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Staying active: resistance training and MS

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Following recent media coverage of a study showing the positive effects it can have on the brain, we're shining the spotlight on resistance training this month. To learn more about what it actually is (and push images of weightlifters bench-pressing 100kg to the back of your mind) and how it could help people with MS, we chatted to chartered physiotherapist Rachel Ross, who runs a resistance training class at the Chilterns MS Centre. 

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Resistance training hit the headlines a few months ago with bold claims it can help slow down the progression of MS. Can you shed some light on the study?

There was a systematic review in 2012 looking at resistance training and symptom management. One of the recommendations of this review was that we need to look more at longer-term studies and how exercise can help physiologically and on a pathological level, so what is actually happening to the disease. The recent study you are referring to was picked up by the media back in August. It showed that resistance training, also known as strength or weight training, not only has an impact on symptoms, but what’s going on in the disease process too. It made an argument that exercise might have a neuroprotective (protecting nerve cells from damage and degeneration) element to it, and maybe can reverse some of what is going on in MS itself.

It was a longer term study, with a 24-week to 48-week follow up, and they used MRIs, measuring brain atrophy (shrinking of the brain caused by the loss of its cells). Everybody’s brain shrinks over a lifetime but in MS it shrinks slightly quicker. They monitored the brain over time, and found a reduction in brain atrophy, so it wasn’t degenerating so quickly. The researchers also looked at lesion size and they could see that lesions started to shrink a little bit at 24 weeks. They also looked at cortical (which is the other layer of the cerebrum - the largest  part of the brain) thickness, and found in some areas of the brain it enlarged. They can’t yet link that to brain function, that’s the big jump science needs to make, but the results of this study are positive.

But remember that when the media picks up on a story like this, headlines can be a little misleading. The study was only looking at people with an EDSS score of 0-2, very early stages of the disease, and the study only had 35 participants. The researchers themselves have said it is very much a pilot study and there’s lots more that still needs to be done in this area.

You mentioned a review into symptom management. How can resistance training help with MS symptoms?

The systematic review in 2012 demonstrated some of the symptom management it can help with. It showed that it can increase muscle mass and tone, so physically what was going on in the muscle improved. That also linked to electromyography (EMG) activity, so the actual impulses getting through to the muscles improved as well. There is some correlation with how strong your muscles are to how well you walk, but we need more evidence to prove that. There is also good evidence to show it can improve fatigue. Previously there was a concern that by exercising, people with MS might make themselves more fatigued and cause more damage, but in more recent times, a lot of studies have proved the opposite. We can now say exercise is absolutely the right thing to be doing. There’s also evidence to show it can improve mood and cognition. Exercise classes also bring social interaction and camaraderie, which is really important too.

“We can now say exercise is absolutely the right thing to be doing. There’s also evidence to show it can improve mood and cognition...”

You run resistance classes at the Chilterns MS Centre, what do they involve?

The main idea behind this type of exercise is that you’re using some kind of resistance to target specific muscle groups - to load them. There are several different ways that you can do this. You could use free weights as an option, for example, using a dumbbell. That can be great as you can use them through the full range of your body’s movement, and you’re having to use your stabilising muscles at the same time, so it is quite a functional way of training.  Another way of increasing resistance in your workouts is using the Thera-bands, which are bits of stretchy material. The great thing about this piece of kit is that it’s quite versatile; you can use it in a range of different movements and positions. For example, you could wrap the band under your feet, and then pull up on it as you perform bicep curls.  The other way you may have seen resistance training used is in gyms,  equipment like the cable row, pull-up bar, or leg-press. You sit or stand in position, there’s usually a diagram there to show you how to do the exercise, and it’s targeting a specific muscle group. You could also use body weight resistance, which means using your own body weight in different functional postures. You could try medicine balls, which are weighted balls you can use in quite a fun and functional way, or perhaps suspension training, which uses ropes and flexible cords.

How could someone with limited mobility use resistance training?

Let’s say you’re in a wheelchair, your hand and arm function is massively important. We use our arms more than we use your legs sometimes and physios really need to make sure they target arm function. Some of the exercises we do in the class certainly can be adapted to do in your chair. For example, free weights and bands, they are really versatile as you can move in any direction and load as much or as little as you like.

What would be your advice to someone who wants to try resistance exercise but is a little apprehensive?

 Sign up to a class at a one of the many MS centres across the country, as the physios will be able to give you the support you need. I’d also say start slowly, listen to your body and do it at a level you’re comfortable with.

We asked people with MS to share their experiences of resistance training

My left side is considerably weaker than my right, particularly my leg, so for me it’s all about building strength on my left. So I use machines, body weight, or dumbbells to strengthen that side. I use heavier weights on my left side to build it up, and that really helps with stability and balance. I’ve found that when I’m walking around I feel much more confident and solid.  Diana

"I feel much more positive since exercising regularly, and my body feels strong and capable"

I’ve had relapsing remitting MS since 2014 and last year I began with some light resistance training alongside cardio. I immediately fell in love with this type of exercise and found that I have more and more energy.  I have been buying heavier weights and now can deadlift 30kg. This might not sound like much but with a starting point of 3kg, with MS, and as a skinny woman, I’m so proud of how far I’ve come, the muscles I’ve developed and how this has improved my everyday life.  I feel much more positive since exercising regularly, and my body feels strong and capable. I no longer need afternoon naps after work, which I always did since having MS. I now get home and do a workout instead! Rebecca

I do body pump and spin and try and get weight training in at least 2 times a week. I had a relapse just recently where my right arm and leg wouldn’t work properly, it lasted 10 days and I feel that if I hadn’t built up some muscle and kept fit, the relapse could have been a lot worse and lasted longer. Charlotte

We’d like to thank everyone at the Chilterns MS Centre for their assistance with this article. For more information about the Chilterns MS Centre, see chilternsmscentre.org