Fitness Testing for Multiple Sclerosis

For individuals with MS, VO₂ max testing measures:

• Aerobic Capacity (VO₂ Max):
  • • Overall cardiovascular fitness level
  • • Typically 20 to 30% lower in MS compared to age-matched controls (due to deconditioning, not necessarily disease)
  • • Can improve with consistent aerobic training!
• Exercise Tolerance & Endurance:
  • • How well your cardiovascular system responds to increasing intensity
  • • Identifies your sustainable exercise capacity
  • • Important for pacing daily activities
• Fatigue Threshold (VT1):
  • • Critical for MS: The intensity where fatigue starts accumulating
  • • Training BELOW this intensity = minimal fatigue, maximum benefit
  • • Exceeding this too often = post-exertional fatigue
  • • This is THE most important zone for MS!
• Safe Exercise Intensity:
  • • Personalized heart rate zones for training
  • • Know what "moderate" intensity means for YOUR body
  • • Avoid under-exercising (not getting benefits) or over-exercising (triggering fatigue)
• Baseline for Progress Tracking:
  • • Starting point before beginning exercise program
  • • Retest every 6 to 12 months to track improvements
  • • Objective proof that exercise is working
  • • Motivational tool

Heat sensitivity (Uhthoff's phenomenon) is common in MS. We accommodate this:

• Testing Environment:
  • • Natural ventilation from ocean breeze near San Lorenzo River
  • • Fans available for cooling during test
  • • Temperature monitoring throughout
• Timing Recommendations:
  • • Best: Morning appointments (cooler, fresher energy)
  • • Evening appointments available
  • • Avoid mid-day testing during warm months
  • • Test on cooler days if heat-sensitive
• Pre-Cooling Strategies:
  • • Arrive well-hydrated and cool
  • • Bring cooling towels or neck wraps if helpful
  • • Allow time to acclimate to testing environment
• During Test:
  • • Stop immediately if heat-related symptoms occur (vision changes, increased weakness, numbness)
  • • We monitor for signs of overheating
  • • Fan cooling throughout test
  • • You control the test-can stop anytime
• Post-Test Recovery:
  • • Extended cool-down period
  • • Rest area available
  • • Allow time before driving if needed

Important: If you experience significant heat sensitivity or pseudo-exacerbations from temperature, discuss testing timing and feasibility with your neurologist.

MS-related fatigue is different from exercise fatigue. We accommodate:

• Timing:
  • • Test at your best time of day (when energy is highest)
  • • Avoid testing on days after poor sleep
  • • Schedule with recovery days before and after
  • • Flexible rescheduling if experiencing a fatigue flare
• Modified Protocols:
  • • Slower ramp protocols if needed (longer stages, gentler increases)
  • • Extra rest breaks during setup
  • • Allow extra time (60 to 90 minutes vs. standard 45 to 60 minutes)
  • • You determine when to stop-no pressure to reach max effort if fatigued
• Energy Conservation:
  • • Minimize physical exertion before test (don't walk far, use accessible parking)
  • • Arrive rested and hydrated
  • • Rest area available before and after

We offer multiple equipment options based on your abilities and symptoms:

• Stationary Bike (Most Common for MS):
  • • Wahoo KICKR Bike: Fully adjustable, stable, no balance required
  • • Good for those with balance concerns, gait issues, or leg weakness
  • • Seated position reduces fatigue
  • • Lower heat generation than running
• Recumbent Bike:
  • • Back support, comfortable seated position
  • • Good if standard bike seat is uncomfortable
  • • Minimal core/trunk demands
• Treadmill:
  • • Option if walking is safe and stable
  • • Self-powered treadmill (you control speed)
  • • Support bars available
  • • Not recommended if: Significant balance issues, gait instability, frequent falls
• Rower:
  • • Full-body exercise option
  • • Seated, stable
  • • Good upper and lower body engagement
• We Discuss Best Option With You:
  • • Based on your mobility, balance, symptoms
  • • What you're most comfortable with
  • • What matches your exercise goals

Exercise recommendations vary by MS type and symptom severity:

• Relapsing-Remitting MS (RRMS):
  • • Most common type (~85% of initial diagnoses)
  • • Exercise during remission periods (stable symptoms)
  • • May modify or pause intense exercise during relapses
  • • Generally good candidates for VO₂ max testing
• Secondary Progressive MS (SPMS):
  • • Gradual worsening after initial RRMS
  • • Exercise still beneficial for function and quality of life
  • • May need more modifications (equipment choice, protocol)
  • • Focus on maintaining function rather than improving performance
• Primary Progressive MS (PPMS):
  • • Gradual worsening from onset (~10 to 15% of cases)
  • • Exercise important for slowing functional decline
  • • Testing helps establish safe, sustainable intensities
  • • Emphasize functional exercise and quality of life

Testing is appropriate for all MS types with medical clearance. Discuss with your neurologist based on symptom severity and stability.

