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Tuesday, February 12, 2013

Strength Training to Improve Quality of Life for People With MS


Gone are the days of doctor-placed restrictions on physical activity. New research shows that adding strength training to your exercise program can bolster your independence and improve your quality of life.

Medically reviewed by Pat F. Bass III, MD, MPH

Denise Pisciotta was diagnosed with MS in 1989. Her initial treatment plan included steroid drugs, which were commonly prescribed at the time but had the side effect of making her bones brittle. She had always been a relatively active person — tennis, running, and golf were some of her favorite activities. In 1993, one awkward step off a curb resulted in a broken femur. Her bones had been weakened so badly from the steroids that the break meant she would need to begin using a wheelchair.

denise pisciotta
Determined to remain independent, Pisciotta (pictured above) found her way to a local gym. At the time, they didn't have a staff trained about MS, but she says the personal trainers were willing to learn what they could to help her develop a workout plan that fit her abilities. She focused on developing her upper-body strength so that she wouldn’t have to rely on others to help her get in and out of her chair. She was able to maintain her upper-body strength, but her bone density continued to deteriorate and her posture was suffering from the time spent in the wheelchair.

New Outlook on Exercise

As recently as the 1980s, exercise, much less weight training, was discouraged for people with MS. There were several reasons for this thought-process, explains Nicholas G. LaRocca, PhD, vice president of health care delivery and policy research at the National Multiple Sclerosis Society. “First, the understanding of what triggers MS and MS attacks was much sketchier at that time," he notes. "Second, it was felt that exercise would worsen the fatigue that is so common in MS. Third, there was the fear that people with MS would get overheated, and their MS would get worse. And fourth, many doctors felt that exercise was a waste of time — people with MS could not benefit from exercise and, even if they did, their MS would eventually get worse anyway, and the time spent exercising would be wasted.”
Time and experience have disproved those theories. It's now known that exercise provides vast benefits. “Exercise for a person with MS can assist with achieving the highest independence possible,improve energy levels, lessen fatigue, help control spasticity, improve mood, improve the muscles that control the bowel and bladder, just to name a few,” says Nancy Dollenmeyer, MPT, MSCS, a physical therapist at Mercy Therapy Services in St. Louis, Mo.
LaRocca cites two reasons for the shift in attitude. Many people with MS, some of whom had been very athletic before their diagnosis, decided not to listen to the naysayers, followed an exercise regimen, and found it helpful for their quality of life. “However, the real turning point came with the publication of an article by Jack Petajan and colleagues at the University of Utah that examined the impact of aerobic exercise on people with MS," he says. "The study, funded by the National MS Society and published in the Annals of Neurology, found that aerobic exercise could not only improve cardiovascular fitness in people with MS, but could also improve quality of life in a variety of ways.” That opened a floodgate of research that extended beyond aerobic activity to explore the benefits of other types of exercise.

Weight Training: More Promising Results

A recent study, published in the Adaptive Physical Activity Quarterly, found that resistance training in particular improved the walking ability of people with MS and their overall quality of life. “When participants were interviewed, most indicated improvements in walking endurance and performance during daily living," says study author Lesley J. White, PhD, FACSM. "Together, these findings suggest that physical function may improve with program participation and suggest that deficits in physical function due to MS may be partially reversible.” Along with walking, many participants found that they could stand for longer periods, had better muscle endurance to do more and not tire as quickly, better balance with more confidence climbing stairs, and added strength for tasks like outdoor chores and getting in and out of the car. “Some also mentioned that being able to do more gave them more confidence,” White adds.
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