Live chat: Best exercises for people with multiple sclerosis
2:48 p.m. EDT, April 27, 2011
Learn how exercise can help people with multiple sclerosis during a live Web chat on Monday, May 2, at 11 a.m. Pacific time (1 p.m. Central time, 2 p.m. Eastern time).
Get advice on what types of exercises and workouts are best for MS from Dr. Barbara Giesser, clinical professor of neurology at the David Geffen UCLA School of Medicine and medical director of the Marilyn Hilton MS Achievement Center at UCLA. Giesser has specialized in treating people with MS since 1982.
Hello and welcome to our web chat. We’ll be back live in about 10 minutes with our guest, Dr. Barbara Giesser, to talk about multiple sclerosis and exercise. In the meantime, please start posting your questions for Dr. Giesser and we¿ll be back very soon.
Monday May 2, 2011 10:48 Jeannine Stein
Hello, everyone! Thanks for being here for our chat today on MS and exercise. Our guest is Dr. Barbara Giesser, clinical professor of neurology at the David Geffen UCLA School of Medicine and and medical director of the Marilyn Hilton MS Achievement Center at UCLA. Since 1982 Dr. Giesser has specialzied in treating people with MS. She received her BS from the University of Miami, an MS from the University of Texas at Houston, and her MD from the University of Texas Medical School at San Antonio. She also trained at the MS Research & Training Center of the Albert Einstein College of Medicine.
Welcome, Dr. Giesser. We¿re so happy to have you with us today.
Monday May 2, 2011 10:58 Jeannine Stein
Good morning and welcome to our participants. I'm a neurologist who specializes in the care of persons with MS. Today we're going to "chat" about the benefits of exercise for people with MS in staying fit, preventing complications and maximizing function. Remember to consult your physician before starting any exercise or fitness program.
Monday May 2, 2011 10:59 Dr. Giesser
I¿d like to start by asking you about the general health benefits exercise can offer someone who has MS.
Monday May 2, 2011 11:00 Jeannine Stein
Exercise confers the same benefits for people with MS as for people with out MS, namely improving cardiovascular fitness, and flexibility. It may also help manage other health conditions such as hypertension or diabetes. For people with MS, exercise may improve some symptoms such as fatigue, depression and spasticity.
Monday May 2, 2011 11:02 Dr. Giesser
[Comment From MaryMary: ]
I need to burn calories, but I can't get my exercise level up to the point of burning calories. I swim in my lake when the weather is good, but I don't have anywhere close to go swim inside. I need something to do at my house.
Monday May 2, 2011 11:02 Mary
Other aerobic type exercises that can burn calories include walking, either outside or on a treadmill, or a stationary bicycle.
Monday May 2, 2011 11:03 Dr. Giesser
[Comment From SueSue: ]
It just seems that if I did everything I'm supposed to do: stretching, physical therapy, aerobics, strength training... I'd be exercising three hours/day?
Monday May 2, 2011 11:04 Sue
In general, a workout of 20-30 minutes/ session, which could include some stretching, some cardio and some resistance training, and done 3-4 days/week would be sufficient.
Monday May 2, 2011 11:06 Dr. Giesser
[Comment From WayneWayne: ]
I have RRMS and recently after a significant weight loss I have started walking for exercise again. Eventhough I walk with a cane I have noticed that after about 20-25 minutes I start to get out of the heel/toe rythmn of walking and my feet tend to slide. I do have neuropathy in both feet. Any suggestions that could help this?
Monday May 2, 2011 11:07 Wayne
This may be something that some work with a physical therapist could help, with specific gait training strategies and exercises.
Monday May 2, 2011 11:07 Dr. Giesser
[Comment From LauraLaura: ]
Are the exercises going to be discussed are for people still active and mobile? Is there anyway you can also address/ cover exercises for those of us that are not very mobile - ie need a walker - cannot get up if I end up on the floor? Thank you
Monday May 2, 2011 11:08 Laura
People with limited mobility may still be able to ride a stationary or recumbent bike, or use an arm cycle for exercise. Stretching exercises may be done with a helper if needed. Swimming often allows people with limited mobility to do things in the water, where gravity is eliminated, that they could not do on land.
