Find the Right Type of Exercise for Your Condition

Find the Right Type of Exercise for Your ConditionPhysical activity is important for people with neurologic conditions, but it poses unique challenges. Overcome them and reap all its benefits.

Before being diagnosed with multiple sclerosis (MS) in 2005, Lisa Emrich, 49, a musician in Falls Church, VA, took occasional yoga classes and swam. After her diagnosis and as her disease progressed and affected her movement, it became too difficult to continue either of these activities.

​Illustration by Janne Iivonen

But after starting a new medication two years ago, she began to feel well enough to resume exercise. She thought cycling might improve her overall health and well-being, contribute to weight loss, and alleviate arthritis pain in her knee. She didn't even consider that it might help her MS.

Emrich met with a physical therapist, who coached her on how to exercise safely. Then she began using a stationary bike at home, building her strength and endurance. In time she bought a bicycle, and she and her husband began to cycle together. She still uses the stationary bike on bad weather days.

"My aerobic capacity improved," says Emrich. She also noticed improvements in her MS symptoms. "I experienced less spasticity and it took longer and longer before I would feel numb and tingly all over and not be able to feel my legs."

Benefits for All As Emrich's experience suggests, people with neurologic disorders also benefit from regular physical activity. In addition to better cardiovascular fitness, exercise can lead to stronger bones and muscles, a leaner physique, better sleep, less fatigue, and a lower risk for depression, according to the US Centers for Disease Control and Prevention.

Exercise can also improve daily function, and in some cases it can even slow the progression of symptoms such as poor mobility and balance problems, says Theresa Ellis, PhD, PT, director of the Center for Neurorehabilitation at Boston University College of Health and Rehabilitation Sciences.

Risks for Some Emrich does have to be mindful of the intensity of her activity: Many people with MS are heat-sensitive, and the overheating that accompanies most exercise may make symptoms more intense temporarily, says Barbara S. Giesser, MD, FAAN, professor of clinical neurology at the David Geffen School of Medicine at UCLA. With that in mind, Emrich and her physical therapist practiced going right up to—but not over—her limit. "I had to learn how to pace myself," she says.

Finding that balance between exercising enough to enjoy the benefits and exercising too much and risking setbacks is why people with neurologic conditions may wonder if they should exercise at all, says Sabrina Paganoni, MD, PhD, assistant professor of physical medicine and rehabilitation at Harvard Medical School. "Many people exercised before they were sick or got a diagnosis," she says. "Afterwards, they still want to exercise and need to know if it's okay to continue. Others wonder if it's safe and whether it will help slow down their disease or improve symptoms."

We asked physical therapists and patients how to get the most out of exercise no matter what neurologic condition you have. Here's their advice.

Find a Therapist The best approach is to work with a physical therapist, says James Nussbaum, PhD, PT, clinical and research director of ProHealth & Fitness, a physical and occupational therapy organization in New York. "Patients should see a skilled provider who can prepare an appropriate, individualized exercise plan that includes necessary modifications and accounts for any limitations," he says.

Incorporate Aerobic Activity Aerobic exercise, which uses the body's large muscle groups to improve cardiovascular health, includes cycling, swimming, dancing, and walking. These types of exercise raise the heart rate and quicken breathing and help to improve the body's use of oxygen.

For people with Parkinson's disease, exercise has been shown in many studies to have a possible neuroprotective effect, says Dr. Ellis. The latest data, from a multicenter study published in JAMA Neurology in December 2017, show that high-intensity exercise—in this case, challenging walks on a treadmill—is significantly more effective than moderate activity such as walking over flat terrain, and can actually delay the disease's progression.

The effect of exercise on other conditions such as stroke, ataxia, MS, and fibromyalgia is not as well studied, but a review published in the Archives of Physical Medicine and Rehabilitation in 2013 found that aerobic exercise, including using an exercise bike and walking, improved mobility, fatigue, quality of life, and cardiovascular health in people with mild to moderate disability from MS.

Work Up a Sweat, Carefully Aerobic activity is good for the heart, but for people with different forms of dysautonomia, such as postural orthostatic tachycardia syndrome (POTS), a condition that causes a rapid heart rate upon standing, an elevated heart rate can cause lightheadedness and fainting. For people with these conditions, a better option than cycling or running is a rowing machine or a recumbent bike, says Brent P. Goodman, MD, assistant professor of neurology at the Mayo Clinic in Phoenix. Exercising in a swimming pool is another good choice: The water pressure can prevent or lessen symptoms that occur upon standing, according to Dysautonomia International.

People with inherited neuropathies such as Charcot-Marie-Tooth (CMT) disease, in which the lower legs may be numb or weakened, compromising mobility and balance, can use walking poles to keep from falling. Swimming or water exercises are other safe activities that reduce the risk of falling.
Estela Lugo, 37, who was diagnosed with CMT at age 3, was elated when she learned about a modified treadmill that uses air pressure to reduce the force of gravity, which decreases the stress on her legs. "My physical therapists put me in it, and in a few minutes I was running, with no risk of falling," Lugo says. "I was able to get that cardio workout I felt I had always been missing."

The treadmill, which is available in physical therapy and rehabilitation practices, can be adjusted to address patients' specific capabilities, says Dr. Nussbaum. (The Hereditary Neuropathy Foundation is doing a pilot study on its effects in CMT patients.)

Build Endurance, Gradually To enhance the benefits of exercise and minimize the risks, make sure the activity is safe, and increase intensity over time, says Dr. Goodman. "Dysautonomia patients really struggle in the beginning," he says, because these conditions typically lead to rapid deconditioning. "We advise starting out with five or 10 minutes of activity, working up to 30 to 60 minutes a day," he says. "Most patients will reach a point where exercise becomes less difficult."

