Multiple Sclerosis: Personal Training Principles for the MS Athlete

Multiple Sclerosis: effective personal training principles for the MS Athlete. In this article, we discuss current research on training members with MS, explain important training principles to consider, and provide the reader with example workouts specially designed for members having multiple sclerosis.

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system. In simple terms, the body’s immune system attacks the central nervous system (CNS) damaging or destroying nerve fibers.

Multiple Sclerosis: Important Symptoms for Weight Training

Multiple Sclerosis Considerations

MS can cause cardiorespiratory weakness, muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, and cognitive impairment. The symptoms of MS are generally aggravated by increases in internal body temperature. Additionally, there are important intensity and programming considerations to take into account. Also, people that have MS will likely experience daily variability in their symptoms, so moderation of the training program is critical.

Should People with Multiple Sclerosis Exercise?

Yes, various medical paper such as Exercise in Multiple Sclerosis, by Alexius E.G. Sandoval, MD, have invariably concluded that exercise benefits people with MS just as much as people without MS.  The chronic health problems that people without MS develop such as obesity, cardiovascular disease, diabetes, etc. affect people MS just the same.1.

The first thing you need to understand as a personal trainer is that every athlete is different. This applies mutatis mutandis for athletes having multiple sclerosis as well. Every person that has MS has varying degrees of symptoms. MS affects some people more than others, and there multiple symptoms to consider. People more significant MS tend to have a greater reduction in aerobic capacity.

Physical Training Capacity of People with MS

That said, various medical studies have shown a propensity for the average person with MS to have some general differences as compared to someone without MS.

  • Decreased Aerobic Capacity Vo2 Max specifically. Generally 30% lower than people without MS.2
  • Decreased maximal muscle strength in both isokenetic3 and isometric exercises.4 Strength impairment tended to larger for legs as compared to the arms.5
  • Slower comfortable and maximal walking speeds.6 7
  • Decreased Flexibility8

Exercise Intensity in the MS Athlete

Brown and Kraft9 recommended exercising below maximal workload to reduce risks of undue cardiac stress, fatigue, and Uhthoff phenomenon.10 For members having MS at Sand & Steel, we utilize a heart rate monitor and keep their target heart rate at about 50-60% of their Vo2max. Roughly, this may be computed as (220-age) x 0.65. Morrison studied use of the Borg scale for MS and MS people. Morrison found, “Despite greater reported fatigue levels, participants with MS showed similar RPE and physiologic responses to submaximal and maximal exercise compared with controls. In MS, the Borg 10-point scale may help improve evidence-based exercise prescriptions, which otherwise may be limited by fatigue, motor impairment, heat sensitivity, or autonomic dysfunction.”11

The Benefit of Supervised Training

Mazzetti’s clinical study12 proved that people improve more when their training is supervised than when one is left to their own devices.

Purpose
The purpose of this study was to compare changes in maximal strength, power, and muscular endurance after 12 wk of periodized heavy-resistance training directly supervised by a personal trainer (SUP) versus unsupervised training (UNSUP).

Methods
Twenty moderately trained men aged 24.6 ± 1.0 yr (mean ± SE) were randomly assigned to either the SUP group (N = 10) or the UNSUP group (N = 8). Both groups performed identical linear periodized resistance training programs consisting of preparatory (10–12 repetitions maximum (RM)), hypertrophy (8 to 10-RM), strength (5 to 8-RM), and peaking phases (3 to 6-RM) using free-weight and variable-resistance machine exercises. Subjects were tested for maximal squat and bench press strength (1-RM), squat jump power output, bench press muscular endurance, and body composition at week 0 and after 12 wk of training.

Results
Mean training loads (kg per set) per week were significantly (P < 0.05) greater in the SUP group than the UNSUP group at weeks 7 through 11 for the squat, and weeks 3 and 7 through 12 for the bench press exercises. The rates of increase (slope) of squat and bench press kg per set were significantly greater in the SUP group. Maximal squat and bench press strength were significantly greater at week 12 in the SUP group. Squat and bench press 1-RM, and mean and peak power output increased significantly after training in both groups. Relative local muscular endurance (80% of 1-RM) was not compromised in either group despite significantly greater loads utilized in bench press muscular endurance testing after training. Body mass, fat mass, and fat-free mass increased significantly after training in the SUP group.