Monday May 2, 2011 11:09 Dr. Giesser
We had a question emailed to us from reader Cheryl G.:
How do I lose weight if my fatigue is so bad that I can barely do 10 minutes of physical therapy at a time? Since my diagnoses I have put on 30 lbs. From going from a very active lifestyle to barely being able to care for myself, it¿s very frustrating and discouraging to me.
Monday May 2, 2011 11:10 Jeannine Stein
Hi Cheryl, weight gain is often a problem for people with limited mobility, and may require a combination of dietary modification and exercise. If fatigue limits your endurance, try several short sessions of exercise rather than one longer one. It's better to do a little every day and build up your endurance, than one or two exhausting session per week.
Monday May 2, 2011 11:12 Dr. Giesser
[Comment From dawnmariedawnmarie: ]
on days that i am suffering from a ms flare (pain and fatigue), what type of gentle exercise can i try? i may not be able to attempt these exercises until the flare subsides but i am willing to try.
Monday May 2, 2011 11:13 dawnmarie
Thanks for the question, DawnMarie. On days, when you are not feeling up to your regular work out, at least try to do some gentle stretching. If you have access to a pool, swimming may also help you feel better.
Monday May 2, 2011 11:14 Dr. Giesser
[Comment From FrankFrank: ]
My only MS sympton is lack of balance. How can I improve my condition?
Monday May 2, 2011 11:15 Frank
[Comment From AnaAna: ]
I have Progressive MS and it is very difficult for me to stay balanced without a walker or a cane .... Can I really improve my limited mobility doing exersise or it won't improve over time due to the condition of being Progressive?...
Monday May 2, 2011 11:16 Ana
Balance problems due to MS may result from a variety of impairments, including weakness, poor coordination, or loss of sensation. Exercises that strengthen the core muscles can sometime help with balance. Also, specific gait training with a physical therapist can be very useful. Exercise and therapy won't stop progressive symptoms, but they can improve safety.
Monday May 2, 2011 11:17 Dr. Giesser
[Comment From JoAnne McCormickJoAnne McCormick: ]
I have done Pilates for 17 years, although not as proficiently as when I started. (I was DX'd in 1987) I have found that 8-10 repetitions of any exercise is exhausting. Is it always necessary to have many reps or OK to have less, but vary the types?
Monday May 2, 2011 11:19 JoAnne McCormick
[Comment From BrendaBrenda: ]
What are your thoughts on Yoga? And what type should be used
Monday May 2, 2011 11:19 Brenda
Hi JoAnne, Many of my patients enjoy and derive a lot of benefit from Pilates. If you can't always do 8-10 reps, do what you can comfortably, and vary the exercises. Try to build up your endurance gradually.
Monday May 2, 2011 11:20 Dr. Giesser
Yoga is an exercise modality that anyone with MS can do. It has been shown to improve mood, fatigue, and flexibility. The National MS Society has special yoga programs tailored for people with MS.
Monday May 2, 2011 11:21 Dr. Giesser
[Comment From Jessica PeeplesJessica Peeples: ]
I read somewhere that people with MS shouldn't allow their body temp to reach 100* +. This made sense to me but how true is it? Other than swimming, how can you excersie in the summer in SO CAL without this happening?
Monday May 2, 2011 11:22 Jessica Peeples
[Comment From PamPam: ]
Hi. I am very heat sensitive. What is the best way for me to exercise properly without getting over-heated?
Monday May 2, 2011 11:22 Pam
Hi Jessica that's a very important question! When a person with MS raises their body temperature, it temporarily may worsen their symptoms. So it is important to use cooling strategies when you are exercising. Sip cold water, chew ice chips, put wet cold cloths on you head and neck, or use a cooling garment e.g. a vest with ice packs. There are also special machines that cool down the core temperature that you can use during or after exercise. Indoors, you could exercise in front of a fan or AC unit.
Monday May 2, 2011 11:24 Dr. Giesser
[Comment From AnnAnn: ]
I agree with Sue and how can I incorporate exercising in with work & family I know its SO important but I dont know when I can find the time
Monday May 2, 2011 11:25 Ann
It's always difficult to find time for everything! It's Ok to just to a 10 minute session if that's all you have time for; the important part is to try to do it as often during the week as possible. many persons with MS are at their best early in the morning, and that may be when you can sneak in a short exercise session.
Monday May 2, 2011 11:27 Dr. Giesser
[Comment From CherylCheryl: ]
Why is foot drop so prevelanf with MS. Doing excercises in water have helped.
