Exercise Safety with Multiple Sclerosis

Exercise Safety with Multiple Sclerosis

 

 

 

 

 

 

 

 

 

 

 

 

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a disease of the central nervous system. This system is comprised of the brain and spinal cord and, when it is compromised, it can be disabling. Essentially what happens is that the immune system attacks the protective covering on nerve fibers which disrupts the communication between the brain and the rest of the body. The affected nerves will vary from person to person, so not all people with MS will exhibit all of the same symptoms.1  

What Do Symptoms Look Like?

The most impacted function with Multiple Sclerosis is movement. Numbness or weakness in the limbs, tremors, and an unsteady gait are among the most recognizable symptoms. Vision, speech, sexual, bowel, and bladder problems are also known to occur.1

Exercise with MS

Muscle weakness, balance and coordination problems, dizziness, and difficulty breathing can make exercise a significant chore for people with Multiple Sclerosis. However, activity is still very important. Common MS treatments and inactivity can render people with this disease more susceptible to developing osteoporosis, which can make balance and coordination issues an even greater concern. This can be prevented or slowed, however, through physical activity and proper nutrition.2  

A 2004 study found that, even though cases of MS vary across patients, exercise programs designed to increase cardiorespiratory fitness, muscle strength, and mobility can enhance a patient’s quality of life while also reducing the risk of secondary disorders.3 However, it’s important to adhere to exercises that are safe.  

 

A publication by BMC Neurology identifies a number of practical and beneficial exercises for patients with MS. An important preface to their findings is that each exercise program should be designed to address a patient’s specific goal and should take into account a person’s baseline impairments and capabilities. Only a healthcare professional can provide the appropriate fitness routine for your needs, but generally, these aspects of training are known to hold benefits for patients with MS: 
  

  1. Aerobic Training: Low to moderate intensity aerobic training is effective on cardiovascular fitness, mood, reduction of fatigue, and overall quality of life. Examples include bicycling, aquatic exercise, and treadmill walking. Rowing and running are also potential options but only for patients with proper functioning.4
     
  2. Strength Exercises: For MS patients, supervised resistance training is safer than unsupervised training, and the use of weight-machines is safer than the use of free-weights. It is also important to prioritize the lower body because that is where the strength deficit is usually greater. Examples of strength exercises include the seated leg press, seated hamstring curls, knee extensions, shoulder press, chest press, and lat pull-downs. As a note, seated exercises are the safer option when compared to standing exercises.4
     
  3. Flexibility Exercises: These types of exercises are important to enhance mobility and improve balance and posture. Slow, gentle, and prolonged stretching is recommended before and after exercise with a particular focus on spastic muscles (tight or stiff muscles). Yoga and tai chi classes may be options for patients with higher functioning.4
     
  4. Balance and Coordination Exercises: Exercises that challenge balance can be very helpful. It is important that a stable support is available or that patients exercise in water. Water exercises provide support that help protect participants from dangerous falls.4  

Common Concerns

As with all new exercise routines, it’s important to know when to stop. You can help protect yourself from injury if you are attentive to how your body is feeling with each movement. When it comes to Multiple Sclerosis, there are a few more things to keep in mind. 

  1. Heat Intolerance: Heat stress caused by exercise can exacerbate the symptoms of MS. For this reason, heat-sensitive patients are encouraged to exercise in air-conditioned rooms, to perform water-based exercises, and to avoid exercising during the hottest part of the day.4
     
  2. Fatigue: Exercise can make symptoms of fatigue worse in MS patients.4 This is part of why it’s important that you don’t push yourself to exhaustion. It can be dangerous to do so, especially if you are using free-weights. In the grand scheme of things, exercise can actually help improve symptoms of fatigue,4 but it is important be aware of your limits during exercise.
     
     
  3. Risk of Falling: It is advised that patients who are at risk of falling be monitored during exercise.4 A fall is a risk not worth taking, so it is important to have non-slip surfaces in areas of aquatic activities and to take precautions during any form of exercise. 

What is your approach to exercise with MS? Share your thoughts in the comments below! For more articles like this one, and to stay in-the-know on important health and nutrition topics, subscribe to our newsletter to receive monthly highlights from the Living Healthy Blog. 

