Studies in MS and Other Conditions

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Exercise may produce a wide variety of health benefits. One well-known study conducted at the University of Utah was reported in 1996 (1). In 54 people with MS, 40 minutes of aerobic exercise was done three times weekly for 15 weeks. Exercise produced benefits for physical and mental symptoms, including:

■ Impaired bowel and bladder function

■ Depression

Similar findings have been reported in other studies. Other MS symptoms that may improve with exercise include fatigue, walking ability, and overall level of disability. Stretching exercises may decrease muscle stiffness (spasticity).

Although exercise in general may be beneficial for bladder and bowel function, a specific type of exercise called Kegel exercises or pelvic-floor muscle exercises may be especially helpful. With these exercises, the pelvic muscles that are used to voluntarily stop urination are flexed on a regular basis. It often is recommended that these muscles be exercised 60 to 80 times daily.

Although mixed results have been obtained, some studies show that Kegel exercises improve urinary function in both women and men by decreasing incontinence, urgency, and frequency. In some of these studies, the exercises have been combined with electrical stimulation or biofeedback (see "Biofeedback").

Men with MS may experience erection difficulties. Research indicates that pelvic exercises may improve erectile dysfunction. However, this approach is not appropriate for men with MS, because the beneficial effect occurs with erection difficulties that are due to blood flow abnormalities (venogenic erectile dysfunction), not for erection problems associated with nerve injury (neurogenic erectile dysfunction).

Studies in MS and other conditions demonstrate that exercise produces emotional benefits. In fact, more than 1,000 studies of variable quality have been conducted in the area of exercise and depression. One study that analyzed the results of 80 different clinical trials of exercise and depression found that the benefits of exercise occurred across a wide range of ages, in both sexes, and with all types of exercise. In general, longer courses of exercise (more than 17 weeks) are more effective than are shorter courses. For treating depression, exercise appears to be as effective as psychotherapy and more effective than relaxation methods or pursuing enjoyable activities. Exercise in addition to psychotherapy is more effective than exercise alone.

Although anxiety has not been studied as extensively as depression, many studies have found that exercise reduces the level of anxiety. Many different types of exercise appear to be effective for depression, and longer exercise programs (more than 10 to 15 weeks) appear to be most effective. Surprisingly, individual exercise sessions that are only 5 minutes in length appear to decrease anxiety levels. Perhaps through these effects on anxiety, a regular exercise program also may improve insomnia.

Exercise has multiple actions on the immune system. The effect that these immune system changes might have on MS has not been studied. Moderate levels of exercise have been associated with immune system activation and a decreased risk of viral infections, although strenuous exercise appears to produce mild immune suppression and an increased risk of viral infections. Because exercise has so many clear beneficial effects, the possible immune-system changes associated with exercise should not factor strongly into decision-making about exercise.

Other benefits are associated with exercise. Regular exercise may prevent osteoporosis, a decrease in bone density that may occur in MS. Low back pain, which also may occur in MS, may be reduced through the use of an exercise program. Large studies have found that exercise decreases the death rate by 25 to 30 percent. This may be due to the protective effect that exercise has on heart disease and stroke. Exercise may also mildly decrease blood pressure, help prevent diabetes, decrease the risk of some forms of cancer, and improve symptoms of premenstrual syndrome.

Given the many emotional and physical benefits associated with regular exercise, it is possible that a lack of exercise, or physical deconditioning, actually may contribute to MS-associated symptoms. Physical inactivity may worsen a wide variety of symptoms, whereas moderate levels of exercise may alleviate multiple symptoms.

An exciting area of exercise research involves proteins known as growth factors. A variety of these growth factors occur in the central nervous system; these usually are referred to by acronyms such as BDNF (brain-derived neurotrophic factor) and NGF (nerve growth factor). Animal studies demonstrate that regular exercise increases the brain levels of several growth factors. Growth factors have multiple effects that could be therapeutic for MS:

■ Anti-inflammatory effects: May decrease the risk of inflammation-related MS attacks

■ Nerve-protecting effects: May decrease the risk of injury to nerve fibers (axonal injury)

■ Nerve-regenerating effects: May help injured nerves grow new nerve fibers

Much of the exercise-growth factor research has focused on aging-related neurodegenerative diseases, such as Parkinson's disease, Alzheimer's disease, and Lou Gehrig's disease (amyotrophic lateral sclerosis or ALS). Exercise decreases the severity of disease in the animal models of Parkinson's disease and Lou Gehrig's disease. In addition, exercise may decrease the risk of developing Parkinson's disease. Limited studies in MS indicate that exercise may increase growth-factor levels in people with MS.

An important issue is whether exercise could improve the overall disease course of MS. It is possible that the exercise-induced increases in growth factor levels could, like the injectable MS medications, have disease-modifying effects in MS. Further research is needed to determine if exercise has such an effect.

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