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Exercise

In 1974, Professor Ritchie Russell, Professor of Clinical Neurology in Oxford, published a book entitled ‘Multiple Sclerosis: Control of the Disease’ in which he detailed a specific MS exercise program which he felt arrested disease progression in MS.1 It was called the Rest-Exercise Program (REP). The program involved people with MS doing short bursts of vigorous exercise, preferably in the lying position, such as press ups or weight-lifting exercises, followed by periods of rest. Russell thought this would help by protecting the blood-brain barrier which we know is intimately involved in the development of MS. He reports in his book details of 21 patients of various ages and the good results he achieved with this multiple sclerosis exercise therapy.

Since then there has been an accumulation of evidence about the beneficial effects of exercise on many Western diseases. Regular vigorous exercise for instance has been shown to be associated with a 50% reduction in the risk of death from established breast cancer.2 More recently the same sort of benefit has been seen with bowel cancer.
It is likely that exercise has an anti-inflammatory effect, and we know the importance of shifting the balance in MS away from inflammation.3 In the 1970s, there was quite strong prevailing medical opinion that people with MS should avoid exercise, that it could somehow be detrimental. There is now good evidence that MS exercise improves fitness and function in mild MS and maintains function for people moderate to severe disability.4 There is strong evidence that exercise therapy, including aerobic exercise and resistance training, improves muscle power function, exercise tolerance functions and mobility-related activities such as walking in people with significant disability.5-11Exercise also improves mood and general well-being.7,12,13 Walking distance has been shown to be increased with regular treadmill training.14 Interestingly, some of the benefit of exercise in MS seems to be more pronounced in women.15

There is growing indirect evidence that it may be helpful too. Two proteins, brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) have been shown to have some protective effects for neurons in MS, helping them repair. Gold and colleagues have shown that exercise significantly increases the levels of these proteins in people with MS.16 German researchers have also shown increased levels of neurotrophic factors in people with MS who undergo exercise training.17 They summarise literature on exercise also playing a role in preventing cognitive decline. There is good work already showing that regular exercise significantly reduces the chances of depression, and improves the quality of life for people with MS.12

Unfortunately, a recent study showed that people with MS do less exercise than those in the general population.18 It is important to consider the benefits of this lifestyle change, not only for general health, but specifically for MS. It is important to say here that not only does exercise improve symptoms in MS and prevent depression, it has been suggested that it may also modify the course of the illness through a neuroprotective effect.19 This is very likely, just as it has benefits in modifying the progression of many other degenerative diseases. A US study of 611 people with MS provided some confirmation, showing that exercise had a positive impact on the progression of disability as well as quality of life.20

So exercise is a really important part of the Taking Control Program. For those who can exercise without difficulty, regular aerobic exercise is best, choosing whatever suits, such as running, swimming, cycling, etc. Swimming has the added benefit of being accessible all year round and enabling you to get adequate sunshine at the same time through heated outdoor pools. For those who have difficulty exercising, the local gym may offer assessment facilities and graded programs to gradually increase the amount of exercise. Alternatively, the MS societies are often quite good at organising mild supervised exercise through their physiotherapists or occupational therapists.

The recommendation is for at least 30 minutes of vigorous exercise 5 days a week, for the maximal benefit.
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  1. Russell WR. Multiple sclerosis – control of the disease. Oxford: Pergamon Press, 1976
  2. Holmes MD, Chen WY, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. Jama 2005; 293:2479-2486
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