Conclusion
Directly supervised, heavy-resistance training in moderately trained men resulted in a greater rate of training load increase and magnitude which resulted in greater maximal strength gains compared with unsupervised training.

Please see the Mazzetti’s entire paper for additional information.

Personal Training Programming for your MS Client

Let me dispel all the confusion right now regarding how to train someone having MS. You train them exactly the same way you would train someone without multiple sclerosis with the exceptions of being more careful about heat, lowering the intensity, providing them with quality scaling, and being mindful of their more limited mobility and flexibility. People with MS can do CrossFit, powerlifting, and any other form of exercise with the right coach. For resistance training, they should weight train 2-3 times per week for 45 minutes to 1 hour per session. They should do 3-5 sets of each exercise for 8-15 reps when starting. With more experience, you’ll zone in on 8-10 for muscle building and 3-5 reps for strength training. To lower the intensity, you might increase recovery time to 2-4 minutes. Endurance training follows much the same framework as strength training — people with MS can run marathons — they just need to be careful about overexertion and overheating.

Stretching & Flexibility of Clients with MS

Mobility and flexibility training is a vital part of every workout program. Mobility training helps reduce injuries, decrease chronic pain, and reduce recovery times. Most MS members will better served by allocating 25-35% of the total workout time towards mobility training.

Multiple Sclerosis Symptom Daily Variability: Prepare to Adjust your Workouts

Athletes with MS experience considerable variations in pain, fatigue, balance, motivation on a daily basis. Since MS affects the nervous system, some days your MS client will have more pain than other days. They may experience more or less fatigue. We have seen members have better balance on some days than others.

Be prepared to scale and adjust your workouts according to the current health of your MS client.

Motivation for Personal Training Clients

Motivating and inspiring members to push through setbacks is a critical part of a personal trainer’s job. There are always setbacks. Depression and anxiety are common symptoms of MS, and they can make staying motivated more difficult. As a coach and personal trainer, it’s your job to support the member when they are having emotional challenges to staying engaged. Let them know that it’s OK if we make a certain workout easier. Getting in shape is a life-long habit, not an instant fix.

Finding the Right Temperature for your MS Client

Temperature control is very important to your MS client.  Medical research has found that people with multiple sclerosis are more sensitive to changes in internal body temperature.13  Grover found a linear decrease in maximal treadmill torque a person with MS could generate as body temperature increases.14 Even an internal change in temperature of half a degree had significant effects.15 

What is the Ideal Gym Workout Temperature?

The actual room temperature isn’t relevant.  Setting the temperature in the gym such that your client with multiple sclerosis can maintain an internal core temperature of about 98°F is the key consideration for external room temperature.  Grover found that heat affects MS athletes differently so there is no ideal temperature.  What is more, the impact of heat on your MS athlete varies from person to person.  On the whole, a large majority of MS athletes will experience a moderate decrease in functional output as their internal body temperature increases. 16  At Sand & Steel, we have full HVAC, plus the ability to change fan speeds to reduce chances of overheating.

Workout Examples for Multiple Sclerosis:

Strength & Conditioning Workout for the Multiple Sclerosis Athlete

Warm-up: 2 Rounds 

  • 10 Arm Circles forward
  • 10 Arm Circles backwards
  • 10 Ab mat Crunches
  • 10 Glute Bridges 

3 Rounds:

  • 10 Reps: Cable Machine Lat Pull Down for Load.
  • 10 Reps High-Low Plank (scale to a box, bodyweight, or TRX as needed)
  • Rest 1 Minute if needed.

3 Rounds

  • 12 Dumbbell Lateral Raise
  • 12 Dumbbell Front Raise

Row 1000m for Time.

Cooldown: 

  • Cat/cow 6 cycles 
  • Arm across body stretch 30-40 seconds per side
  • Child pose 30-40 seconds
  • Piriformis Stretch 30-40 seconds per side
  • Forearm Stretch palm up 30-40 seconds per side
  • Forearm Stretch palm down 30-40 seconds per side

Strength & Mechanics Workout for the Multiple Sclerosis Athlete

Warm-up: 2 Rounds 30s each exercise 

  • Air Squats
  • Glute bridges
  • Lunge with rotation
  • Ankle Circles

Workout: 1-2 sets of 10-15 reps per exercise | Score Load | 60s rest between sets and 2 min between exercises 

3 Rounds for Time:

  • 10 Box Squat
  • 10 L Lunges 
  • 20 Ab mat Situp 
  • 10 R Lunges

Rest as needed between sets.