That was true for Emrich. When she first started cycling, she could complete only a few revolutions on her stationary bicycle. Thanks to careful pacing over time, her endurance has improved consistently—without setbacks. "If I overdo it, I pay the price and can't exercise for a while," she says.

Start Early Start or resume physical activity as soon as possible after a diagnosis. The earlier the better, says Dr. Ellis. That's advice Pamela Quinn wished she'd heard when she was diagnosed with Parkinson's disease 20 years ago. A former dancer, she stopped dancing after her diagnosis, especially after her doctor discouraged all physical activity for fear she might fall. She eventually resumed dancing, and today the 63-year-old teaches movement classes for other Parkinson's patients in New York City, where she uses music and dance, theater, and sports activities such as obstacle courses to encourage students to get moving.

"The phrase 'use it or lose it' applies to people with or without Parkinson's, but it's especially true for people who have movement disorders," says Quinn.

Find Your Balance Exercises that improve balance such as tai chi and yoga, including chair yoga, can improve mobility and reduce the risk of falls, says Dr. Paganoni.

At the urging of a friend, Lugo decided to try a yoga class. "I knew with my CMT it was going to be a challenge because I can't stand up without leg braces," she says. "There was a ballet barre on the side of the room and I hung onto it if I needed it." As she learned the routine and the poses, she was able to modify a lot of the movements to accommodate her disability.

"To improve balance, try activities that require you to shift your weight from side to side, such as boxing," Quinn suggests. Dance is also good, as it provides rhythmic cueing, the use of sensory stimuli—in this case, music—to facilitate repetitive movement, which may improve gait in people with Parkinson's, Quinn says.

Don't Forget to Stretch For most conditions, stretching exercises can help prevent pain and loss of range of motion, Dr. Paganoni says. For example, people with CMT should stretch their heel cords daily to keep their ankles flexible.

Lift WeightsFor people with neurologic conditions, having stronger muscles often translates into better function. For example, says Dr. Goodman, people with dysautonomia, including POTS, who strengthen their abdomen and leg muscles may have less blood pooling, which occurs when blood doesn't flow back to the heart properly and gathers in the veins in the legs. "Several studies have [also] shown that resistance training can help with the slowness of movement associated with Parkinson's disease," Dr. Paganoni says.

A few studies suggest that lifting weights may also help people who have mild symptoms of myasthenia gravis such as weakness in the arms and legs and muscle fatigue improve both their muscle strength and endurance. Patients should stop short of muscle fatigue, which varies from patient to patient based on age, overall fitness, and symptoms, according to Conquer Myasthenia Gravis, formerly the Myasthenia Gravis Foundation of Illinois.

Keep Moving Although strength training can't help muscles weakened by neuropathy, strengthening unaffected muscles can help compensate for the deficits and help patients function better. After Bethany Meloche, 26, had surgery to correct foot deformities due to her CMT, she had to re-learn to walk. As her strength returned, she started walking everywhere—including a five-day, 50-mile walk in Ireland. "As far as the disease process and the neuropathy go, I've gotten worse every year," Meloche says. "But if I had not done all that walking, I believe I would be in a wheelchair right now."

Last year, Emrich reached a level of fitness she never dreamed possible. She and her husband participated in a two-day bike ride, the Bike MS Chesapeake Challenge, covering 66 miles over two days. "Looking at the goal of riding up to 35 miles a day was daunting," she admits. "But it was exciting to be able to reach new distances and get comfortable and stronger."

This year, Emrich aims for an even greater challenge—to ride 50 miles in one day before she turns 50 this summer. "I'm determined to do it," she says.

5 Ways To Motivate Yourself To Move Sticking to a regular exercise routine is challenging—for everyone. For people who are also dealing with balance and movement problems, fatigue and pain, or apathy and depression, it's even harder. These strategies may help.

By DDARA from the Noun Project Do what you love. "Find a movement form you like that you can work into your schedule," says Pamela Quinn, who was diagnosed with Parkinson's disease more than 20 years ago and who now teaches movement classes in New York to other people with the disease. "It can't be a New Year's resolution. It has to be something you do for life," she says. When you find something that you enjoy, you're more likely to stick with it.

By DDARA from the Noun Project Find your style. If you prefer to exercise with others, join a class or find an exercise buddy. If you'd rather exercise on your own, look for DVDs or online courses. Do you respond better to music or being outdoors? Keep trying different combinations until you figure out what works best for you, says Quinn. And don't be afraid to change it up if your interests change or your disease progresses.

By DDARA from the Noun Project Make your environment your gym. Exercise doesn't have to be a class that you go to twice a week, says Quinn. Incorporate movement into everything you do. "I use the lines on the sidewalk to propel my gait, or I get up on the curb and walk along it the way a kid might in a playground." Try getting off the bus two stops early and walking the rest of the way, or parking your car as far away from the grocery store as you can, or taking the stairs instead of the elevator, Quinn suggests.

By DDARA from the Noun Project Focus on the benefits. "Exercise can be a fabulous antidepressant," says Quinn. "For illnesses that have depression as a symptom, that's a real bonus." Physical activity also improves function, says Theresa Ellis, PhD, PT, director of the Center for Neurorehabilitation at Boston University College of Health and Rehabilitation Sciences. "People are living longer with neurologic conditions like Parkinson's disease. Who wants to live longer with more disability? If you're going to live longer, you have to live better."

By DDARA from the Noun Project Enlist a physical therapist. Physical therapists can create customized exercise plans and help patients stay focused, says Dr. Ellis. After identifying appropriate exercises and teaching patients how to do them, therapists then help patients integrate them into their lives. "Figuring out the most successful way to integrate these exercises into their lives is critical."
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