WASHINGTON — For people with multiple sclerosis, winter is a good time for sports.
The effects of the disease, which attacks the nervous system, can be partially offset with exercise. But the overheating that results from exercise increases MS symptoms, so the workout goes better when the patient is cool.
"The more physically fit you can keep yourself, the easier it is to fight the fatigue symptoms and the other symptoms," said Robb Adams of Salt Lake City, a 41-year-old ski instructor who was diagnosed in 1993.
Adams skis and helps other MS patients to ski. For instance, he skis backward in front of an MS patient with bad eyesight so she can guide herself by his shape, he said. Adams said he also guides a man who skis in a device that amounts to skis on chairs.
MS patients do better in cold-weather sports because, when they overheat, their conditions get worse and stay that way until they cool down. "It's been known for over 100 years," said Dr. George P. Garmany, a neurologist in Boulder, Colo.
In the 1950s and '60s, diagnosis could be made with the "hot bath test," Garmany said. When people with MS spent long enough in hot water to raise their internal temperature, their vision got worse, he said.
The effect is a product of the nature of the disease. In multiple sclerosis, immune cells attack the sheath that acts like insulation around nerves. The heat that results from exercise reduces the efficiency of the remaining insulation, creating short circuits in the nervous system's electrical signaling, said Andrea T. White, a researcher at the University of Utah.
The short circuit is only temporary, while the exerciser is overheated, and symptoms ease back to baseline while the person cools down. But the symptoms that come with exercise can be scary, White said.
"A person under normal conditions might be able to walk fairly well, but when they get overheated they may not conduct as efficiently, and may develop a limp or not be able to move the leg," White said. "They think it is making their whole disease worse, when it is a temporary change," White said.
Just the same, exercise is good for MS patients. Improved muscle tone makes better use of muscles that still respond to signals from the damaged nervous system. And improved muscle creates a savings account of strength that can keep a person functioning longer, White said.
The idea that an MS patient should exercise is relatively new, Garmany said. It had been thought that patients should avoid exercise and overheating, he said. A consensus favoring exercise began to build in the mid-1980s, based on research and on the efforts of pioneering athletes with MS, such as skier Jimmie Huega.
Huega, who had won an Olympic bronze medal in the slalom in 1964, was diagnosed in 1970. Heeding then-conventional medical advice, he got out of athletics.
But he couldn't give up exercise completely. And in 1976 he rededicated himself to it, figuring doctors who couldn't cure MS were in no position to give him advice on how to live with it. "I've got to exercise because it makes me feel good," Huega said.
Huega's activity--and his activism, including the founding of the Jimmie Huega Center in Vail, Colo., to help people learn to deal with MS--prompted the National Multiple Sclerosis Society to give him a Making a Difference award recently.
But when he first returned to exercise, Huega had to figure out how to deal with the effects of overheating. "I would take a cold shower, and several things happened. I became more lucid when I cooled my body down. I began to regain some of my strength. Definitely, my balance was better."
Although Huega's disease finally forced him into a wheelchair, he returned to skiing last winter. He liked it so much that he is considering leaving Lewisville, Colo., where he resides in an assisted living center, for a new center in Steamboat Springs. The skiing would be better in Steamboat Springs, he said.
But MS patients can exercise and keep cool even when it's warm.
White tested having patients cool their lower bodies in water at 60 to 65 degrees for 30 minutes, then doing 30 minutes of moderate activity on a stationary bike. The patients were tested on their ability to walk after exercise, and questioned about how tired they felt.
White's preliminary results, published in June in the journal Multiple Sclerosis, found precooled patients walked better and felt better. Cooling before exercise is simple, and patients can do it in a bathtub, White said.
National Multiple Sclerosis Society:
NMSS advice on exercise:
National Institute of Neurological Disorders and Stroke multiple sclerosis summary page:
National Institute of Neurological Disorders and Stroke electronic booklet on MS: