Stronger than MS – Strength training in Multiple Sclerosis
Today is the beginning of MS Awareness Week. In light of this we spoke to Herb Karpatkin, assistant professor of physical therapy at Hunter College, about his research on how different types of interventions can result in improved mobility for persons with MS.
Dr. Herb Karpatkin is a board certified neurologic clinical specialist through the American Physical Therapy Association, and a certified Multiple Sclerosis Clinical Specialist through the Consortium of Multiple Sclerosis Centers. He has held clinical posts at the Rusk Institute of Rehabilitation Medicine, Burke Rehabilitation Hospital, the International Multiple Sclerosis Management Practice, and academic posts in the physical therapy departments of Touro College and Hunter College.
Multiple sclerosis (MS) is a neurodegenerative disease in which the insulating covers – myelin sheaths – of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of the nervous system to communicate, resulting in a range of symptoms, such as muscle weakness, impaired sensation, trouble with coordination, and visual problems. While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells. Proposed causes for this include genetics and environmental factors.
There is currently no known cure for multiple sclerosis, so most established treatments simply attempt to alleviate symptoms and improve function after an attack and prevent new attacks. Since up to 90% of all persons with MS have some evidence of difficulty with gait and balance, it is necessary for them to pursue some type of exercise program to address their movement difficulties, preferably with a Physical Therapist (PT) that has experience in working with persons with MS. However, it is important that persons with MS who seek exercise programs to aid their walking and balance realize that not all exercises are the same; MS affects each patient differently, therefore each person with MS will need an exercise program that is tailored to their specific needs.
Weight training of various types are often used by PT’s who work with persons with MS to improve strength in weakened muscles. However, there are many types of weight training that might be appropriate for MS patients and it may not be clear which type to use. Historically, PT’s have avoided very aggressive strengthening programs for MS patients, presumably to limit the effects of fatigue. However recent research completed at the Physical Therapy department at Hunter College has found very encouraging results using a relatively aggressive training program.
In the past, previous studies have examined strength training programs for persons with MS based on performing repetitions at 50%-70% of a patient’s one repetition maximum. That means they determined what is the maximum amount a patient could lift one time, and then perform a certain number of repetitions at 50-70% of that weight. In the Hunter College study, patients performed repetitions at 85-90% of their one repletion maximum. Subjects performed 4 sets of 4 repetitions of right and left leg extensions twice a week for 8 weeks. Subjects took 90-second recoveries between sets. At the end of eight weeks, all subjects showed significant improvements in gait endurance, balance and, lower extremity strength. None of the subjects complained of increases in fatigue as a result of the strength training, and no injuries were reported. More importantly, subjects reported that they found that successfully participating in a strengthening program that in the past might have been considered to taxing for them made them feel more positive about themselves and the effects of their disease.
Of course, the results of this study should be interpreted with caution. A relatively small number of subjects participated in the trial. All subjects were closely supervised during the weight training by PT’s for safety and correct form. However, this study illustrates that persons with MS can benefit from exercise programs that might have been considered too aggressive in the past. It also illustrates that improvements in gait and balance in persons with MS are possible if given the appropriate exercise program. The key is that the program must be tailored to the specific needs of the patient under the guidance of a PT with specific training in MS.
I have had the privilege of spending the last 20+ years of my career working with persons with MS. I have always been surprised by how few persons with MS utilize exercise as a means of improving their condition. It is my hope that more persons with MS will realize that improving their gait and balance may only be an exercise program away.
Opinions in this blog post are that of the author, and not necessarily that of Hindawi. The text in this blog post is by Herb Karpatkin and is distributed under the Creative Commons Attribution License (CC-BY). Photo by Herb Karpatkin. Illustration by Hindawi and is also CC-BY.