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Exercise as Part of Everyday Life
by Mary Harmon

booklet cover

INTRODUCTION

We hear the message everywhere: Regular, moderate physical exercise is good for body, mind, and spirit. Exercise reduces the possibility of coronary disease, lowers blood pressure, raises the good HDL cholesterol, helps to control weight, and cuts the risk of diabetes. It helps protect against stroke, osteoporosis, and certain types of cancer. And many people regularly turn to exercise to reduce stress.

But what does this mean for people like me, who live with MS? Fatigue, weakness, and lack of coordination are often everyday facts of life.

It turns out that we have extra incentives to do everything possible to stay fit. A 1996 study of people with mild to moderate disability from MS, conducted under the supervision of Jack Petajan, MD, PhD, an MS specialist at the University of Utah, demonstrated the payoffs. Regular aerobic exercise—exercise vigorous enough to raise the pulse and respiration rate—increased fitness, arm and leg strength, workout capacity, and improved the participants’ bowel and bladder control. People in the study also reported reduced depression, fatigue, and anger.

Other studies have shown that exercise can combat the loss of fitness caused by a sedentary lifestyle and be therapeutic for such MS-related problems as spasticity and poor balance.
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There’s even more: Exercise builds a reserve of muscle strength and cardiovascular function. Then, if an attack or exacerbation of MS calls for a time-out from physical activity, the reserve is available. When the symptoms subside and the person is able to go back to a more normal life, there is a better foundation on which to rebuild.

However, all benefits of exercise are short-term; that is, they fade away if exercise is discontinued. On the other hand, all exercise provides benefits. If you find you can’t do what you used to do, don’t give up. You can always modify or turn to something more feasible. Physical therapists and exercise physiologists can provide expert help.

MS isn’t a reason to sit on the sidelines
With some modifications, people at all levels of disability can enjoy the benefits of exercise. It’s easier than it may sound. Almost everyone can find some form of healthy physical activity that is appealing enough to be challenging and fun.

Some of the options include starting the day by taking a morning swim, or joining friends to walk around a shopping center or indoor track. Attending regular exercise classes, playing an adapted sport, working out with weight machines in a gym, or practicing aerobics and stretching exercises in a chair at home are still other options.
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Reluctant exercisers can expect to feel a psychological lift just from taking control of this important component of good health. Exercise can release both the “fight or flight” adrenaline hormones, which rev up body and mind for action, and the endorphins, known for their mood-elevating and painkilling power. This psychological lift promotes a sense of well-being that is so important in our lives.

Whether swimming or sailing, working out in a gym, relaxing in a yoga class, or competing at a round of golf, the revitalizing enjoyment of healthy exercise comes in many forms for people with MS.

Choose fitness that fits
Exercise need not be a prescription to be swallowed like distasteful medicine. Moderate exercise for 20 minutes or so every day yields the same benefits as rigorous sweat-and-grunt workouts. In fact, the less pain the more gain, because exercisers are more likely to stick with activities that feel good. Sticking with a program is the only way to keep the benefits rolling in.

Start by talking to your physician about the types of exercise most likely to be good for you. Then, consider your individual temperament.

Some people prefer exercise that is free from the stress of competing with opponents or keeping up with others. They might choose an activity such as swimming or walking, which doesn’t require a team or partner.
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People who have a competitive streak may find that adaptive sports or group workouts motivate them.

Exercising alone at home may not supply the motivation that a class or a group provides but this can be an ideal choice for some.

National MS Society–sponsored classes and activities tailored to people who have MS offer a comfortable environment for those who feel self-conscious when the mind says, “Action!” and a limb replies, “Not today!”

Some people find that exercising with a partner or a small group of friends supplies both incentive and flexibility. Informal groups make a commitment to swim, stretch, or work out together on a regular basis. Everyone is free from the stress of having to show up at (and pay for) a class no matter what. Recording personal progress and rewarding people who achieve goals can add to the fun.

Try several options that look personally attractive and see what fits best before making a financial commitment. Many health clubs, Ys, and recreation centers allow guests to sample facilities with a 1-day trial pass. Exercise classes may offer a single-class option, and some facilities allow pay-by-the-month trial memberships. Consumers Union recommends saving money on home exercise equipment by purchasing good secondhand models. There’s a lot of barely-used equipment for sale!

Ask your chapter of the National MS Society for referrals and recommendations.

