All persons with multiple sclerosis (MS) should exercise, but not all exercises confer the same benefits. That’s because MS can result in different deficits in each person, so an exercise program needs to be tailored to a person’s individual needs. In fact, each exercise within an exercise program should have a specific goal.
It is this level of specificity that will lead to success in achieving exercise-related goals. And since MS often affects mobility — including walking, balance, and positional changes — the exercises chosen for a person with MS typically address mobility impairments.
Fitness and Function Not the Same Thing
There is a difference between exercising with a purpose and exercise in general. Years ago I (Dr. Karpatkin) saw a patient with MS who couldn’t understand why he was having trouble with walking and balance. He spent multiple hours a day in the gym or the pool, but no matter how much or how hard he worked out, his walking was not getting any better.
When pressed for details of his gym routine, he mentioned doing pushups, situps, upper-body exercises, the stationary bike, and swimming. Never did he mention that he was working on exercises that would target the impairment that was causing him the most trouble — walking.
After an examination and gait analysis, it became apparent that the reason that he was having difficulty was a foot drop (an inability to lift the front of the foot during walking) that was causing him to trip and fall. In his multiple hours in the gym, none of the many exercises he was doing was addressing this issue. He had exercised to increase his fitness but not his function.
Exercises to Improve Foot Drop
What should this individual have been doing? To address the problem of foot drop, we worked on stretching his calf muscles to prevent them from pulling the foot down further. We also progressively strengthened the muscles in the shin that pull the foot up, starting simply by performing that motion and then progressing to adding resistance using TheraBands or manual resistance.
Then we practiced walking, with a focus on landing on the heel and pushing off of the toes. Even within the first session he could see that his walking had improved.
This example of task-specific exercise is one that all persons with MS should consider.
Below are some common functional deficits seen in MS that many people deal with at one time or another, and all of these can be addressed with functional exercises.