Monday May 2, 2011 11:28 Cheryl
We had a similar question sent via email from Mari Trafecanty:
I would really like to know about cardio exercises for relapsing MS (foot drop) patients. Thank you so much!
Monday May 2, 2011 11:29 Jeannine Stein
Foot drop is a common problem for people with MS; the muscles that lift the foot do not get appropriate signals from the nerves that control them. If the foot drop makes walking difficult, try a stationary bike; your fett can be strapped to the pedals. Also an arm cycle can provide a great cardio work out. Foot drop problems during normal gait or exercising can often be helped with a splint, or electronic stimulator that helps lift the foot.
Monday May 2, 2011 11:31 Dr. Giesser
[Comment From karenkaren: ]
When walking, I sometimes feel "stiff" in my legs. I can still walk though. Is it ok to push through this and keep walking? That is what I have been doing. Am I causing further damage?
Monday May 2, 2011 11:32 karen
[Comment From NoelNoel: ]
If you are feeling fatigued, is it harmful to "push through" and still continue exercising? If you have some mild stiffness,wouldn'ttaht be helpful?
Monday May 2, 2011 11:32 Noel
Stiffness is ine if the most common symptoms of MS, ( it is also referred to as spasticity). It can be helped with stretching, and certain medications. While exercise usually improves spasticity, in the beginning it may become worse. Try cooling strategies, or taking some anti-spasticity medication at the beginning of your exercise session.
Monday May 2, 2011 11:33 Dr. Giesser
[Comment From GuestGuest: ]
Is weight training important for people with MS? Does MS affect your muscles directly?
Monday May 2, 2011 11:34 Guest
Muscles can become weak in persons with MS, not because the muscles themselves are affected, but because the muscles do not get enough electrical signals from the nerves. Weight training ( resistance training) has been shown to produce some improvements in muscle strength in some studies in people with MS
Monday May 2, 2011 11:35 Dr. Giesser
[Comment From AnaAna: ]
What type of special machines that cool down the core temperature you can recommend?... any web site?...any product?... I live in South Florida and it is very difficult to go out for anything at all with the high temperatures here.... I have progressive MS and just to get into the car with the rolling walker takes me about 10 min and it is usually under temperatures above 90 degrees...when I finally get in the car I really feel sick.... a cooling device might help a lot...
Monday May 2, 2011 11:37 Ana
In addition to very simple cooling techniques, such as ice chips or cold cloths, there are other " higher-tech" things you can try. the "Avacore" machine is a hand held device that will cool down the entire body core temperature in minutes, and can be used before or during exercising. Also, cooling garments such as vests with ice packs, or circulating water are also available.
Monday May 2, 2011 11:39 Dr. Giesser
[Comment From JoyceJoyce: ]
What should we tell our personal trainers who may not really understand what exercises are preferred for MS clients?
Monday May 2, 2011 11:39 Joyce
Hi Joyce, The main limits on exercising for people with MS are to avoid excessive heat and/ or humidity. It's generally OK to push a little, stop if an activity becomes too painful or difficult.
Monday May 2, 2011 11:41 Dr. Giesser
Thanks for all the great questions so far, and we're trying to get to as many as we can. Dr. Giesser will be with us for about another 15 minutes, so if you do have any more questions please post them!
Monday May 2, 2011 11:41 Jeannine Stein
[Comment From ArlenArlen: ]
Can exercise "ward off" the progression of future MS sympyoms?
Monday May 2, 2011 11:41 Arlen
Hi Arlen, One of the very exciting areas of MS research is the effects exercise may have on the disease itself. Animal studies have shown that exercise can increase certain "good" anti-inflammatory proteins, and nerve growth factors. While it has not yet been shown that exercise can slow or stop progression, it certainly can be helpful in managing or avoiding other medical co- morbidity such as hypertension, diabetes, bone loss, and muscle atrophy.
Monday May 2, 2011 11:43 Dr. Giesser
[Comment From SalliSalli: ]
I find my legs get really stiff from sitting with legs down ie feet on the floor like in a movie. When it is time to go my legs are extremely stiff, as if I have someone else's legs...is this normal?
Monday May 2, 2011 11:44 Salli
[Comment From MaryMary: ]
Are there any drawbacks to taking medicine for spasticity?
