Neuromuscular Conditions and Disorders
Patrick L. Jacobs, PhD, CSCS,*D, FNSCA Stephanie M. Svoboda, MS, DPT, CSCS Anna Lepeley, PhD, CSCS
After completing this chapter, you will be able to ◆ describe the physiological characteristics of the
various neurological disorders; ◆ discuss the health-related consequences for each of the special
populations with neurological disorders; ◆ explain how different neurological disorders affect the ability
to exercise, acute exercise responses, and chronic adaptation to exercise training; ◆ explain the benefits
of appropriate exercise conditioning in persons with various neurological disorders; and ◆ design
appropriate exercise programming specific to the needs of individuals with particular neurological
disorders.
Exercise Modications, Precautions, and Contraindications for Clients With Multiple Sclerosis Fatigue is a
common symptom seen in clients with MS (121). This may limit a person’s ability to exercise on a given
day. To avoid further increasing fatigue, exercise should not be performed maximally or to volitional
fatigue or failure. In addition, all exercises need to be progressed slowly. Clients with MS are very
sensitive to external and internal increases in heat (45). An increase in internal body temperature of as
little as half a degree can further complicate a demyelinated nerve’s ability to conduct an impulse (199).
Due to this sensitivity, exercise should be performed in a cool (72-76°F [22-24°C]) indoor air-conditioned
facility; exercise in the sun or any humid environment is not recommended. Sensitivity to the heat may
be further compromised by a decreased sweating response seen in some clients with MS (45). Pre- and
postexercise cooling is a good strategy for helping with the natural increase in temperature with
exercise. In addition, the client should remain well hydrated in order to further combat heat stresses.
Another concern arises when a client is experiencing an exacerbation, or are-up. Exercise should be
discontinued until the attack has completely subsided. When it is deemed safe to return to exercise, it
may be necessary to adjust the exercise prescription to match the person’s new level of ability. It is
possible for people to regain all preattack functions, but they may now also have some new symptoms.
Also, clients with MS often use wheelchairs, canes, and walkers. Persons administering exercise
programs to this population should be familiar with proper use of this equipment and proper ways of
aiding transfers. Key Point Persons with MS should always perform exercise training in well-ventilated
areas with relatively cool temperatures. Even slight increases in internal body temperature may acutely
limit nerve conduction in demyelinated nerves and over time may hasten further demyelination.
Case Study Multiple Sclerosis Mrs. F is a 46-year-old woman who was diagnosed with relapsing–
remitting MS four years ago. She works at home on the computer. She has difculty getting around the
community and recently started walking with a rolling walker that has a folding seat. She gets fatigued
easily. She wanted to do more activities outside of her home, so she enrolled at a tness center. Her
daughter hired an exercise professional to work with Mrs. F three days per week for an hour at a time.
Mrs. F’s neurologist cleared her to exercise with instructions not to exercise if she is having an
exacerbation of symptoms or if she is overly fatigued on a particular day. Mrs. F is taking disease-
modifying drugs, has a body mass index (BMI) of 32, and has prehypertension. She self-reported that
she has not exercised in years. The exercise professional started Mrs. F’s exercise sessions in a cool-
water pool. The sessions began with shallow-end water walking and deep-end water “jogging” for
Patrick L. Jacobs, PhD, CSCS,*D, FNSCA Stephanie M. Svoboda, MS, DPT, CSCS Anna Lepeley, PhD, CSCS
After completing this chapter, you will be able to ◆ describe the physiological characteristics of the
various neurological disorders; ◆ discuss the health-related consequences for each of the special
populations with neurological disorders; ◆ explain how different neurological disorders affect the ability
to exercise, acute exercise responses, and chronic adaptation to exercise training; ◆ explain the benefits
of appropriate exercise conditioning in persons with various neurological disorders; and ◆ design
appropriate exercise programming specific to the needs of individuals with particular neurological
disorders.
Exercise Modications, Precautions, and Contraindications for Clients With Multiple Sclerosis Fatigue is a
common symptom seen in clients with MS (121). This may limit a person’s ability to exercise on a given
day. To avoid further increasing fatigue, exercise should not be performed maximally or to volitional
fatigue or failure. In addition, all exercises need to be progressed slowly. Clients with MS are very
sensitive to external and internal increases in heat (45). An increase in internal body temperature of as
little as half a degree can further complicate a demyelinated nerve’s ability to conduct an impulse (199).
Due to this sensitivity, exercise should be performed in a cool (72-76°F [22-24°C]) indoor air-conditioned
facility; exercise in the sun or any humid environment is not recommended. Sensitivity to the heat may
be further compromised by a decreased sweating response seen in some clients with MS (45). Pre- and
postexercise cooling is a good strategy for helping with the natural increase in temperature with
exercise. In addition, the client should remain well hydrated in order to further combat heat stresses.
Another concern arises when a client is experiencing an exacerbation, or are-up. Exercise should be
discontinued until the attack has completely subsided. When it is deemed safe to return to exercise, it
may be necessary to adjust the exercise prescription to match the person’s new level of ability. It is
possible for people to regain all preattack functions, but they may now also have some new symptoms.
Also, clients with MS often use wheelchairs, canes, and walkers. Persons administering exercise
programs to this population should be familiar with proper use of this equipment and proper ways of
aiding transfers. Key Point Persons with MS should always perform exercise training in well-ventilated
areas with relatively cool temperatures. Even slight increases in internal body temperature may acutely
limit nerve conduction in demyelinated nerves and over time may hasten further demyelination.
Case Study Multiple Sclerosis Mrs. F is a 46-year-old woman who was diagnosed with relapsing–
remitting MS four years ago. She works at home on the computer. She has difculty getting around the
community and recently started walking with a rolling walker that has a folding seat. She gets fatigued
easily. She wanted to do more activities outside of her home, so she enrolled at a tness center. Her
daughter hired an exercise professional to work with Mrs. F three days per week for an hour at a time.
Mrs. F’s neurologist cleared her to exercise with instructions not to exercise if she is having an
exacerbation of symptoms or if she is overly fatigued on a particular day. Mrs. F is taking disease-
modifying drugs, has a body mass index (BMI) of 32, and has prehypertension. She self-reported that
she has not exercised in years. The exercise professional started Mrs. F’s exercise sessions in a cool-
water pool. The sessions began with shallow-end water walking and deep-end water “jogging” for
