Multiple Sclerosis and Fitness: Helping a Client Progress from Multi-Symptom to MegaStar

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Within the parameters of Personal Training, there exists a multitude of specialties in which one can become certified, including how to work specifically with clients suffering from Multiple Sclerosis or MS.

Occasionally we encounter a member with some physical limitations, looking to improve his quality of life. This is not something to be feared nor shied away from; rather, we must view this as an opportunity for mutual growth. The client will benefit from our expertise as we learn more about a condition previously unfamiliar to us. The key lies in the trainer being willing to step out of his comfort zone and research the condition, thereby becoming a successful fitness partner for the journey upon which the new client is looking to embark.

One of the more common physical conditions that may bring a client to the gym, looking for improvements in his lifestyle, is multiple sclerosis. This disease is not easily recognizable; chances are high that the client will actually have to inform the trainer that he is living with this condition. There are many variations within a diagnosis of MS, and the progression of the disease is difficult to predict. However, the ability of most affected individuals to exercise at an impressive level should encourage trainers to take on such a client with complete confidence.

Multiple sclerosis is a nerve disorder caused by the destruction of the insulating layer (known as the myelin) which surrounds neurons in the brain and spinal cord. This insulation helps electrical signals pass quickly and smoothly between the brain and the rest of the body.

When the myelin is destroyed, nerve messages are sent more slowly and less efficiently. Gray patches of scar tissue, called plaques, form over the affected areas, further disrupting nerve communication. The symptoms of MS occur when the brain and spinal cord nerves are no longer able to communicate effectively with other parts of the body.

The progression of symptoms in MS is correlated with development of new plaques in the portion of the brain or spinal cord controlling the affected areas. There appears to be no regular pattern to the appearance of new plaques, rendering the progression of MS quite unpredictable. Given the long list of symptoms which can vary from patient to patient – challenges with vision, balance, strength, coordination, sensation and bodily functions – it is often difficult to know how to pace a client who is eager to improve his physical affect.

A study published by scientists at the University of Utah in 1996 was the first to clearly demonstrate that exercise is beneficial for people living with MS. Those patients who participated in an aerobic exercise program had better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude and increased participation in social activities. Since that time, several additional studies have confirmed these results. So, as a Certified Personal Trainer, you should consider a specialty education and certification that allows you to better serve MSers.

A more recent study, led by Assistant Psychology Professor Ruchika Shaurya Prakash at Ohio State University, points to the discovery of exercise conferring a protective effect on the brains of individuals living with multiple sclerosis. MRI scans of MS patients revealed that those who had participated in aerobic exercise exhibited less damage in parts of their brains that show deterioration as a result of the disease, as well as a greater volume of vital gray matter.

Physically fit MS patients had fewer lesions compared to those who weren’t as fit and the lesions they did have tended to be smaller,” Prakash said. “This is significant and can help explain why the higher-fit patients did better on tests of brain functioning.”

The Professor expands in more detail: “Our hypothesis is that aerobic exercise enhances these nerve growth factors in MS patients, which increases the volume of the gray matter and increases the integrity of the white matter,” she said. The result is one of improved cognitive function for these subjects when compared to the control group.

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There are many areas of special consideration when training a client with any neuromuscular disorder, and multiple sclerosis falls into this category. This article will attempt to cover the major aspects of the disease and how a trainer may work to help the client deal more effectively with activities of daily life.


Individuals affected by MS typically have impaired balance owing to deficiencies in fluid movement capability, as well as a partial absence of sensation and proprioception. The focus of balance training is to realign the center of gravity.

Like any fitness component, balance must be addressed with a progressive program in order for the client to be appropriately challenged to the point of seeing results. It is helpful to keep in mind that a body’s balance progresses in a cephalocaudal direction (head to toe); from static to dynamic; and from a wide base of support to a narrower one.


Due to the common occurrence of muscle spasms in clients with MS, stretching through a comfortable range of motion can go a long way toward reducing the shrinkage and shortening of muscle fibers, as well as increasing blood flow. Exercises should be executed by the trainer gently applying the external force to the particular area of the client’s body; this enables the trainer to control the direction, speed, intensity, and duration of the stretch.

The overall goal of passive stretching is to have the client’s muscles permanently adapt and adhere to a lengthened position. Spasticity may be most notably observed in the hip adductors and abductors; since muscle weakness also tends to be greatest in the lower part of the body, this area requires considerable attention during a training session. If a spasm does occur in the midst of a flexibility workout, it is advisable to reduce the stretch until the spasticity has subsided, and then gently continue through range of motion.


Individuals living with MS are acutely sensitive to changes in temperature and may tend to overheat more easily than other clients. Excessive heat may also exacerbate symptoms and places these clients at an increased risk for heat-related injuries. Training during the cooler parts of the day (i.e., indoors and early in the morning during the hot summer months) can prove beneficial, as can looser clothing made of breathable fabrics. Trainers might gently remind the client of the need to remain adequately hydrated, not only during the workout but also before and immediately upon completion of exercise.

As with any specialized population, an exercise program for clients with MS must be appropriate to the capabilities and limitations of the individual and may need to be periodically modified as symptoms vary or progress. Consulting with a physical therapist that is trained in the unique symptoms of MS can be a good first step in designing a well-balanced exercise protocol. With some guidelines, a good exercise program can lead an individual with MS toward gaining the maximum potential from his body. This sense of mastery over the disease can be empowering to your client, and to you, as well.

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Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at [email protected]. She welcomes your feedback and your comments!