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Exercise
By Sarah Watts

How Weight Training Boosts Strength and Balance

For years, Tanya Farmer wasn't much into exercise. That changed in 2009 when the oncology nurse and single mom to a teenager was diagnosed with relapsing-remitting multiple sclerosis (MS) at age 35.

Illustration of woman progressing from using cane to walking
Illustration by Janne Iivonen

Farmer was prescribed a disease-modifying drug, but her symptoms worsened—she developed optic neuritis, muscle spasms, and sudden, stabbing pains in her legs—and she feared becoming a burden to others. Within two years of her diagnosis, she experienced a relapse and needed to lean on her boyfriend to walk short distances and had to use a cane and wheelchair to get to doctor's appointments. After a course of steroids, the symptoms resolved, and Farmer no longer needed a cane or a wheelchair, but she was determined to be more self-sufficient.

The first thing she did was talk to her doctor about exercise. With his permission, she joined a local gym and enlisted a personal trainer, who devised a workout of cardiovascular and strength-training exercises.

"We started off just using my body weight and trying to squat down to a seated position on the bench," Farmer says. She also incorporated short distances on the treadmill, taking breaks as needed. On days when her muscle spasms were particularly bad, she used a rowing machine and an elliptical instead of the treadmill. After a couple of weeks, she started using kettlebells and bench-pressing an empty barbell over her head.

"When I started doing barbells and deadlifting, I felt like I was able to accomplish something," Farmer says. Several weeks into her new routine—around the same time she started adding weights to the ends of the barbell as she bench-pressed—she noticed that her MS symptoms, once debilitating, had started to improve.

"It took six or eight weeks, but my muscle spasms started happening less frequently and were less intense," she says. The stabbing nerve pain subsided as well. Farmer also noticed she was sleeping more soundly and better able to function. Best of all, the waves of depression that had worsened since her diagnosis began to dissipate.

While it is not a miracle cure, strength training—and its effect on symptoms that accompany neurologic conditions—does have some science behind it, says Cynthia L. Comella, MD, FAAN, professor emeritus of neurology at Rush University in Chicago. In a 2017 study published in Multiple Sclerosis Journal, patients with MS who did weekly resistance training showed less brain atrophy in MRI scans compared with participants in the control group.

In a 2013 randomized control trial published in Movement Disorders, patients with Parkinson's disease who completed 24 months of progressive resistance exercises had significantly reduced motor symptoms compared with participants in a stretching and balance program.

The reasons for these benefits aren't clear. "We don't have a good biomarker for disease progression since you can't count the neurons in a patient's substantia nigra [the part of the brain that controls movement]. We can't really measure whether strength training improves that," says Dr. Comella, who has studied the effects of strength training in Parkinson's patients. "If we want to measure whether it helps, we must find accessible biomarkers in living people that can be measured and reflect progression of the neurodegenerative process, and we aren't there yet."

But doctors do know that all kinds of exercise, including strength training, are beneficial for neurologic symptoms if practiced consistently. In her own practice, Dr. Comella has seen strength training reduce slow movements (bradykinesia) and muscle stiffness and boost memory and focus.

Certain exercises such as tai chi and yoga may help prevent falls in people with MS, says Jacob J. Sosnoff, PhD, associate professor and director of the Motor Control Research Laboratory at the University of Illinois at Urbana-Champaign, who studies how exercise affects symptoms of MS. But any kind of exercise is good, he adds. "The best kind is one you like and want to do. Anything is better than sitting on the couch."

Strength training for people with neurologic disorders can be complicated by spasticity, says Gwen Weibel, DPT, a physical therapist at the Neurobalance Center in Barrington, IL. Muscles that contract constantly cause stiffness and make movement difficult. She recommends stretching and trying new movements before building strength. Patients also can take anti-spasticity medication beforehand, says Barbara S. Giesser, MD, FAAN, professor of clinical neurology at the David Geffen School of Medicine at UCLA.

Weibel and Dr. Sosnoff both recommend strength-training exercises that reflect everyday movements and incorporate muscle lengthening, core work, and balance, so that muscles are primed for functional tasks like eating, dressing, and walking.

For example, instead of a bench press, Dr. Sosnoff recommends standing up from a chair. "With a chair stand, you're focusing on your leg muscles in a way that you'd actually use them," he says.

And strength training can help more than just muscles, says Weibel. "It can also lessen mental fatigue," she notes.

Today, Tanya Farmer's life is totally different. She used to take medication regularly for muscle spasms. Now she goes weeks or months without taking any. And thanks to her current medication—she switched from interferon beta-1a to injections of glatiramer acetate (Copaxone)—and regular exercise, she had only one relapse this year. She and her husband—the boyfriend she leaned on during the worst of her symptoms—live in the Dallas area, where she continues to work as an oncology nurse. And in a surprising move, Farmer took up powerlifting as a sport, training at the gym four days each week and competing in events on the weekends. Doing squats, bench presses, and dead lifts, she heaves hundreds of pounds of metal into the air at a time.

"Strength training has made me realize I can do things I never thought I could," Farmer says proudly.


4 Steps to Strength Training

        1. Customize. For people with neurologic conditions, strength training involves more than just picking up a set of dumbbells, says Gwen Weibel, DPT, a physical therapist at the Neurobalance Center in Barrington, IL. "Patients with MS, for example, have to break the spasticity in their muscles, prepare for each movement, and relearn balance before strengthening," she says. Weibel recommends finding a physical therapist or trainer who has experience working with people who have neurologic conditions. A good place to start is a health or fitness center connected to a large hospital system.
          dumbells icon
           Round Dumbbells by Sneha Cecil from the Noun Project
        2. Start slowly. The National Institute on Aging recommends 30-minute sessions twice a week, but the fatigue associated with many neurologic disorders can affect endurance, says Weibel. She suggests starting with 10 to 15 minutes of exercise and working up to longer periods in five-minute increments. "Focus on three or four exercises and do 10 to 15 reps, then rest after each set," she advises. If you have more severe fatigue, start with fewer reps.
        3. Pick the right pace. "If you walk away from your workout and don't feel tired or taxed, try adding one or two exercises to your routine the next time," says Weibel. Alternatively, you can increase the length of your workout by five or 10 minutes.
        4. Stay safe. Watch for signs that you're overdoing it to prevent injury or debilitating fatigue, says Weibel. "Sometimes people don't know they've pushed too hard until they try to walk out of their session and they can't move," she says. In addition to resting between exercises, pay attention if you're overheating or your face is flushed. "Start with less, and if you feel up to it, push harder the next day," she says. "If you work out for 30 minutes and then can't function for the rest of the day at your baseline level, that's a sign you did too much."

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