SOURCES 

  1. “Multiple Sclerosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 Apr. 2019, https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269. 
  2. Pietrangelo, Ann, and Kristeen Cherney. “The Effects of Multiple Sclerosis on Your Body.” Healthline, 2018, https://www.healthline.com/health/multiple-sclerosis/effects-on-the-body#7. 
  3. White, L.J. & Dressendorfer, R.H. Sports Med (2004) 34: 1077. https://doi.org/10.2165/00007256-200434150-00005  
  4. Halabchi, F., Alizadeh, Z., Sahraian, M. A., & Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology, 17(1), 185. https://doi.org/10.1186/s12883-017-0960-9  

Intermittent Fasting: How to Hit Your Protein Goals | QA

Intermittent Fasting: How to Hit Your Protein Goals | QA

Question:

I’m wanting to start intermittent fasting for the numerous benefits it has… yes, including a little fat loss as well! The only issue is that I’m also trying to add muscle at the same time. Subscribing to the 1-2 grams of protein per body pound theory, is that enough time in the IF window to ingest that much protein? (I weigh 230 now, that’s a lot in a short window of time! 😳 What are the recommendations in order to achieve this with IF and low-carb/high protein? Is it even possible? Thanks!

– Chris T. 

Answer:

First, I’d modify your protein goal to the lower end of the range you proposed: 1 gram per pound goal body weight. That’s still over the 1.7 gm protein/kg recommended by the American College of Sports Medicine to increase muscle mass. Since there is no physical storage of amino acids in the body, consuming large quantities of protein at once doesn’t mean you’ll use all of what you eat.  

For intermittent fasting, I’d advise breaking down your total so that you’re consuming 30-40 grams of protein* every 2-3 hours for the span of time you do eat. Remember to support your workouts with protein before, during and after to provide your muscles with amino acids when it needs them most and to promote muscle protein synthesis. 

* Amount of protein generally supported in the literature as that which can be utilized at one sitting. 

Schoenfeld, B.J., Aragon, A.A. How Much Protein Can the Body Use in a Single Meal for Muscle-Building? Implications for Daily Protein Distribution. Journal of the International Society of Sports Nutrition; 15,10 (2018). https://doi.org/10.1186/s12970-018-0215-1 

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Recommended Reading - Q+A

Eggs and Cholesterol: How Much is Too Much? | QA

Eggs and Cholesterol: How Much is Too Much? | QA

Question:

How many egg yolks are allowed per week when trying to lower my LDL cholesterol?

– Theresa D. 

Based on my friend’s advice, I’m eating one boiled egg at each meal, that’s three times a day for me. But now I fear about the effects on cholesterol. So far, I’m good. But what is your advice about eating three eggs each day, every day. I do work out on the treadmill for 30 minutes and weight lift for 30 minutes every day. Regards,

– Abdu K. 

Answer:

Egg consumption in relation to high cholesterol levels was a much debated topic 30 years ago, but confusion still remains. On the whole, eggs are healthy – they contain many nutrients and are good sources of vitamins A and D. One egg yolk contains 5 grams of fat, including 1.5 grams of saturated fat, and approximately 186 mg of cholesterol. Though eggs are high in cholesterol, it’s the saturated fat that has greater impact on your blood cholesterol.  

Eating foods that contain saturated fats raises the level of cholesterol in your blood.” – American Heart Association 

Prominent dietary sources of saturated fat are bacon, sausage, meat, eggs, butter, cheese and processed foods containing palm, palm kernel and coconut oils. It’s often how eggs are prepared (in butter) or served (with bacon, sausage, cheese, muffins, or scones) that’s the culprit in affecting dietary cholesterol. 

Most people can eat an egg daily without increasing their risk for heart disease. If you have diabetes, are at high risk for heart disease, or already have heart disease then it’s wise to limit egg consumption to no more than three per week. Remember that only the yolk contains the egg’s saturated fat, so these guidelines refer to whole eggs, not egg whites or egg substitute. 

Sources: 

  1. American Heart Association (n.d.) “Saturated Fat” https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats  Accessed 2.7.2020 
  2. Komaroff, Anthony, MD. (2019, June 24) “Are Eggs Risky for Heart Health?” Harvard Health Letter.  https://www.health.harvard.edu/heart-health/are-eggs-risky-for-heart-health  Accessed 2.7.2020 
  3. Lopez-Jimenez, Francisco, MD. (2020, Jan. 9) “Eggs: Are They Good or Bad for My Cholesterol?” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol/faq-20058468  Accessed 2.7.2020 
  4. Vannice, G and Rasmussen, H. (2014, Jan.) Position of the Academy of Nutrition and Dietetics: Dietary Fatty Acids for Healthy Adults. Journal of the Academy of Nutrition and Dietetics, 114(1): 136-153. Doi: https://doi.org/10.1016/j.jand.2013.11.001 

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Recommended Reading - Q+A

Calculating Macros on a Plant-Based Diet | QA

Calculating Macros on a Plant-Based Diet | QA

Question:

Hi my name is Alex, I am a 22yearold male, about 5’5 in height, and I weigh about 123 pounds. I recently have changed my diet from regular eating to plantbased food which seems to give me more energy and better sleep. I was curious about how many macronutrients I should be getting and how many calories I should eat. I work out about 5-6 times a week, do cardio first for about 20-30 minutes, and then do about 45-60 minutes of intense cardio and weightlifting.   