A word on exercise books and videotapes: Those directed toward the general public are appropriate for people with MS only as a supplement to in-person instruction, preferably by a knowledgeable physical therapist. Even books and tapes geared toward people with MS are best used after first working with a professional instructor who is familiar with MS. Again, borrow or rent materials before making a purchase.

 

STARTING OUT

Please advise
MS presents some definite exercise challenges. It’s important to work within individual abilities and to stay attuned to new needs as symptoms or medications change.

Some people with MS will experience numbness, tingling, or blurred vision when they exercise. These symptoms are temporary and decline within 35 minutes of stopping. They should not cause alarm. But you may want to avoid driving yourself home alone until you are back to your baseline or know that you are not affected by this.
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While people with MS can enjoy—and succeed at—many activities, physicians, physical therapists, and fitness instructors who are knowledgeable about MS are needed for instruction and guidance on such issues as:

  • How to monitor your pulse and breathing rate and establish an appropriate target range.
  • How to pace exercise to avoid overdoing.
  • How to adapt and modify routines as MS symptoms fluctuate.
  • How to time exercise with MS medications for best results. This may be particularly important for people taking antispasticity medication.
  • How to handle symptoms including heat sensitivity, poor balance, low fatigue threshold, muscle weakness, or spasticity.
  • How to modify exercises, especially if symptoms cause a difference in strength or ability between 1 side of the body and the other.
  • How to progress to more challenging activities safely and effectively.

Realistic goals
Even the most able-bodied person can’t expect to dive into exercise and achieve immediate dramatic change. Success is accomplished by meeting a series of small goals that fit individual strengths and needs. The less rigid the program, the greater the likelihood of success.

A word of caution: Exercise may be so gratifying that it can lead to overdoing. Then comes fatigue and increased possibility of injury. Start slowly and exercise a little longer at each session. People with MS can increase their endurance just as anyone else can, but we should avoid overdoing. Studies show that exercisers with MS who work more slowly at the beginning achieve more in the end.

Consumer checklist
Along with looking for a fitness routine that fits, check these points as well:

  • Choose a location within easy traveling distance; the commute shouldn’t be a workout in itself!
  • Guard against overheated environments. Check locker room temperature and humidity. Inquire about pool temperature: the ideal is between 80 and 84 degrees.
  • Look for nonslip floors in locker rooms and around pools; grab rails in pools and shower areas; pool lifts if needed. Check sandy beaches or rough terrain that may present accessibility problems.

And safety matters!

  • Learn how to monitor your pulse and respiration and stay within your appropriate target range.
  • Always wear rubber-soled nylon or plastic water shoes or sandals on the wet floors of locker rooms and pool areas.

  • Don’t hesitate to lean against a wall or use a chair for support in stretching, yoga, or aerobics classes.
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  • When working to improve balance, have someone standing nearby for protection.

 

WARM UP AND COOL DOWN

Warm-ups start blood flowing freely to muscles and set the stage for the greatest benefits from exercise. Stretching helps ligaments, tendons, and muscles to lengthen; helps maintain flexibility and range of motion; eases muscle soreness; helps prevent injuries; and shortens the time needed to recover from injuries.

Some people find that exercise actually worsens symptoms of spasticity. This can be relieved or reduced with a gentle warm-up.

Take 5 to 8 minutes to warm up before exercise:

  • Drink juice or water before beginning.
  • While standing, move head and hips in a circular motion, several times in each direction.
  • With arms down at sides, rotate each shoulder several times as if freestyle swimming. Repeat in reverse as if swimming backstroke.
  • Lift each foot and rotate ankles several times in each direction.
  • Flex and rotate wrists several times in each direction.
  • Gently stretch the muscles that will be most used in your activity. Slowly extend the muscle just to the end of your comfortable range and hold the position while taking 5 or 6 deep full breaths in and out.
  • Deep breathing is important for building lung capacity. Remember to keep breath flowing during both warm-up and exercise periods.

