MS Symptom Management: Fatigue & Heat sensitivity
To start off this series discussing the management of some of the most common symptoms experienced by people with Multiple Sclerosis (MS), I wanted to explain how I came to this specialty. Growing up, I was a gymnast and frequently got injured, which exposed me to physical therapy very early; I knew I would be a PT before I even started high school. When I was working towards my undergraduate degree in Exercise and Sport Science at UNC, I began working as a caregiver for Joanne, who had MS. Joanne had primary progressive multiple sclerosis and used a scooter as her primary means of mobility. I helped her with normal daily activities and was instructed by her physical therapist to assist her with her stretching and exercise program. I was amazed at her dedication to her work and abilities despite significant weakness in both legs and 1 arm. When I learned that UNC had a specific scholarship program dedicated to Multiple Sclerosis, I knew it was the right path.
FATIGUE
The symptom that most affected Joanne, which I did not understand at the time, was fatigue. We would have to get her exercise in and all of her work done by about 2 o'clock because the fatigue would hit her, and she would need to rest for a few hours. I now know that fatigue is the most common symptom in MS and is present in more than 80% of individuals. Fatigue can be difficult to describe and quantify and can be a primary symptom of the disease. Fatigue can also be a secondary symptom in MS. For example, it may come secondary to something like disrupted sleep due to spasticity or bladder symptoms.
It used to be believed that people with MS should not exercise due to fatigue as it may trigger a relapse or worsen symptoms associated with the disease. However, research in the past 20 years has changed the way of thinking significantly. Many studies (I have linked some great articles below) have found significant improvements in exercise capacity and fatigue after participating in an appropriately dosed exercise program. Furthermore, researchers have found both short and long-term benefits on many aspects of quality of life.
Though we know the significant benefits of exercise for managing fatigue and other symptoms of multiple sclerosis, it is important that the exercise program be tailored to the individual's specific needs, level of mobility and to start gradually. Therefore, it is best to consult your healthcare provider before beginning an exercise program. In addition, it is beneficial to work with a physical therapist to develop a program specific to your level of ability/fitness and that can be progressed as needed based on your performance and goals.
Things to consider when exercising:
Eat a small snack or meal before exercise for energy
Listen to your body and monitor exercise intensity, it should be mild to moderate intensity
Monitor for heat sensitivity, use cooling devices
Allow for rest periods
Group exercises together/focus on total body exercises to maximize the benefit and conserve energy
HEAT SENSITIVITY
When talking about fatigue, it is imperative to consider a person's sensitivity to heat. For example, when someone with MS is overheated, it can cause progressive fatigue, loss of balance/falls, visual changes or could cause a pseudoexacerbation. A pseudoexacerbation is an event that appears like a relapse with a flare of symptoms but lasts less than 24 hours and does not cause a worsening of the disease.
Although physical therapy cannot specifically address or treat someone's heat sensitivity, your physical therapist should always consider this. When exercising, you should make sure:
You are in a cool room or environment if possible, in summer it would be best to exercise during the coolest times of the day if outside.
You have a cooling device or cooling towel ready when needed.
You drink plenty of cold water.
You allow for rest breaks.
Stay aware of early signs of heat-related problems.
Over the coming weeks, we will continue to discuss different symptoms commonly associated with MS. We will provide specific stretches, exercises, and guidance for maintenance from a physical therapy perspective. Next up will be muscle weakness.
I have more information on my website at:
https://movementmatters-pt.com/multiple-sclerosis
Follow me on Social Media!
Articles related to MS Fatigue
Impact of aerobic training on fitness and quality of life in multiple sclerosis - PubMed (nih.gov)
For more information on all things related to MS or to find a health care professional near you visit: Home | National Multiple Sclerosis Society (nationalmssociety.org)
Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
