As recently as twenty years ago, people with multiple sclerosis (MS) were advised to avoid physical activity/exercise because it could increase symptoms or possibly even increase disease activity. Today it is well accepted that exercise is beneficial in maintaining or increasing one’s health, decreasing secondary complications and improving psychological well-being. There is recent evidence that exercise may have some neuroprotective and anti-inflammatory effects for people with MS, but more research needs to be done in this area.

Cardiorespiratory exercise or aerobic exercise is designed to improve conditioning of the cardiovascular and respiratory systems. The cardiovascular system includes the heart and blood vessels. The respiratory system primarily includes the lungs. These systems are trained through aerobic (with oxygen) exercise. Aerobic exercise allows the heart to pump blood, carrying oxygen, to the working muscles.

Any physical activity that includes continuous, rhythmic movements of large muscle groups is considered aerobic exercise. Aerobic exercise includes, but is not limited to, swimming, cycling, walking, jogging, dancing, rowing, pushing a wheelchair and upper body ergometry. In order to gain the benefits of aerobic exercise, it is important to participate in the activities on a regular basis. Therefore, it is important to find an activity (or varied activities) that is enjoyable.

Once the type or mode of activity is determined, it is important to determine the frequency, intensity and duration of the activity. If initiating an exercise program, it would be beneficial to consult a physician, physical therapist or exercise physiologist with experience in managing people with MS. A cardiovascular fitness evaluation may be appropriate to rule out any cardiac problems. In addition, this evaluation can provide additional information related to the proper exercise intensity and duration.

The preferred method for measuring exercise intensity is through a rate of perceived exertion (RPE) scale. One of these scales is a 0-10 scale with 0= no exertion and 10= maximal exertion. The RPE scale is advantageous because it automatically adjusts as one improves their fitness to allow slow increases in work rate, adjusts to different activities and allows adjustment for exercise intensity depending upon environmental conditions, etc.

Exercise duration is also an important factor to consider when starting an exercise program. As little as ten minutes of activity can provide cardiovascular benefits. Progression of exercise duration should be done slowly to avoid the symptoms of fatigue and overuse injury. Progressing exercise duration by 10% per week will reduce the problems associated with overdoing it and will permit development of a healthy habit.

Another aspect to consider when starting your exercise program is the frequency of the program. It is optimal to incorporate the activity on a ‘regular’ basis in order to create the ‘healthy habit’ so a goal of activity everyday is appropriate with the understanding that you will not miss more than two days in a row. This will result in exercise 3-4 times per week which meets the requirements for ‘regular exercise’.

Some tips for success with your aerobic or cardiorespiratory program are:

• Avoid using absolute amounts of work (i.e. mileage, speed, distance) to measure your exercise program because you will have good days and bad days. It is better to use exercise duration (time) as your measure.
• You should feel as well or better two hours following your exercise program as you did when you started. If you don’t, you probably did too much. It is OK to back off.
• It is what you do every day that counts not what you do on one day. Be consistent with your exercise program. If you miss a day it is OK, but don’t try to do two days of exercise because you missed the previous day.
• Try not to miss more than two days in a row. There will be times you are not able to participate in your exercise program, because of family commitments, meetings etc. Have a goal to schedule so you don’t miss more than two days in a row.
• If you are heat sensitive, plan your aerobic exercise in a cool environment or consider cooling aids such as vests, cool towels.
• Drink plenty of water before, during and after your exercise session.

If you are having trouble getting started, think about exercising as part of a group or consulting a rehabilitation professional. Studies have shown that adhering to an exercise program is increased when participating as part of a group. Finally, remember that many daily physical activities may meet the requirements of aerobic exercise (i.e. regular, rhythmic, continuous movements of large muscle groups). For example some types of yard work and/or housework could have aerobic benefits. It is important to ‘give yourself credit’ for these activities as part of your overall physical activity program.

Now go have FUN!