And take 5 to 8 minutes to cool down at the end:

  • Cool down by repeating the activity at a gradually decreasing pace for 2 or 3 minutes.
  • Stop and gently stretch the muscles you have used, holding each stretch for 6 to 8 breaths.
  • Have a drink of water or juice.
  • Rest following exercise. Fatigue that lingers after 1 hour of rest is a sign of having overextended.
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STRATEGIES FOR HANDLING FATIGUE

  • Plan ahead. Get adequate sleep the night before engaging in sports or taking a class. Take a 15-minute nap a few hours preceding any demanding exercise.
  • Coordinate exercise with body rhythms. Schedule physical activity for the time of the day when energy is highest. Alternate more demanding exercise with activity requiring less.
  • Always talk with exercise instructors about MS before starting a new class. This will avoid embarrassment if you need to stop and rest.
  • Apply the “2 minute” rule: When feeling too sluggish for working out, commit to moderate exercise for just 2 minutes. The activity may generate the energy to continue. If fatigue persists, stop and rest.
  • Avoid exhaustion. When it looks as if energy might start to fade, a 15-minute time-out may be all that’s required to recharge. A short do-nothing mind-and-body break can be more rejuvenating than a 1-hour nap. Lie or sit with eyes closed and breathe slowly and deeply. Do nothing, except possibly listen to soothing music or repeat a comforting word, sound, or phrase such as “home” or “I am calm.”
  • Keep cool. This is wise for everyone. But people with MS have an additional issue. For many of us, heat leads to poor nerve conduction, and that means increased fatigue, as well as weakness and other MS symptoms. Vision can blur and balance can become disturbed. For those who are heat-sensitive, keeping cool is essential.

Tips for keeping cool

  • In warm weather avoid outdoor activities between 10:00 a.m. and 4:00 p.m.
  • Carry cold drinks in insulated containers that attach comfortably to a belt, waist-pack, backpack, or shoulder strap.
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  • Wear lightweight shoes. When the feet are cool, the rest of the body tends to be cool too.
  • Wear vests, hats, or kerchiefs that hold “blue ice” gel packs or materials that can be chilled for long-lasting coolness.
  • Dress in layers, in order to add or remove clothing as body temperature changes.
  • Lower body temperature immediately before and/or after exercise with a cool soak. First, sit in a bathtub of tepid water. Gradually add cooler water and soak for up to 30 minutes. This will help keep body temperature down.
  • If a bathtub is unavailable, take a cool 20-minute shower, or relax in a swimming pool if the water temperature is 80 to 84 degrees.
  • When no showers, tubs, pools, or gel packs are handy, try running cold water over your wrists for 3 to 5 minutes.
  • Use air conditioners, electric fans, or even a battery-powered, handheld mini-fan.
  • Refresh with “spritzes” of water from a plastic spray bottle—the type used for misting houseplants.
  • Limit time spent in hot, steamy locker rooms by taking your shower at home. Go to the gym wearing easy-on, easy-off clothing. After exercising, run cool water over wrists, or apply cold paper towels to neck and forehead. You may even enjoy a quick head-and-neck dunk in a sink of cool water. Then change into street clothes and leave.

 

STARTING AGAIN

Even the most dedicated and enthusiastic exercisers have lapses. Attacks or exacerbations of MS, other illnesses, injuries, travel, demands of work or family, and bad weather may put exercise on the back burner.

It may take as long as 6 weeks for strength and stamina to return to former levels after as little as 1 week of inactivity. Don’t be discouraged. This is normal, even for people who do not have MS. Muscle mass and blood volume decrease noticeably after 1 or 2 weeks of inactivity.

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When an exacerbation has interrupted an exercise routine, resume only after a doctor’s OK. And prepare to be patient. It is not unusual for an exacerbation to cause a significant decrease in fitness level and physical capacity. It may take weeks or months to determine if a loss of function is permanent or not. If regular exercise has built up a reserve of strength, it will be easier to rebuild, even if some losses prove to be permanent. If the loss is not permanent, it is even possible to exceed one’s former fitness level in time.

When beginning to exercise again, set reasonable expectations. It is rarely possible to pick up a fitness program at the point where it was when the exacerbation began. Standards that are too high—such as making a commitment to pedal an exercycle for 45 minutes a day—lead to almost certain failure. Decreasing the intensity and/or the duration of an activity is a good way to get back into a routine.

THOSE FLUCTUATING SYMPTOMS

Like rude intruders, MS symptoms show up unannounced, without consideration for personal plans. Instructors, teammates, and exercise partners should be forewarned of the possibility of last-minute cancellations. Those unfamiliar with MS may need a short description of how symptoms can come and go.

Sometimes symptoms show up that don’t call for bowing out of an activity altogether, but do require making temporary alterations. Explaining this to class instructors ahead of time helps avoid embarrassment. Discuss any limitations that your MS is posing and ask about ways the activity might be modified. Some people might also want to request that corrections be given in private after class.