Thank you, 

– Alex 

Answer:

Using a predictive energy calculation* it seems your total energy expenditure (TEE) falls in the range of 2600-2800 calories per day based on resting energy need + physical activity where the PA factor is 1.27 for active men. To determine macronutrient amounts, you could allocate 50-60% of energy to carbohydrates, 15-20% to protein and the remaining 20-35% to fat given your exercise level and reliance on plant foods. From 2700 calories and the midpoint of each macro range, this would calculate to about 370 gm Carb., 122 gm Prot., and 81 gm Fat daily. 

Your macronutrient needs and goals shouldn’t really change much based on the source of your food. However, switching to eating all plants (strictly vegan) may mean getting fewer micronutrients if not done properly. So amping up your consumption of iron, zinc, magnesium and calcium may necessitate an adjustment in diet to increase plant sources of those minerals. Please see the Institute of Medicine’s Dietary Reference Intake tables of vitamins and minerals for your micronutrient intake targets. 

*TEE for men = 864 − 9.72 × age (years) + PA × [(14.2 x weight (kg) + 503 × height (meters)] 

Equation source: 

Gerrior S, Juan W, Basiotis P. An easy approach to calculating estimated energy requirements. Prev Chronic Dis [serial online] 2006 Oct [date cited]. Available from: http://www.cdc.gov/pcd/issues/2006/ 
oct/06_0034.htm
. Accessed 1.24.2020 

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Recommended Reading - Q+A

I’m Not Seeing Progress! What Am I Doing Wrong?

I’m Not Seeing Progress! What Am I Doing Wrong?

When You’re Stuck in Your Weight Loss or Stuck in Your Muscle Gain

Whether you’re hitting a plateau after weeks of steady progress, or you’ve been working hard from day one and have hardly seen a dent of change, something is happening when your body is seemingly stuck.

Is it something you’re doing wrong? Has your body simply adjusted to your routine? Let’s break down some of the reasons why your weight loss or muscle gain progress has hit a standstill. 

Weight Loss Plateau

1. You’re Gaining Muscle 

It’s possible that the scale isn’t moving because your body composition is changing. You may still be losing fat, but the scale may not be reflecting it because you’re gaining muscle at the same time. Author of our Body Composition article, Deanna Mercurio, explains that a more accurate way to track your progress is not with the scale but with body measurements and pictures. 

2. You’re Consuming Too Many Calories 

If you haven’t felt the need to track your calories, it might be a good time to start. Too many calories could be the culprit behind your plateau. Your body is smart, and it knows you’ve been depleting those precious fat stores. A study on weight gain found that the body’s internal protection against starvation encourages eating just so you will regain lost weight! Keeping track of what you’ve eaten can help you outsmart this natural response to weight loss. 

3. You’re Eating Too Many Processed Foods 

You might be hitting the right calorie count but turning a blind eye to the nutritional content of your food. Your body needs a variety of macro- and micro-nutrients to keep functioning at its best. Our dietitian recommends that you focus on real, whole foods and that you avoid processed food products.1  

4. Your Sugar Intake is Too High 

Sugar is the enemy in the battle with weight loss, partly because it’s easy to consume too much. The World Health Organization recommends that sugars comprise no more than 10% of your daily calories; that’s about 50 grams per day.2 A single beverage can easily contain more than that. Yes, that also means cutting back on healthier beverages like fruit juice. Our dietitian also warns against seemingly healthy smoothies that contain sherbet or fruit syrups. Those sweet additions, she explains, contain refined sugars that are easily absorbed and metabolized into fat.3 

5. Your Metabolism Has Adapted 

Switching things up can help kickstart your weight loss again. Again, we’ll lean on our dietitian’s recommendation. To switch things up, she suggests adding to or intensifying your existing fitness routine with weight training/resistance, cardio, or HIIT workouts, while adding some nutritious calories to those workout days. Those calories can take the form of vegetables, legumes, and pre-workout shakes or recovery drinks.4  

Muscle Gain Plateau 

1. You’re Not Eating Enough 

As you gain muscle, your energy needs change as well. You’ll need more nutritious calories (from lean proteins, vegetables, whole grains and healthy plant fats)5 and more protein than the average person because your body needs them to repair and build the muscles you’re working. Read our Protein article to learn how to calculate what your body needs (based on your weight and activity level) to help you bulk. 