Cooldown: 1 Round 

  • Cat/cow 6 cycles 
  • Child pose 30-40 seconds
  • Knees to chest 30-40 seconds
  • Thoracic Rotation Stretch 30-40 seconds
  • Seated hip stretch 30-40 seconds
  • Lying hamstring stretch 30-40 seconds

Final Thoughts on Training Considerations for the Multiple Sclerosis Athlete

As a personal trainer, your goal should be help your multiple sclerosis athlete mitigate symptoms and improve their quality of life. A well-optimized personal training program and coaching can help a person with MS improve their conditioning, flexibility, strength, balance, and coordination. The key to helping a client with MS is mindful and deliberate adjustments of their intensity level and pacing. Design your workout programs so that they are easier to adjust based on current multiple sclerosis symptoms. Maintain a cool workout environment, and reinforce the concept that working out is a lifelong investment in your health. Take every day one day at a time and smash some goals!

More Multiple Sclerosis Resources

  1. Exercise by National Multiple Sclerosis Society
  2. Definition of MS by National Multiple Sclerosis Society
  3. Multiple Sclerosis and Exercise
  4. Managing MS Through Rehabilitation
  5. Exercise in Multiple Sclerosis
  6. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations
  7. Environmental temperature and exercise modality independently impact central and muscle fatigue among people with multiple sclerosis
  8. Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis
  9. Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis
  10. How to Stay Cool With Multiple Sclerosis by US News
  1. Sandoval at page 3
  2. BrownTR, Kraft GH. Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehabil Clin N Am 2005;16(2):513–55.
  3. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance-, and combined training. Mult Scler 2008;14(1):35–53.
  4. Garner DJ, Widrick JJ. Cross-bridge mechanisms of muscle weakness in multiple sclerosis. Muscle Nerve 2003;27(4):456–64
  5. Schwid SR, Thornton CA, Panday S, et al. Quantitative assessment of motor fatigue and strength in MS. Neurology 1999;53(4):743–50.
  6. Thoumie P, Mevellec E. Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis. J Neurol Neurosurg Psychiatry 2002;73(3):313–5.
  7. Savci S, Inal-Ince D, Arikan H, et al. Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil 2005;27(22): 1365–71.
  8. White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports Med 2004; 34(15):1077–100.
  9. Brown TR, Kraft GH. Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehabil Clin N Am 2005;16(2):513–55.
  10. Uhthoff phenomenon is a transient amblyopia due to overheating from exercise. Amblyopia is more commonly known as lazy eye. The exact mechanism of Uhthoff phenomenon is unclear. It may be due to heat-worsened conduction across partially demyelinated axons, fatigue of damaged neuronal pathways with repetitive nerve transmission, or a hormonal factor produced with cooling. Exercise-induced Uhthoff phenomenon is generally reversible within an hour, but should be avoided.
  11. Morrison EH, Cooper DM, White LJ, et al. Ratings of perceived exertion during aerobic exercise in multiple sclerosis. Arch Phys Med Rehabil 2008;89(8):1570–4.
  12. Mazzetti SA, Kraemer WJ, Volek JS, et al. The influence of direct supervision of resistance training on strength performance. Med Sci Sports Exerc 2000;32(6): 1175–84.
  13. Grover G, Ploughman M, Philpott DT, Kelly LP, Devasahayam AJ, Wadden K, Power KE, Button DC. Environmental temperature and exercise modality independently impact central and muscle fatigue among people with multiple sclerosis. P1. Mult Scler J Exp Transl Clin. 2017 Dec 21;3(4):2055217317747625. doi: 10.1177/2055217317747625. PMID: 29318030; PMCID: PMC5753932.
  14. Id. at P6, Figure 5.
  15. Id.
  16. Id. at P4, Figure 2.

1 thought on “Multiple Sclerosis: Personal Training Principles for the MS Athlete”

  1. Personal training is mainly a supplement to my daily exercise regiment. When I workout by myself I spend about an hour and a half doing weight training and cardio. Recently I have been going to the gym after my personal training session, since the time is limited, and still have energy to do more. Ever 28 days, I receive an infusion of Tysabari, which resets things prior to my episode a few years ago. Additionally, I take lots of medication to handle many of the symptoms. During week 4, I just go to the gym by myself.
    Additionally, please see : https://msfitnesschallenge.org/team/david-lyons/
    Thanks,

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