Members of an exercise group will need to tell friends or teammates that MS is imposing some restrictions. Be specific. Explain, for example, that optic neuritis is making it difficult to see a ball, or that balance problems mean you will need some help to climb out of the canoe.

SPECIFIC EXERCISE OPTIONS

The aqua cool
Exercising in cool water is ideal for people with MS. Water prevents overheating, and its natural buoyancy gives support, making movement easier and enhancing endurance. (Float boards and vests can provide additional help for people who need it.)

Aqua exercise lets people with MS move in ways that their disability might not otherwise allow. Even those who don’t normally have use of their legs can perform water walking exercises, which have psychological as well as physical benefits.

A weighty idea
Exercises using free weights, fitness club weight machines, and the resistance of one’s own body are options for people with MS. Routines can be adapted to meet each person’s level of flexibility and mobility. Modifications include using lighter weights or even going through the exercise motions with no weights at all. New research shows that stretching combined with weight training can actually create strength faster than weight training alone. Moreover, strength training with weights fights osteoporosis and aids weight loss or weight maintenance.

Caution: No one should practice weight training 2 days in a row, as it creates tiny tears in the muscles that require a day to heal. However, if a full workout is too fatiguing to practice in 1 day, it is safe to do split workouts. On the first day, exercise using only the upper body. The following day, focus only on the lower body.

The stretch that relaxes
Yoga combines breathing with movements that can alternately stimulate or calm the body. Many people with muscle tightness or decreased range of motion find yoga practice brings noticeable improvement. Because yoga is relaxing and noncompetitive, it is especially recommended for people with MS. Benefits can be felt when poses are held for as little as 5 seconds, and many poses are designed to allow gravity to help stretch muscles.

The rhythmic, abdominal breathing done in yoga is also important for people with MS who may not be able to achieve deep breathing through vigorous exercise. Deep breathing aids circulation and helps maintain respiratory health, diminishing the possibility of lung infections such as pneumonia.
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Yoga can be adapted for people with MS and other disabilities, sometimes by using props such as a folded towel, cushion, or chair. Many yoga classes end with a meditation exercise that helps the mind relax, and may support physical, mental, and spiritual awareness.

An exercise system called Pilates offers many or the same benefits as yoga and is becoming popular among people with MS.

Balance and the Swiss ball
The cerebellum is a brain center associated with balance. When MS affects that part of the brain, balance is upset. Demyelination affecting nerves to other body systems—such as the eyes, ears, or major muscle groups—can impair balance as well. However, consistent practice at simple exercises can help the body’s stronger systems to compensate for the weaker ones.

Balance programs should be taught by a qualified physical therapist. The PT will start with an individual assessment to determine which systems are healthy and which are weak. The PT will then design a program of exercises, which may be as simple as standing still with eyes closed for 1 minute or standing on 1 foot for 1 minute.

Balance exercises using a Swiss ball (a 22 inches to 25 inches high inflatable ball) integrate strength, balance, and coordination. Swiss ball exercises also promote cardiovascular fitness without placing too much demand on the joints. Some Society chapters offer Swiss ball exercise programs.

Gentle martial arts
T’ai chi is an ancient Chinese discipline. Although it is called a martial art, it is comprised of a series of movements that resemble ballet in slow motion. It can help improve or maintain strength, flexibility, and balance, and may boost aerobic capacity as well. T’ai chi is favored by many people with MS as a gentle exercise that works all the limbs and muscles without wear and tear on joints. Like yoga, it is noncompetitive and encourages a meditative mental state.

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In addition to t’ai chi, other martial arts such as karate, aikido, qigong, and kung fu can be modified by professional instructors so that people with MS can enjoy their benefits.

Aerobics
Technically, aerobic means any exercise vigorous enough to raise the pulse and respiration rate. However, we tend to think of aerobic exercise as running, dancing, a workout on a bike, or a sequence of fast-paced exercises. Fifteen minutes of aerobic exercise is considered ideal. The good news is that people who tire easily can do aerobic exercise in 3 separate 5-minute periods, with rests in between, and still attain all the benefits.

Adjustable-speed treadmills offer the benefits of walking in a comfortable environment. Striding in an air-conditioned room while grasping handrails overcomes the challenges of outdoor heat and humidity, uneven paths, and uphill climbs.

