Exercise Training Among Wheelchair Users with Multiple Sclerosis: Benefits, Safety, and Prescription

Exercise training is a promising second-line treatment approach for wheelchair users with multiple sclerosis (MS), given the limited options for medical management of MS. The aim of the current chapter is to summarize the benefits and safety of exercise training and provide recommendations for the prescription and promotion of exercise among wheelchair users with MS. Benefits of exercise training among wheelchair users with MS may include improvement in MS symptoms such as mobility and fatigue as well as increases in strength and balance that can aid in fall prevention. Safety considerations for exercise training among wheelchair users with MS include heat sensitivity or intolerance and accessibility that can be addressed with appropriate environmental adaptations. Measurement of physical activity remains a challenge for wheelchair users with MS with a reliance on adapted self-report measures or device-measures that have not been widely validated. However, progress has been made in guidelines for exercise training in this population with three options outlined within this chapter that provide a base for exercise training prescriptions. Rigorous measurement of fitness among wheelchair users with MS to guide individualized exercise prescription is most appropriately conducted using a recumbent stepper or cycle ergometer. The key to the promotion of exercise training among wheelchair users with MS is development of evidence-based behavioral interventions. Within the chapter a recent three-step, community-engaged research agenda for creating an adapted exercise training program for wheelchair users with MS is outlined as the newest vision of a complete program. Future directions in this area of research include continued community engagement to support uptake of programs broadly in the future and measurement of relevant outcomes (e.g., MS symptoms and metabolic health) to improve quality of life among persons living with MS.