The Latest on What Exercise Works Best to Combat MS

We've all heard, probably hundreds of times, how good exercise is for us. It not only helps folks to drop pounds and stay in shape, but it can lead us to live stronger, healthier and happier lives.

When you have multiple sclerosis, there may be even more benefits. A 2016 comprehensive study of workout routines for MS patients reports exercise can reduce relapses and lesions (scarring) on the brain and spinal cord associated with MS, improve cognition and even slow down the progression of the disease.

But there's a Catch-22: Most MS patients don't exercise enough, according to a survey in the June 2015 issue of Acta Neurological Scandinavia. It's understandable since multiple sclerosis, an autoimmune disease that damages the myelin sheath (covering) around the neurons in the central nervous system, can cause symptoms such as fatigue, overheating, muscle weakness, tremors and other disabilities, all of which can make exercising especially challenging.

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That's why if you have MS, you'll want to choose an exercise routine you not only enjoy, but one that also fits your particular needs. "You should start by seeing a physical therapist who will help adjust exercises to fit your capabilities," suggests Dr. Michelle Fabian, assistant professor of neurology in the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Hospital in New York. "An important rule in MS is to start out small and work up gradually," she adds.

Which workouts will give you the best bang for your buck? It turns out that aerobic exercises probably offer the most benefits. A 2013 study published in the International Journal of MS Care reported on an eight-week program where MS exercisers used a treadmill. The result? The participants had improved balance and increased walking capacity, with secondary benefits of reduced fatigue, enhanced mood and improved overall quality of life as well as decreased disability.

Aerobic activities also boost the brain, according to a study in the 2015 issue of the Archives of Clinical Neuropsychology; it found that tests measuring memory and thinking skills were improved in MS participants who worked out aerobically. "Cardiovascular workouts (aerobics) may help the brain function more efficiently because this type of exercise helps blood and oxygen flow up to the brain and that can increase cognitive ability," Fabian explains. "If you can't walk fast enough to increase your heart rate, that doesn't mean you can't get the benefits of aerobic activity. I have a patient who can't stand but she gets her aerobic workout in a rehab facility using a machine that involves her upper body."

Aerobic workouts aren't the only choice for MS patients. "You don't have to stick to one routine," Fabian stresses. "Stretching, the kind you get in yoga, offers all kind of benefits including stress reduction, increased flexibility, better balance and a wider range of motion, all of which can help MS patients maneuver with more ease in the world." In fact, it's been shown in clinical trials that yoga can even help reduce fatigue. According to the National Multiple Sclerosis Society, as many as 80 percent of MS patients complain of fatigue at some time.

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Aquatic exercise, preferably in a pool where temperatures can be controlled, is also an effective option. Water offers natural buoyancy, which allows the body to feel lighter so movement takes less effort. "It also promotes muscle relaxation," Fabian says. "And you don't have to swim. Just standing and moving in water, or merely floating, gives patients benefits. Water offers resistance so it helps to increase balance and coordination."

Utilizing different forms of exercise, including yoga, aquatics, strength training and aerobics, could offer the most advantages, especially if the program is designed to fit particular levels of ability. Dr. Leorah Freeman, an assistant professor and multiple sclerosis expert in the department of neurology at McGovern Medical School at UTHealth in Houston -- working in collaboration with the YMCA of Greater Houston and National Multiple Sclerosis Society of Houston -- created "Moving Stronger," a free exercise and education program specifically designed for folks with MS. "Before we developed this program, people in the MS community who came to the Y only had an option of taking yoga or aquatics classes, and neither were designed for different levels of ability," Freeman explains. "Now there are four different kinds of exercise programs with trained instructors offering four levels of modification for MS participants, from the fully-abled, to those who are unable to stand and require the use of a wheelchair."

[See: 9 Ways to Exercise in the Pool Beyond Swimming.]

Participants in a 12-week pilot study of the program, that included six to 10 people in each level, reported 30 percent more endurance, a 22 percent improvement of their MS symptoms and 34 percent less fatigue, according to a questionnaire they completed at the end of the program. "The results are preliminary and need to be confirmed with a larger group and in a controlled trial. That said, these are extremely promising results," Freeman says. "Ultimately, our goal is to help the program grow so that it can be offered throughout the country to as many MS patients as possible."

Exercising routinely can help you cope with your MS symptoms. But if it's not a good day and you're either dealing with a flare-up, feeling too fatigued or really can't seem to get motivated to move, don't get down on yourself. Take a break and look ahead to the next day.

Robin Westen is a freelance Health reporter at U.S. News. She's an award-winning journalist who has written for numerous national magazines, including AARP, Family Circle, Psychology Today, MORE, Health, Self, Parents, Glamour and Cosmopolitan, in addition to others. She has authored more than a dozen books on health and relationships, including "The Yoga-Body Cleanse," "The Complete A to Z for Your V," "Ten Days to Detox" and "808 Conversation Starters for Couples," among others. Westen also won an Emmy for her writing on the ABC show "FYI."