500 Owens St., Suite 320
San Francisco, CA 94158
Multiple Sclerosis Glossary
Use this Multiple Sclerosis (MS) Glossary to better understand some of the more esoteric terminology including, ataxia, gamma globulin, intrathecal and more.