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Table 2 Special considerations and precautions for exercise prescription in MS patients

From: Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations

Special considerations Precautions
Fatigue Schedule resistance training on non-endurance training days [13, 53, 54].
Spasticity Consider foot and/or hand straps for ergometers. Use machines instead of free weights [53,54,55].
Heat intolerance and reduced sweating response Encourage adequate hydration, keep room temperature between 20 and 22 ̊ C. Using of cooling fans and precooling before aerobic exercise might have positive effects on performance. It is better to plan exercise in the morning when body temperature is at the lowest [53, 54, 93].
Cognitive deficits Provide written instructions, diagrams, frequent instructions, and verbal cues [53,54,55, 94]. Exercise tasks should be initially performed with minimal resistance. Individuals with cognitive impairments may require additional supervision during exercise to ensure their safety [18].
Lack of coordination in extremities Consider using a synchronized upright or recumbent arm/leg ergometer to ensure balance and safety [53,54,55, 94].
Sensory loss and balance problems Perform all exercises preferably in a seated position; use machines or elastic bands instead of free weights [53,54,55, 94].
Higher energy cost of walking (2–3 times greater than age-matched healthy persons) Adjust workloads to maintain target heart rate and check heart rate regularly [13, 53,54,55, 94].
Daily variations in symptoms Provide close exercise supervision and make daily modifications to exercise variables [13, 53,54,55, 94].
Urinary incontinence /urgency Ensure adequate hydration, and schedule exercise in close proximity to restrooms [53,54,55, 94].
Symptom exacerbation Discontinue exercises and refer the patient to a physician. Resume exercise program.
Once symptoms are stable and the patient is medically ready to continue [13, 53,54,55,56, 94].