Tuula Tyry, PhD, MAEd––Program and Editorial Manager, Barrow Neurological
Institute, Phoenix, Arizona

Introduction
Lifestyle choices––such as physical activity, weight management, smoking cessation and healthy diet––have gained a prominent place in today’s cost conscious yet patient centered health care. In this issue of MSQR we have continued to address the role of physical activity in the treatment and management of MS, this time highlighting some of the benefits of yoga.

As many of the readers may have noticed, NARCOMS has collected a variety of physical activity-related data on several occasions over the past few years. Detailed results of the associated longitudinal analyses will be reported in the form of manuscripts and presentations in the course of next year. In the meanwhile, this article will briefly summarize the responses to the exercise related questions in the spring 2007 update survey––both to encourage further discussion on this topic and to motivate everybody to once again explore opportunities for healthy exercise. Chicken raising, anybody?

Current Level of Participation
In the spring 2007 update survey, 10,691 NARCOMS participants reported on their current involvement in physical activity. Over a half (52%) rated their exercise participation to be rare or occasional at the most and only 26% reported exercising 3 or more times a week (Figure 1). These results are consistent with those obtained a year earlier, when a more detailed survey instrument revealed only 23% of NARCOMS responders to engage in at least moderate level of leisure time activity (Tyry et al., 2007). Similar findings in the general population indicate, that the current CDC recommendation for “moderate level of exercise on most if not all days of the week” is not that easy to meet (Steffen et al., 2006). Active measures are clearly needed to increase and support exercise participation not only in the general population, but within the MS community in particular. To find out what might work, let’s review what some NARCOMS participants have done to successfully incorporate a regular exercise routine in their life.

Regular Exercise Routine
When asked about their regular exercise routine in the past 4 weeks, 41% of the spring 2007 update survey responders either skipped the question (< 2%) or indicated that they don’t exercise on a regular basis (40%). Among the 6,265 responders reporting a regular exercise routine, aerobic exercise (e.g., walking, swimming, etc.) was the most common (63%), followed by strength training (34%). Activities focusing on muscle tone, coordination or relaxation (e.g., pilates, yoga, and tai chi) also made the top three (32%). Other types of exercise were far less common, although even extreme sports had a following (Figure 2).

It is quite revealing, that over 13% of all the responders reported specific activities beyond those listed as a standard response option. While some of the text entries served primarily to specify the nature of the sport in question (e.g., golf), the comments also painted a picture of tremendous creativity in overcoming physical limitations and other obstacles. The multitude of activities described ranged from adapted kayaking, foot cycling, and equestrian sports to wood working and raising chickens–– clearly demonstrating the wide range of opportunities people have sought out. The challenge for the health care system and the MS community is to support these endeavors as much as possible, including instilling and nurturing a positive and encouraging attitude towards exercise in the minds of patients and health care professionals alike. This leads us to the next question…

Is It Just What the Doctor Ordered––or Not?
Less than two out of three responders (57%) recalled their treating physician ever having recommended exercise to them. The main reasons given for an exercise recommendation were general health benefits, weight control, and fatigue management (see Table 1). Interestingly, 8% of the responders who had received an exercise recommendation were unsure of or could not recall the specific reason for it. More importantly, among this group only 38% were engaged in regular physical activity, versus 51% among those who were able to name the specific reason. Also worth noting is, that in several cases the discussion on exercise participation was initiated by the patient rather than the clinician.

Only 4% of the responders had been discouraged from exercising by their treating physician, while another 3% were unsure about it. Among the main reasons physicians had given to discourage physical activities were energy conservation, overheating, and concerns for imbalance and falling. Most of the comments referred to temporary limitations during an injury or an exacerbation, or to reasonable precautions not to “overdo it”. In some cases, however, the perceived message seems unnecessarily pessimistic, such as “it won’t do any good”. In those interactions time constraints may have curtailed the dialogue and left the patient with a very narrow impression of the potential benefits of exercise. We hope that readily available information in MSQR and elsewhere will heighten awareness of the value of physical activity among both patients and clinicians.

Conclusion
Despite the well-known general health benefits of regular exercise, it frequently does not get promoted to patients with MS. All clinicians involved in providing care to patients with MS may not be fully aware of its broad range of potential benefits, nor the willingness and creativity of their patients to ”make it work”––as long as it is sanctioned by their physician. As always, be sure to follow the guidelines and advice provided by your healthcare provider––but do remember to bring up the topic of exercise at your next appointment. The ball is in your court now.

References
Steffen, L., Arnett, D., Blackburn, H., Shah, G., Armstrong, C., Luepker, R., et al. (2006).Population trends in leisure-time physical activity: Minnesota heart survey 1980-2000.

Tyry, T., Marrie, R. A., Cutter, G., Campagnolo, D., Bullock, B., &Vollmer, T. (2007). Leisure time physical activity levels in Narcoms MS population. Poster S99 presented at the CMSC conference in Washington DC, June 2007. (Abstract published in International Journal of MS Care, 9, 2, 79.)

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