Written By: Dr. Irina Fedulow Plante, PT and Board Certified Neurologic Clinical Specialist

Multiple Sclerosis (MS) is an autoimmune disease where healthy cells attack the myelin sheath(cushioning for the nerves) resulting in inflammation throughout the nervous system. 2 MS is characterized by exacerbations (active disease state resulting in lesions throughout the brain and spinal cord) and remission (inactive disease state with scarring as a result from the exacerbations). There are different classifications depending on the presentation of exacerbations and remissions. Symptoms vary greatly ranging from weakness, muscle tone changes, visual issues, bowel and bladder problems, pain, cognitive changes, sensory issues such as numbness and tingling among other symptoms.

MS is more common in women (4 to 1) and is often diagnosed during childbearing years (20-40’s). 2 Many individuals with MS report symptom onset years prior to receiving a formal diagnosis, but may get delayed attention due to thinking the symptoms are nothing serious or gaps within the medical system. Research has come a long way with a better understanding of MS, so with medical management and lifestyle changes, many can optimize their quality of life with reduced severity of inflammation and symptoms.

Research continues to show that getting outdoors and being immersed in nature has numerous neurological benefits, including reduced inflammation, improved resilience and sleep quality, enhanced body awareness, decreased pain and many more. 1 For individuals with a neurologic presentation, although the idea sounds incredibly appealing, many have a fear of falling or sustaining an injury in a more unpredictable outdoor environment. However, with the right tools, preparation, education and support, individuals with MS can safely enjoy the great outdoors.

Here are some tips to get started if you have MS and want to get outdoors more often. This information is not a substitute for medical advice, so always speak to your medical provider before engaging in more outdoor activities or using the strategies below.

1. Do your research on where you want to explore. Make sure to start with flatter terrain, shorter distances and check if the park can accommodate assistive devices or equipment. You can check out alltrails.com to look at the characteristics of a trail or park you’re interested in. You can also contact the park ranger’s office and ask about what services and accommodations are available in the area.

2. Make sure to not overheat. Increased body temperature often exacerbates symptoms relate to MS. Wear breathable light clothing with layers, bring lots of water and check for shaded areas for a break. Bring cooling agents such as a cooling neck scarf, ice packs or water spray. In addition, eat foods rich in water such as berries, watermelon and cucumbers bring along with protein-rich snacks to sustain energy during your adventure. Check weather conditions frequently.

3. Start slow and don’t overdo it. Getting out in nature can bring on a lot of excitement, distraction or pressure to keep up with others, so take breaks to check in with yourself. If you start to feel fatigued or experience an increased severity of symptoms, take a rest break and do some light stretching or something that makes you feel better. If needed, go back to your car, tent or cabin to recuperate. Try to schedule some rest hours every day if possible. As you get started, try not to create lofty goals or go into areas with limited access for help, dangerous terrain or far away from your site.

4. Wear sturdy hiking shoes. Many individuals with MS have muscle weakness, especially in the feet, so stability is key. Make sure the shoes you purchase are stable, have breathable material and are not overly heavy. A few great brands to look at are Salomon, Merrell and Hoka. Go the store and try them on to see what works best for you.

5. Prepare yourself physically. It’s important to have an exercise routine that incorporates all the fitness principles including strength, balance, aerobic and flexibility (see the next point for more detail). Be sure to progress gradually and train for the activity you want to achieve. Have a back-up plan for fatigue - using hiking poles, a lightweight wheelchair or an ankle-foot orthosis depending on the amount of support you require. Pack a lightweight camping chair, too. Lastly, seek out the guidance of a physical therapist who treats individuals with MS who can help merge your goals with getting outdoors and optimizing your overall function.

6. Focus on exercises and activities that parallel to the outdoors. Some examples include practice walking on uneven surfaces, performing exercises with your eyes open and closed, learning about muscle tension releasing techniques and fine motor tasks for outdoor cooking, pitching a tent or tying up shoes with thin laces. Practice these only with the supervision and clearance from your medical provider.

Lastly, have fun while outdoors and give yourself grace and compassion if things don’t go as you anticipated. Each experience in nature is an opportunity to grow, adapt and problem solve. MS is often called the “snowflake disease” because every individual has a different presentation, so do the exercises and activities that feel right for you. Make sure to obtain the support you need from friends, family, healthcare providers and the community to safely embark in nature depending on your activity levels and medical history.

References:

1. Bennett et al. The Heath Benefits of the Great Outdoors: A Systematic Review and Meta-Analysis of Greenspace Exposure and Health Outcomes. Environ Res 2018

2. https://www.nationalmssociety.org