#CMSC16 – Susan Bennett On the Importance of Exercise for MS Patients

Susan E. Bennett, a specialist in multiple sclerosis (MS) rehabilitation, reinforced the importance of exercise for MS patients to improve quality of life, during the June 1-4  2016 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), in National Harbor, Md.

“Everybody should be exercising. If you have MS it is even more important that you exercise.” said Dr. Bennett, a clinical professor at the departments of Rehabilitation Science and Neurology at the University of Buffalo (UB), and an associate in the UB Neurosurgery department at CMSC 2016.

Over the last two decades, a substantial amount of evidence regarding the benefits of exercise for MS patients has been published. Although exercise has not been shown to slow the progression of MS, it can help increase patients energy, improve balance, decrease muscle atrophy, manage spasticity, and allow patients to better perform daily activities.

Recent studies have also shown that exercise may prevent cognitive decline and decrease depression in MS patients, elevating the overall sense of well-being.

It is common knowledge that proper rehabilitation programs for stroke patients can rewire the brain to become more active, and to train unaffected regions of the brain to connect the affected side of the body.

“We’ve seen the exact same thing happening in MS,” said Dr. Bennett.

Dr. Susan Bennett. Photo credit: University at Buffalo

“Back in the 1990s the talk was ‘If you have MS go home and lie in a couch. Don’t overheat yourself’. Now what’s been shown is 20 minutes of moderate exercise with someone with MS actually promotes the secretion of brain-derived growth factor,” she said. “The chemical BDNF is present during the first two years of life when the brain is highly active and molding, a lot of dendritic synapses are forming, and the whole central nervous system is becoming myelinated. We can actually trigger BDNF to be secreted again with 20 minutes of moderate exercise.”

Although BDNF is only secreted for four weeks after the training exercise, it gives patients an opportunity to start rehabilitation programs that trigger reorganization of the brain.

“That’s something that is truly missed. Individuals think they have MS and there’s not much that can be done, and that is totally the opposite.” said Bennett.

Types of exercise may vary among patients. Bennett suggests patients should start with short exercise periods in order to let the body adapt to new movements. Riding a stationary bicycle, an elliptical, or walking on a treadmill helps build up to the the 20-minute moderate exercise routine.

“The key thing is an exercise program that the patient enjoys doing. Not everybody likes yoga, not everybody likes tai chi, but both of those types of interventions are really good towards posture, balance, tone. And yoga and tai chi help to tie in some meditation. That could be another factor in managing spasticity,” Bennett said.

The type of MS disease-modifying drug the patients take, or the state of the disease, does not seem to affect the benefit of exercise or type of rehabilitation.

“It’s an ongoing journey” Dr. Bennet explained. “If the patient has primary progressive MS, I’m pretty much going to treat them the same way as someone who has relapsing-remitting [MS].”

Bennet, a certified multiple sclerosis specialist, said she was challenged to unravel the role that physical therapy could play in rehabilitating individuals dealing with MS and decided in 1992 to establish a solo practice in neurologic rehabilitation with a focus in MS.  Since then, she has been devoted to teaching students about MS rehabilitation.

“My students know MS, but in the majority of programs they (learn) stroke, and they know spinal cord injury, and probably head trauma. They really don’t learn about MS, they don’t learn about Parkinson’s disease, they don’t learn about ALS [amyotrophic lateral sclerosis], they don’t learn about muscular dystrophy” she noted.

The International Organization of MS Rehabilitation Therapists (IOMSRT), is now developing new programs to teach rehabilitation therapists how to assess and treat MS patients. The idea is two-fold.

“One piece is to do some individual programs for individuals that are already working, and the other piece is to develop modules that can be used in curriculum that will be developed by the IOMSRT” she said.

Dr. Bennett, a former president of CMSC, said she is excited that CMSC annual meetings continue to bring specialists in MS care together.

“One of the nicest things I love about the CMSC is it truly has comprehensive care. You have nurses, you have nurse practitioners, you have physicians assistants, of course the neurologists, you have neuropsychologists, you have social workers, you have everybody in the rehabilitation. And we all come together to figure out what is the best way to help individuals with MS,” Bennett said.