Monday May 2, 2011 11:44 Mary
Stiffness or spasticity happens when muscles do not get appropriate " relax" signals from the nerves. Cooling, Stretching and weight bearing exercises can usually help with this. Also, taking anti-spasticity medication before or during the exercise can help. Anti-spastciity medications help to relax the muscles and are very safe and generally very well tolerated. Sometimes they can produce a little sedation.
Monday May 2, 2011 11:46 Dr. Giesser
[Comment From CindyCindy: ]
How do we know when too much is too much, especially when exercising "through" the pain/stiffness? Any warning signs? I think I give up too easily for fear of making my disease/symptoms worse.
Monday May 2, 2011 11:47 Cindy
[Comment From MaryMary: ]
how do you know if you are doing "too much" exercises or "too little" exercising for your MS
Monday May 2, 2011 11:47 Mary
Hi Mary, It's important to "listen to your body", especially since for many people with MS, one day is not the same as another, and what felt OK yesterday, hurts today. Be mindful of what you are feeling and pay attention to any particularly painful areas. It's Ok to feel tired after a workout but you should not be exhausted. Usually, people find that regular exercise actually improves their fatigue.
Monday May 2, 2011 11:49 Dr. Giesser
[Comment From dawnmariedawnmarie: ]
what type of vitamin supplements do you recommend? i already take a multi; vitamin d; and magnesium. thanx.
Monday May 2, 2011 11:50 dawnmarie
There is no vitamin therapy for MS. If you feel you are not getting sufficient nutrition form your diet ( which is the best place to get vitamins) that a multi vitamin is fine. there is growing evidence that Vitamin D is important for persons with MS, but too much Vit D can be harmful. Ask you doctor to check your vitamin D levels ( with a blood test) and then take appropriate amounts of Vit D under their supervision.
Monday May 2, 2011 11:52 Dr. Giesser
[Comment From KristinKristin: ]
Any suggestions for exercise when you have the "MS hug"? It really makes it hard to breath very well. Are there exercises that would help with it specifically?
Monday May 2, 2011 11:53 Kristin
The MS " hug" is a feeling as though one has a tight band or belt around the chest or abdomen. it results from nerve damage in the middle of the spinal cord. While there are no exercises that will help this, it often responds to medications, such as gabapentin, or carbamezepine.
Monday May 2, 2011 11:54 Dr. Giesser
[Comment From LoriLori: ]
Is there any downside to "aggravating" symptoms when exercising? For example, causing a vision decline when doing some form of aerobic exercise that returns after cooling off...
Monday May 2, 2011 11:56 Lori
The aggravation of MS symptoms when one gets overheated is very common( it is called Uhthoff's phenomenon), and results from temporary conduction block in the nerves, but the overheating does not cause more nerve damage. Using cooling strategies such as we have discussed today will help minimize or avoid this.
Monday May 2, 2011 11:57 Dr. Giesser
Thanks, everyone, for being part of our chat today with Dr. Giesser. We really appreciate you joining us and asking such great questions. Dr. Giesser, thank you very much for taking the time to lend your expertise.
Please don't log off from the chat yet, Dr. Giesser will provide some resources for you.
Monday May 2, 2011 11:58 Jeannine Stein
Thanks very much to all our participants for their great questions! For more information about some of the things we've discussed, go to www.nmss.org for the National MS Society, or to www.neurology.ucla.edu to find out more about programs and research at UCLA, or www.clinicaltrials.gov for the NIH listings ofcurrent research trials in MS.
Monday May 2, 2011 12:00 Dr. Giesser
We¿d also like to let people know that the National MS Society is having a live webcast on May 24, 2011, about “Working Toward Your Best Life: Advances in Quality of Life Research”. The webcast will focus on how complementary therapies can enhance traditional pharmacological approaches to successfully manage MS symptoms. Here¿s the link: http://bit.ly/gyfGBl
Today¿s chat will be archived on our site. Please join us next Monday, May 9th at 11 a.m. when we¿ll be chatting live with Olympic ice skater Kristi Yamaguchi, who has a new fitness DVD out. Be sure to check out all the chats from the LA Times and our sister Tribune papers: http://lat.ms/gv9Z5t
Monday May 2, 2011 12:00 Jeannine Stein
Photo credits (L-R): Courtesy of Dr. Barbara Giesser; Don Bartletti / Los Angeles Times