Resistance Training Guidelines for Multiple Sclerosis
Multiple sclerosis is a progressive disorder that results in a deterioration of the myelin sheath around the spinal nerves. As the disease progresses, secondary conditions may include impaired gait, genitourinary dysfunction (incontinence), and loss of movement in some or all limbs (Greenspun, Stineman, & Agri, 1987). The disease affects more women than men and is often diagnosed in the 20s and 30s (National Multiple Sclerosis Society, 1999).
Persons with multiple sclerosis may exhibit several symptoms. These include fatigue, occasionally severe enough that activities of daily living cannot be performed independently, and weakness in one or more extremities. The hands are often affected in the later stages of the disease, which makes it difficult to grasp objects.
Multiple sclerosis is characterized by periods of exacerbation and remission. An exacerbation results in the condition worsening. The individual may incur additional weakness or complete loss of function in several different muscle groups. Some individuals with multiple sclerosis have few exacerbations and little disability, while others get progressively worse. Because multiple sclerosis affects each person differently, it is difficult to make generalizations about the progression of the disease and the amount of disability that may result from it.
Resistance Training Guidelines
1. Persons with multiple sclerosis have an attenuated or absent sweating response (Mulcare, 1997). Resistance exercise that is performed in warm environments could result in early-onset fatigue and should therefore always be performed in cool environments. If the room is warm, use fans to improve air circulation. Make sure the client drinks water before, during and after the activity, since dehydration can also result in higher core temperatures. Persons with multiple sclerosis would also benefit from resistance training exercises performed in a cool swimming pool (77 - 800F). The water will help maintain or lower the person's core temperature and can serve as a resistance mode at the same time. Certain commercial resistance devices are also available to help develop strength in the water.
2. Balance is often impaired in persons with multiple sclerosis, particularly as the condition progresses (Mulcare, 1997). Make sure that balance is assessed on a regular basis, so that if it does decline to a point where standing exercises are difficult or dangerous, the instructor can switch to routines from a chair or provide support for standing exercise (i.e., parallel bars, holding on to a railing, leaning against a wall).
3. Tremor and incoordination may result in an inability to perform smooth movements. This could cause the movement to look somewhat 'choppy.' Provide as much assistance as necessary to help the client move the resistance through the full range of motion as smoothly as possible, but don't overemphasize this because they may be incapable of doing so as a result of the neurological involvement.
4. Blurred vision or double visions are often common associated conditions in persons with multiple sclerosis (Poser & Ronthal, 1991). Make sure that equipment is marked clearly. Use bright colors (yellow tape on a black weight plate) or magnets to identify where to place the pin on weight machines. Small weights and objects should not be left in the middle of the floor where a person could trip over them.
5. Persons with multiple sclerosis may need to urinate frequently during the resistance training program, particularly if there is pressure displaced on the urinary bladder. Because they are unable to sense the need to void their bladder due to the neurological involvement, accidents may occur. Make sure that the bladder is voided before exercise and intermittently during the training program, particularly if they are drinking fluids to prevent dehydration and overheating.