Many individuals with MS participate in exercise programs:

• Aerobic Exercise (Zone 2 Focus):
  • • Walking, cycling, swimming, aquatic exercise
  • • Frequency: 2 to 3× per week (build up gradually)
  • • Duration: 10 to 30 minutes (start low, progress slowly)
  • • Intensity: Moderate (Zone 2-identified by testing!)
• Resistance/Strength Training:
  • • 2× per week, all major muscle groups
  • • Helps maintain muscle mass, strength, bone density
  • • Important for mobility and fall prevention
• Balance & Flexibility:
  • • Yoga, tai chi, balance exercises
  • • Reduces fall risk
  • • Improves coordination and proprioception
• MS-Specific Programs:
  • • Physical therapy with neurological specialists
  • • Aquatic therapy (heat management, low-impact)
  • • MS fitness classes (group support)
  • • Adaptive sports programs

VO₂ max testing helps determine appropriate intensity for these activities and tracks improvements over time.

VO₂ max testing should be integrated into your comprehensive MS care:

• Before Testing:
  • • Discuss with neurologist (required medical clearance)
  • • Confirm cardiovascular health (MS increases cardiovascular risk)
  • • Discuss heat sensitivity and symptom management
  • • Ensure symptom stability (not during active relapse)
• Using Test Results:
  • • Share results with physical therapist or exercise physiologist
  • • Use data to inform exercise prescription
  • • Set appropriate intensity targets (especially VT1/Zone 2 ceiling)
  • • Adjust exercise program to avoid fatigue-inducing intensities
• Retesting:
  • • Consider retesting every 6 to 12 months
  • • Track changes in aerobic capacity
  • • Adjust zones as fitness improves
  • • Monitor for declines (may indicate need to modify training)

Safety is our top priority. Before scheduling testing:

• Required:
  • • Medical clearance from your physician (required)
  • • Discuss with neurologist first
  • • Cardiovascular clearance if any heart conditions
• Inform Us Of:
  • • MS type and current symptom severity
  • • Medications (especially if affect heart rate or blood pressure)
  • • Heat sensitivity and past pseudo-exacerbations
  • • Mobility limitations, balance concerns, gait issues
  • • Fatigue patterns and best time of day
  • • Recent relapses or symptom changes
• When NOT to Test:
  • • During active relapse or significant symptom flare
  • • Severe heat sensitivity without adequate cooling
  • • Significant cardiovascular concerns not cleared by physician
  • • Severe fatigue preventing any exertion
• We Can Stop at Any Time:
  • • You control the test-stop whenever uncomfortable
  • • We monitor heart rate, breathing, and overall condition
  • • Safety always prioritized over data collection

Test day overview (with MS accommodations):

• Duration: 60 to 90 minutes (allowing extra time for comfort, rest, cooling)
• Process:
  • • Setup (15 to 20 min): Medical history, equipment choice, heart rate monitor, acclimation
  • • Warm-up (5 min): Easy effort to acclimate and assess response
  • • Graded test (8 to 15 min): Intensity increases gradually. You decide when to stop.
  • • Cool-down (10 min): Extended cooling, recovery monitoring
  • • Rest/Recovery (as needed): Time to cool down, rehydrate, recover before leaving
  • • Results discussion (15 min): Same-day analysis, Zone 2 emphasis, recommendations
• Breathing:
  • • Breathe into mouthpiece with nose clip
  • • Measures oxygen consumption and CO₂ production
  • • Challenging but not painful

VO₂ Max Test: $250

60 to 90 minutes. Includes full report with heart rate zones (especially VT1/Zone 2 ceiling), aerobic capacity, and MS-specific exercise recommendations. Medical clearance required.

RMR Test: $75

Optional add-on for nutrition planning. Useful if managing weight, muscle loss, or optimizing fueling for exercise.

Insurance: Not typically covered, but you can submit for out-of-network reimbursement. We provide detailed receipts.

Fit Evaluations
311 Soquel Ave
Santa Cruz, CA 95062

Finding Us: Downtown Santa Cruz behind Hindquarter restaurant (second entrance off Dakota St.). Accessible parking available. Natural ventilation from nearby San Lorenzo River and ocean breeze.

Contact:
Phone: 831-400-9227
Email: info@fitevals.com

What to Bring: Medical clearance from neurologist, medication list, comfortable athletic clothing and shoes, water bottle, cooling towel if desired, any mobility aids you normally use, caregiver/support person welcome.

VO₂ max testing is a tool for tracking fitness-not a medical treatment:

• • We measure cardiovascular fitness, not MS disease activity or progression
• • Testing does not diagnose, treat, or cure Multiple Sclerosis
• • Always work closely with your neurologist, physical therapist, and healthcare providers
• • Continue all prescribed disease-modifying therapies
• • Use test results to inform exercise programming (with medical guidance)
• • If you have questions about appropriateness, discuss with your medical team first