MS Patients No Longer Have to Sit on the Bench, Docs Say

ALLENTOWN, Pa. —  Keith Nash has just gone from doing reps on a leg-press machine to a weight bench, where he’s now in the middle of a set of biceps curls with a pair of 15-pound dumbbells. At 5-foot-8 and 155 pounds, he looks trim and wiry, and he happily reports he’s lost 10 pounds since he started working out in May.

Here on the gym floor at the Allentown Sports Medicine and Human Performance Center, the 40-year-old Nash might be just another convert to exercise, until he offhandedly remarks how frightened he was to start his program.

“I was deathly afraid of doing this,” he said. “I was afraid I’d make myself worse.”

Nash’s fears were not unfounded. Nearly two decades ago, the Allentown man was diagnosed with multiple sclerosis. For years, the advice he followed--conserve your energy, don’t overtax your body--was thought to be the most prudent course for the nearly 300,000 Americans with the medically puzzling and potentially disabling neurological condition.

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Nash is in the vanguard of what amounts to a major medical change of mind, as experts come to recognize that exercise not only might not harm MS patients but, for many, may actually improve their health.

“A regular exercise program in MS is as valuable as any of the medicines we have now,” said Dr. Alex Rae-Grant, an Allentown neurologist who treats many MS patients. “I think it’s a really valuable part of comprehensive care.”

With MS, the body’s immune system mistakenly attacks the myelin, a sheath-like covering of the nerves. The resulting inflammation and myelin loss give rise to a gamut of symptoms.

MS patients can have tingling and numbness of the limbs, blurred or double vision and slurred speech. Muscle weakness, tremors and stiffness are common, as are difficulties with balance and coordination, pain and profound fatigue. In severe or late-stage cases, paralysis can occur.

In up to 20% of patients, most of whom are diagnosed between 20 and 40, acute MS will flare only once. But most patients face symptoms that mysteriously come and go and may worsen. Studies suggest that half of those with MS will become disabled within 10 years and a third will be unable to walk after 30 years.

Although no one knows exactly what triggers the condition, research centers on the role of genetics and viruses. And, though drugs may lessen the severity of symptoms, the illness has no cure.

About 10 years ago, reports about exercise’s benefits to individual patients started trickling in, said Dr. Nancy Holland, vice president of clinical programs for the National Multiple Sclerosis Society in New York City.

The trend, she said, was fueled partly by former alpine skier Jimmy Heuga, who continued to exercise after being diagnosed with MS and pressed members of the medical community to do exercise research. The Jimmy Heuga Center in Vail, Colo., was founded to advance the idea.

A turning point, Holland said, came when a study confirming earlier research was published in the 1996 Annals of Neurology, a major medical journal.

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In the study of 54 patients with MS, those who did 40 minutes of aerobic exercise three times a week for 15 weeks improved their strength, lung capacity and blood-fat levels--all without making their illness worse.

Patients’ neurological conditions did not improve, but the study found patients significantly decreased their scores on tests for depression, anger and fatigue, while increasing several aspects of social functioning.

The results led the authors to conclude that exercise can improve both patients’ physical fitness and quality of life.

According to study author Dr. Jack Petajan of the University of Utah, experts aren’t sure why the changes happened.

“We don’t know all there is to know about the physiology involved,” he told Inside MS, published by the National Multiple Sclerosis Society.

The study’s authors believe some improvements may be due to an immune system response to increased physical activity, Petajan said. Others may stem from muscle tolerance--the ability of active muscles to respond positively to activity. Still other benefits might come as side effects of exercise, such as deeper or more restful sleep or exercise-induced differences in brain chemistry.

“It [exercise] really can make a difference,” said Holland, who estimates that the number of MS patients exercising has grown to 25% to 30% in the last five years.

The MS society now endorses the idea of medically supervised exercise programs, she said.

“One of the things that struck me is [improved] endurance,” Holland said. “Fatigue is one of . . . the most common problems in MS, and so many people say exercise helps them with increased endurance, so they can work and . . . have enough energy to enjoy their families.”

Still, patients with MS must take their illness into account when they exercise, said John Graham, director of the Human Performance Center and an exercise physiologist who designed Nash’s program and has worked with MS patients.

“I think what you find with MS patients is that every one is unique,” he said.

Graham said he has devised programs both for patients like Nash, who have weakness in their legs but minimal difficulty walking, to one who uses a wheelchair. He consulted available research to come up with the programs and hopes to evaluate patients for results.

Before starting an exercise program, Graham said, MS patients should be carefully evaluated as to which parts of their body are affected by the illness and to what extent. He works closely with patients’ physicians, he said.

The goal is to maintain or improve the strength and functioning of muscles while developing the cardiovascular system and enhancing flexibility.

A need common to all with the illness, Graham noted, is avoiding rises in the body’s core temperature, as even small increases may worsen MS symptoms. Experts attribute the phenomenon to the interruption of nerve signals at places where myelin has been destroyed. Concern about body temperature was a major reason patients in the past were told to avoid exertion.

However, patients can counter the temperature problem with a number of techniques, Graham said.

Taking frequent exercise breaks, drinking water, exercising early in the day when the body tends to be cooler, taking a cool shower before exercising and working out in a cool room are all recommended.

Those with MS also need to stop short of exercising to the point of fatigue, Graham added. That means keeping exercise intensity down. When aerobic activity is appropriate, he said, patients are kept to 60% to 85% of their maximum heart rate, less than the 70% to 90% sought by healthy exercisers.

Without physical activity, Graham said, MS patients of any age can face not only a worsening illness but also health problems and muscle deconditioning stemming from a sedentary lifestyle.

“You count that with the [problems of the] condition of MS, and you’re really putting yourself behind the eight ball. You’ve got two whammies,” he said.