1

INTRODUCTION
TO MS FOR
FITNESS
P r e s e n t e d B y : G r e g o r y B r u s o l a , P T, D P T, M S C S
PROFESSIONALS
Gregory Brusola, PT, DPT, MSCS
 2

LEARNING OBJECTIVES

AFTER COMPLETION OF THIS PRESENTATION

• Describe the basic facts of MS
• Understand and identify common MS symptoms that affect movement and activity
• Formulate ways to modify exercise and movement to adapt to the functional issues
and concerns of people with MS
• Engage more comfortable with people with MS
• Describe safety and accessibility issues important to people with MS

Gregory Brusola, PT, DPT, MSCS

 3

TABLE OF CONTENTS

WHAT IS MS? SPECIAL CONSIDERATIONS

A general overview of multiple sclerosis OF PEOPLE WITH MS
Precautions, contraindications, and small things to keep in
mind when working with people with MS

WHAT ARE THE SYMPTOMS A SAFE AND EFFECTIVE WORKOUT

OF MS? General guidelines to assist you in developing and structuring
A review of the most common symptoms seen in people with an exercise program for people with MS
MS

EXERCISE AND MS SHORT AND SWEET

What the current recommendations and research say about COMPETENCY QUIZ
the role of exercise in MS No worries. We’ll go through this together.

Gregory Brusola, PT, DPT, MSCS

 4

Chronic, inflammatory
MS is a chronic, inflammatory disease process of
the central nervous system (CNS). It is the most
common non-traumatic neurological disorder in

WHAT younger adults.

IS Immune-mediated
It is an immune-mediated process affecting the
myelin of the brain, spinal cord, and nerves fibers.

MS Nerve conduction becomes disrupted.

Heterogeneous
MS is often a disabling condition that produces a
variety of symptoms affecting movement, cognition,
and sensation differently in every person with MS.

Gregory Brusola, PT, DPT, MSCS

 5

CLINICAL COURSES

Relapsing Secondary Primary Progressive

Remitting
– 85% of people diagnosed
– Characterized by relapses and
periods of remission
Progressive
– 50% of RR-MS will transition to SP-
MS in ~10 yrs
– 90% of RR-MS will transition to SP-
MS in ~25 yrs
– Progressive after initial RR-MS
Progressive
– 10% of people diagnosed
– NO relapses, progressive from
the start
Relapsing
– 5% of people diagnoses
– Characterized by relapses and
progression
Gregory Brusola, PT, DPT, MSCS
OTHER 6

CLINICAL COURSES
Clinically Isolated Radiologically-
Syndrome (CIS) Isolated Syndrome
• One-time neurologic event consistent • Incidental finding of MS-looking
with demyelination or inflammation lesions on MRI
• Transverse Myelitis or • NO clinical signs or symptoms of MS
Optic Neuritis
• 60-80% chance of conversion
to MS

2017 Revisions of Clinical Phenotypes

• Active vs NOT Active
• With Progression vs WithOUT Progression
• Stable disease: NOT active & withOUT progression

Gregory Brusola, PT, DPT, MSCS

 7

IMMUNE
DYSFUNCTION

• T and B Cells
• Macrophages

PLAQUES MYELIN SPONTANEOUS

LESIONS DAMAGE APs

Accelerated 5-10% conduction Paroxysmal symptoms

brain atrophy rate Gregory Brusola, PT, DPT, MSCS
 8

EPIDEMIOLOGY

MS affects more than 450,000 people in the US and more than 2.5 million people worldwide.
There is a geographic distribution that is latitude gradient. Although most common in Caucasians, African-Americans have
higher incidence of MS. Hispanics and AAs also tend to have a more progressive and aggressive disease course.

1:2 – 1:4 25-35 y.o. Most common Lowest risk in

Male:Female with North European AA, Asian, AI
ancestry
Gregory Brusola, PT, DPT, MSCS
 9

BENEFITS OF EXERCISE
Cardiovascular
health

Cognition Strength

EXERCISE &
MS
Bladder & Bowel
Participation
function

Less fatigue &

Positive attitude
depression

Gregory Brusola, PT, DPT, MSCS

 10

ROLE OF
THE FITNESS PROFESSIONAL
DOs DON’Ts
• Use general screening and non-invasive assessment of • Assess neurological manifestations or evaluate
strength, endurance, ROM, etc. symptoms
• Design and implement a program that addresses the • Make a diagnosis and/or prescribe a treatment-based
body as a whole program for specific symptoms
• Encourage independent performance, providing • Provide information outside your area of expertise
hands-on help only if needed
• Stay within your realm of practice and expertise. Refer
to clinicians for accurate advise about matters outside
your field

Gregory Brusola, PT, DPT, MSCS

 11

As a fitness and wellness professional, your skills and expertise in teaching activities that focus on
movement positively impact the person with MS in performing their activities of daily living. Rehabilitation
professionals focus on therapeutic services with goals differing from those of fitness instruction.

You have a wealth of knowledge and expertise to share.

However, remember to refer to the appropriate health professional for any specific treatment
recommendations or advice.

