Dear Colin: My sister has had multiple sclerosis for 12 years. She’s starting to have difficulty walking and doing daily things like climbing stairs and gardening. I know there’s no cure for MS, but can exercise help? — Barry L.

Yes, it can help a lot. But for those who don’t know, neurologists report that multiple sclerosis (MS) is one of the scariest diagnoses a person can get, often prompting anger, fear, sadness and depression.

What makes MS difficult to treat is its unpredictable effect on the central nervous system (the brain and spinal cord) where sclerotic plaques occur for unknown reasons, eventually creating strokelike symptoms. All of the body’s movements come from the central nervous system, so as these plaques spread (as they tend to do with MS), a person’s movements become more uncoordinated because the plaques interfere with nerve signals transmitted from the central nervous system to working muscles.

There’s no cure for MS, but studies show that consistent, purposeful exercise can help decrease pain while improving strength, endurance, walking speed, balance and overall function.

Now, for your sister to fully reap the benefits of exercise, her program should be individualized and carefully monitored by a physical therapist specially trained in exercise prescription. This will help your sister avoid overexertion and minimize risk of injury.

Again, the physical therapist must have advanced training in exercise (unfortunately, most do not) because people with MS have a unique exercise challenge: They overheat if pushed too hard, taking hours or even days to recover. Dr. Todd Woods, a Portland neurologist, said, “If allowed to overheat during exercise, most patients with MS see symptoms worsen while injury risk also significantly increases, underscoring the importance of expert PT guidance.”

A perk for most people with MS: Health insurance covers physical therapy.

Complicating matters is that the majority of patients with MS suffer from chronic low back pain often due to progressive asymmetrical weakness in the lower body, most notably in muscles surrounding the thighs, hips and foot/ankle. Whether your sister has back pain, I recommend she perform a custom-designed physical therapy strengthening program every other day to combat pain while maximizing function in daily life. The strengthening program must pay careful attention to preserving low-back comfort during all exercises to be safe and effective.

Your sister should also do stretches and endurance exercise daily. Stretching the hamstrings, hips, calves and chest muscles will help lower spinal stress by improving posture and joint range of motion. The type of endurance exercise your sister does should depend on what she enjoys doing, but I usually recommend brisk walking (either on a treadmill or sidewalk) to help promote balance and endurance as long as it doesn’t exacerbate pain.

Medications have improved the past decade in helping patients with MS manage symptoms (especially pain), so make sure your sister complies with her medication regimen and notifies her doctor if complications arise.

Millions of people with MS live long, happy and productive lives. Your sister can, too, by being proactive and never giving up hope.

Colin Hoobler is a certified physical therapist and writes a regular column

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