Other types of equipment used to exercise the lower body include stair steppers, stationary bicycles, and cross-country ski machines. Recumbant bikes and exercycles work both arms and legs. If equipment for exercising the lower body only is uncomfortable or impossible, ask about equipment for the upper body only—and always learn how to adjust any equipment you use to fit your specific needs and limits.

 

PLAY AROUND AT FITNESS

When exercise happens naturally, as a by-product of an enjoyable sport, a relaxing game, or a hobby, the physical and psychological benefits come as easily as the fun.

Adaptive sports
Adaptive sports with modified equipment and/or rules allow people with disabilities to participate in basketball, handball, tennis, and golf. The modified rules for tennis, for example, allow the ball to bounce 2 times instead of once before the player takes a swing. The United States Golf Association has approved modified rules for golfers with disabilities, and customized golf clubs are available for people who play from wheelchairs or carts.

Boating sports such as sailing, paddling, rowing, and rafting are exercise as well as recreation. Benefits include periodic rests while other crew members continue the work, readily available water for a refreshing splash, and cooling breezes as the vessel moves across the water.
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Therapeutic horseback riding promotes balance, coordination, and strength. It stretches spastic muscles and improves posture. Participants report having such a good time they forget that it’s therapeutic.

Other moves, too
Even activities not normally classified as sports can render the physical and psychological benefits of exercise. Dancing, gardening, housework, even playing with pets can lead to fitness.

Some people incorporate stretching exercises into everyday life. During meetings, they practice unobtrusive routines such as pressing feet firmly against shoe insoles with a rhythmic beat or firmly pressing hands on a table or desk and then releasing without lifting.

Stretching can and should be incorporated into many everyday routines. Desk workers—or anyone who spends most of the day sitting—should stretch up and reach for the ceiling every hour or so.

When reading a book or talking on the telephone, rotate wrists and ankles and stretch out arms and legs. Many stretching exercises can be performed while watching the evening news.

Information about adaptive sports
The National MS Society can provide local referrals to private and group instruction in a wide variety of sports activities modified for people with MS. Additional resources include:

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  • The Heuga Center, 27 Main Street, Suite 303, Edwards, CO 81632; 1-800-367-3101. Web site: www.heuga.org. The Heuga Center is a nonprofit organization that runs a variety of helpful wellness programs for people with MS.
   
  • The National Sports Center for the Disabled (NSCD), P.O. Box 1290, Winter Park, CO 80482; 970-726-1540. E-mail: info@nscd.org. Web site: www.nscd.org. The NSCD is a nonprofit corporation that offers winter and summer recreation. Winter sports include snow skiing, snowshoeing, and cross-country skiing. Summer recreation activities include fishing, hiking, rock climbing, whitewater rafting, camping, mountain biking, sailing, therapeutic horseback riding, and a baseball camp.
  • Adventures Within, Inc., 1250 South Ogden Street, Denver, CO 80210; 303-744-8313. E-mail: adwithin@aol.com. Web site: www.adventureswithin.org. This nonprofit organization specializes in providing safe “Outward Bound West” adventures tailored to the many different abilities and skill levels of people with MS.

 

THE BOTTOM LINE: ENJOY THE PROCESS

Just as the effects of MS vary from person to person, so the benefits of exercise show up in different ways and at different rates for each individual. Take it slowly. Exercise is not a battle with the body to overcome spasticity, weakness, or any other MS symptom. Instead, it’s an opportunity to do everything possible for good health. And to have fun!
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For additional information
 Food for Thought: MS and Nutrition
 Healthy Living with MS
 Managing MS Through Rehabilitation
 Taming Stress in Multiple Sclerosis
 
 
 

Mary Harmon is a freelance writer who has been living with MS since 1988. Her favorite sport is kayaking.

Cover photograph: Nancy Chamberlayne, MEd, a volunteer telephone counselor for the British Columbia MS Society, and a self-proclaimed “exercise junkie”. Photograph by Gary Neilson.

Other photos courtesy of Jeanine Schmitz (hiker), Tamar Sherman (wheelchair hiker), and the following chapters of the National MS Society: Desert Southwest (aqua exercise class), Greater Delaware Valley (women in a Pilates class), South Florida (Tai chi class), Upstate New York (couple boating; adapted bowling).

This publication is supported by contributions to the National Multiple Sclerosis Society from its members and friends.

Reviewed by the Client Education Committee of the National Multiple Sclerosis Society’s Medical Advisory Board.

 
     
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