Gregory Brusola, PT, DPT, MSCS

 12

FIVE COMPONENTS

S F C R B
Strength & Flexibility & Cardiovascular Relaxation & Balance &
Endurance ROM Exercise Awareness Coordination
Integrating both isolation Promoting self-stretching Involving larger muscles, Integrating mind/body Promoting control of
and functional exercises and exercises that can be increasing HR and RR. techniques like those in movements, proper posture
that target areas of independently performed Use the RPE scale of 0-10 Yoga or Tai-Chi, and alignment, proper body
weaknesses and do not exceed 5-6/10 visualization exercises, mechanics
during activity breathing exercises.
Yoga, Tai-Chi, Pilates,
Feldenkrais
Gregory Brusola, PT, DPT, MSCS

SPECIAL CONSIDERATIONS
• Medications that may impact participation
• Awareness of limitations and pacing
• Short breaks throughout recommended
• New challenges to exercise routine or increase in symptoms?
• Refer to healthcare provider
• Low to moderate levels of intensity
• Gradual progression of activity
• Interval training vs continuous training
• Heat sensitivity! Cooling equipment, cold/ice water, use of a fan
• Symptoms can fluctuate considerably
13
• Functional Levels
• Level 1: no symptoms or mild symptoms. Walking independently
or with a cane. Symptoms may be “invisible”.
• Level 2: motor-physical limitations, postural difficulties.
Walking with walkers or using W/C for mobility. They can
transfer well, but may need physical assistance with balance
while participating.
• Level 3: greater functional impairment and spend most of the
time in a W/C. Will require much assistance.
• Refer to Symptom Table & Modifications handout
Gregory Brusola, PT, DPT, MSCS
 14

A SAFE & EFFECTIVE WORKOUT

See Canadian Physical Activity Guidelines

Aerobic Activity Strength Training

How often • At least 2x/wk for aerobic activity and 2x/wk for strength training
• They can be done both on the same day, if tolerated
• At least 1 rest day between strength training days

How much Gradually increase to performing at least 30 min each Working up to 3 sets of 10-15 repetitions of each exercise
session

How hard Low to moderate intensity at around 5 or 6 on the modified A resistance heavy enough to just barely, but safely complete 10-15
RPE scale repetitions
Rest 1-2 min between each set/exercise

How to UBE, bike, stepper, rower, skierg, TM, aquatics Weights, free weights, cables, bands, calisthenics, aquatics, pool, yoga,
Pilates, Tai-Chi

Common Barriers to Exercise Adherence:

Fatigue, Heat Sensitivity, Equipment, Limited Energy, Transportation
Gregory Brusola, PT, DPT, MSCS
 15

LEARNING
ASSESSMENT

Gregory Brusola, PT, DPT, MSCS

COMPETENCY QUIZ
16

QUESTION #1
Multiple sclerosis is
A. A chronic, dysimmune disease that can damage any part of the body
(muscles, nerves, joints, organs)
B. An often disabling disease of the peripheral nervous system resulting in loss
of muscle control
C. An infectious disease that causes fatigue, headaches, depression,
numbness
D. A chronic, often disabling disease affecting the central nervous system

Gregory Brusola, PT, DPT, MSCS

COMPETENCY QUIZ
17

QUESTION #2
Which clinical course is characterized by clearly defined attacks of
worsening neurologic function followed by either partial of complete
recovery periods?
A. Secondary-Progressive
B. Relapsing-Remitting
C. Primary-Progressive
D. Progressive-Relapsing

Gregory Brusola, PT, DPT, MSCS

COMPETENCY QUIZ
18

QUESTION #3
TRUE or FALSE

The most common symptom of MS, occurring in more than 80% of people
is pain.

Gregory Brusola, PT, DPT, MSCS

COMPETENCY QUIZ
19

QUESTION #4
Which of the following is true?
A. Your role is to evaluate a person’s medical status and when he/she
experiences new difficulties or symptoms
B. Being aware of your client’s medications is unnecessary
C. It is important to remember that MS symptoms are pretty much stable day-
to-day
D. Modifications to fitness routine or exercise regimen may be required, and
may be required on a daily or weekly basis

Gregory Brusola, PT, DPT, MSCS

COMPETENCY QUIZ
20

QUESTION #5
Your client returns to you on Thursday and reports that she ended up napping for majority
of the day after your last session. The workout included 10 minutes of continuous biking
at 5/10 RPE, calisthenics for the core, and flexibility exercises at the end. What would
be the most appropriate modifications to the workout?
A. Modify the bike activity to interval training
B. More frequent rest breaks and use of cooling equipment or strategies
C. Increase repetitions of the core exercises
D. A and B
E. The patient’s complaint of fatigue is normal for persons with MS for up to 24 hours after a
workout

Gregory Brusola, PT, DPT, MSCS

 21

CASE STUDY
CLIENT DESCRIPTION
• 60 years old & 5’7” tall
• Vitals at rest
• 94/64 (74)
• First experienced physical problems with MS at 11 y.o.
• Loss of balance weakness of leg muscles
• Paralysis of Rt side of the body
• Remitted and continued on with active life
• Diagnosed at 19 y.o with RR-MS and later developed SP-MS
• Most recently tells you she was in a minor remission or plateau
• Balance and leg strength are most affected, needing to use cane for past 2 yrs

Gregory Brusola, PT, DPT, MSCS

CLIENT RESOURCES
22

GREATER HOUSTON AREA

• MS Society
• Self-Help Groups (MS Society)
• NW, SL, Bear Creek, Clear Lake, TIRR TW
• MS Yoga
• Adaptive Yoga every Thursday (Houston)
• Adaptive Yoga every Saturday (Pearland)
• Adaptive Yoga every Monday (The Woodlands)
• Seated Yoga every 3rd Tuesday (Houston)
• Art Therapy every Wednesday
• https://www.nationalmssociety.org/Chapters/TXH/Calendar
• MSFit & Friends every 3rd Wednesday and Saturday at MMSC
• Moving Stronger @ Trotter Family and Monty Ballard YMCAs
• betterhealth@ymcahouston.org

Gregory Brusola, PT, DPT, MSCS

 23

For any questions:

Gregory Brusola, PT, DPT, MSCS
gregory.brusola@memorialhermann.org

Gregory Brusola, PT, DPT, MSCS