2. Your Muscles Have Adapted 

Just like your metabolism, your muscles can adapt to your routine. This is why workout routines should be anything but “routine.” You’ll need to do things differently to break your body out of its comfort zone. Remember when you first started a certain type of workout and you really had to push yourself through your sets? If you no longer feel challenged by your workout, your body has adjusted. Try increasing your working weight or incorporating some more intense training, like drop sets, to get your muscles back into build-mode. Sticking to the same routine may help you maintain muscle, but progressive overload is crucial to building muscle. 

3. You’re Not Drinking Enough Water 

When your body doesn’t have enough water, your muscles must compete with other organs that are also demanding it. As you lose water through sweat, your blood volume is reduced. This slows oxygen delivery to and carbon dioxide removal from your muscle tissue.6 Essentially, you won’t be able to work as hard during training if you’re not giving your body enough water to cope with the physical exertion. It’s important to hydrate before, during, and after exercise.5 

4. You’re Inconsistent 

As we mentioned earlier, progressive overload and variety in your workout is very important to building muscle. Now you have to make sure you’re consistent about how you train. Your body needs to know that this type of exertion isn’t a once-in-a-while thing; that your muscles need to do this job often! Consistency, paired with progressive overload, prompts your body to build muscle because the physical tasks your body is being asked to do are not going away and they’re getting more difficult. 

5. You’re Doing Too Much Cardio 

The right amount of cardio can help you build muscle. Too much can do the opposite. Go back to the first item on this list for a second. To build muscle, you need to eat more calories! Regular cardio can help you consume those extra calories without gaining a lot of fat.7 Cardio also increases your blood flow, which if you remember for item 3, is important for oxygen delivery to and waste removal from your muscle tissue. The increased blood flow also helps deliver fresh nutrients (which your muscles obviously need for recovery and growth)7 

Too much intense cardio, on the other hand, can pull resources away from your muscle tissue. Now instead of those resources going towards building muscle, they’re fueling your cardio. If you’re trying to bulk, keep your cardio at low intensity and low volume.8  

Let us know in the comments below if you’ve learned something new! Will you be adjusting your workout or nutrition regimen? Stay in-the-know on trending health and nutrition topics and subscribe to our newsletter to receive monthly highlights from the Living Healthy Blog! 

Sources  

  1. James, Debbie. “How to Handle a Weight Loss Plateau: QA.” Living Healthy, 25 Jan. 2020, https://blog.lafitness.com/2019/09/19/how-to-handle-a-weight-loss-plateau/ 
  2. “Daily Sugar Intake – How Many Grams of Sugar a Day?” Food Pyramid, http://www.foodpyramid.com/daily-sugar-intake/ 
  3. James, Debbie. “My Weight Loss Has Plateaued… Any Advice?” Living Healthy, 20 Apr. 2018, https://blog.lafitness.com/2018/03/29/weight-loss-plateaued-advice/ 
  4. James, Debbie. “What to Do When Weight Loss Stalls: QA.” Living Healthy, 25 Jan. 2020, https://blog.lafitness.com/2020/01/28/what-to-do-when-weight-loss-stalls/ 
  5. James, Debbie. “How Much Protein Should I Be Eating?: QA.” Living Healthy, 25 Jan. 2020, https://blog.lafitness.com/2020/01/09/how-much-protein-should-i-be-eating/  
  6. Muñoz, Colleen X., and Evan C. Johnson. “Hydration for Athletic Performance.” Nutrition and Enhanced Sports Performance (Second Edition), Academic Press, 12 Oct. 2018, https://www.sciencedirect.com/science/article/pii/B978012813922600045X 
  7. Hitchcock, Heather. “How Much Cardio Should I Do When Bulking?” LIVESTRONG.COM, Leaf Group, 2 Sept. 2019, https://www.livestrong.com/article/437460-how-much-cardio-should-i-do-when-bulking/  
  8. Hartman, Bill. “Will Cardio Keep Me from Gaining Muscle?” Men’s Health, Men’s Health, 25 May 2018, https://www.menshealth.com/fitness/a19540296/will-cardio-keep-me-from-gaining-muscle/ 

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