Fatigue is a common problem for people with multiple sclerosis (MS). My friend who was diagnosed five years ago is able to continue having an active life, but she tells me there are days she is too tired to move -- so it may be startling to learn that researchers have recently concluded that regular exercise is one of the few things that may help her feel better.
Researchers at Flinders University in Adelaide, Australia, recently did a review to coalesce findings of 162 studies on this subject from a period of 20 years. The studies reviewed were mostly small, but they consistently demonstrated that aerobic exercise, such as walking, cycling and jogging, may help people with MS beat fatigue. It may also be helpful for people with rheumatoid arthritis and lupus too -- both also autoimmune disorders. Optimally, the exercise regimens should include both aerobic and resistance training, and occur at least three times weekly, for 15 to 30 minutes as tolerated. Exercise program intensity should be low initially and gradually increase.
I called Aaron Miller, MD, medical director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at the Mount Sinai School of Medicine in New York City, to get his advice on this topic. It's important for all MS patients, at every stage of the disease, to participate in some kind of exercise program because it has been consistently shown to reduce fatigue, he told me. Physical activity in general helps to stabilize blood sugar, reducing inflammation. It also gives patients a psychological boost, and increases endorphins and other brain chemicals that may affect fatigue. He agrees that aerobic exercise should be primary (and says even running is fine for many people), but that resistance exercise and other types are also worthwhile. For patients in more advanced stages, with limited mobility, exercise works to strengthen the muscles that still function, thereby easing the body's overall work load. Although there is no evidence (at present, anyway) that exercise makes any difference in the course of the illness, it may help the patient to tolerate some symptoms better.
Dr. Miller offers one cautionary note: Exercise elevates body temperature, which is problematic for some people with MS. Dr. Miller says the increase in body temperature does nothing to worsen the disease, but it can exacerbate uncomfortable symptoms. However, this can be considered an annoyance, and not dangerous, and is not a reason to stop. My friend often wears a cooling neckpiece during tennis for just that reason. Other options might include setting up fans in front of your treadmill, or limiting workouts to air-conditioned environments. (For information from the Multiple Sclerosis Association of America about such devices, go to http://www.msaa.com/programs/cooling.html.)
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