MS Healthy Living Series - Physical Activity, Exercise and MS
Content
Physical Activity, Exercise and MS
MS SERVICES – HEALTHY LIVING SERIES
Why be physically active? Physical activity includes any body movement that results in energy expenditure. This includes any leisure time or recreation physical activity, transportation (e.g walking or cycling), occupational (e.g work), household chores or playing games in the context of daily family and community activities. Exercise relates to any structured or planned activity above and beyond your usual daily activities.
The benefits of participating in regular exercise and physical activity for people with MS are many and varied. There is an increasing body of research that supports regular, sensible exercise as a strategy to help in the long term management of MS and improve symptoms such as fatigue, weakness, pain, in-coordination, balance difficulties and depression. Research shows that
many people with MS can improve their fitness to similar levels as those without MS. In addition, regular exercise and physical activity can: Help prevent high blood pressure, stroke, heart disease, improve circulation and optimise heart and lung function. Reduce the risk of developing type II diabetes and some cancers. Assist in maintaining a healthy weight. Help maintain healthy bones and joints and increase muscle strength, endurance, coordination and balance. Promote psychological well being, improve quality of sleep and restore alertness.
How much exercise should I be doing? A regular exercise program including aerobic, resistance, balance and flexibility exercises is recommended beyond activities of daily living to improve and maintain health and physical fitness. It is recommended that:
Adults should accumulate at least 150 minutes of moderate-intensity aerobic exercise throughout the week OR accumulate at least 75 minutes of vigorousintensity aerobic exercise throughout the week OR an equivalent combination of moderate and vigorous exercise. This is the minimum recommendation and additional health benefits may be reached with increased exercise levels.
Aerobic activity can be broken down into smaller bouts of activity, with a minimum of 10 minutes in duration. Muscle strengthening activities should be included on 2 or more days per week, involving the major muscle groups. Adults with poor mobility should perform neuromotor exercises (see below for more information) to enhance balance and prevent falls on 3 or more days per week.
Flexibility exercises should be included for the major muscle groups on 2 days per week to maintain joint range of movement. When adults are unable to meet the recommended amounts of exercise due to health conditions, they should be as physically active as their condition and ability allows.
For those who are currently physically inactive, participating in exercise levels below the recommendations can still provide some health benefits and symptom management of MS. It is encouraged to start slowly and gradually progress to higher levels of exercise and physical activity.
The total time spent doing sedentary activities (sitting watching TV, using computer, seated at work) should be minimised and aim to include short bouts of physical activity or standing time during these activities, irrespective of exercise levels.
What is Aerobic Exercise? Aerobic exercise is the type of exercise you need to make your heart, lungs and blood vessels work more efficiently. walking, swimming or cycling. Aerobic exercise has to be done at a certain level (intensity), so that you breathe harder and faster than at rest but without overdoing it. A good guide is that during moderate intensity exercise you are puffing, but still able to keep talking. The 10 Aerobic activities include things like brisk
point Borg scale (see below) has been designed to measure rating of perceived effort and is a valuable tool for gauging intensity of aerobic exercise. A light to moderate intensity aerobic exercise program is recommended for people with MS (24 on Borg scale). An exercise program should be tailored to each individual according to their current level of fitness, MS symptoms and of course your interests! physiotherapist or exercise physiologist if you are unsure. Borg 10 Point Scale Talk to your
What is Strength Training? Strength training is important to improve the ability of the muscle to contract, coordinate movements, utilise energy sources and maintain independence. Research shows that many people with MS have the same ability to improve their muscle strength and control as people without MS. MS does not directly affect the muscles, they weaken because the nerves are unable to get the message down to activate them fully. This can result in people with MS decreasing their levels of activity, leading to further weakening and disuse of the muscles and worsening fatigue. Keeping the muscles in their own right fit and strong helps prevent or break the disuse, weakness cycle.
You may wish to go to a gym and have a gym assessment for your strength program. Alternatively you can start at home with some hand and leg weights, Many strength
resistance band or using your own body weight as resistance.
exercises can be interspersed with general activities; you can even do them in front of the TV or during a coffee break! A physiotherapist, exercise physiologist or experienced personal trainer can help set you up with a home program or gym program.
Handout H01 CS PT Information for Personal Trainers and Gym Instructors may be a useful reference.
What is Flexibility and Stretching? Movement required for daily activities such as walking, getting out of a chair, getting dressed and sitting with good posture can become difficult if joints become stiff and muscles become tight. Stretching is important to help maintain the range of motion around your joints and has also been shown to help with controlling spasms/cramps and pain associated with MS.
What is Neuromotor Exercise Training Neuromotor exercise training incorporates motor skills such as coordination, balance, agility, and gait and has been shown to improve balance, strength, agility and reduce the risk of falls. This is type of training is especially important for people with MS who have balance and gait difficulties or a history of falls. Tai Chi has been shown to be an effective way to include neuromotor exercises into your training program.
Other exercise options (Aquatic Exercise, Yoga, Tai Chi, Pilates, Chi Ball) When planning your exercise program there are other forms of exercise that may be of interest to you and have also been shown to provide health benefits. Aquatic Exercise: The aim of aquatic exercise is for clients to improve or maintain their joint mobility, muscle strength, balance and general well-being by performing exercises in water independently or within a group. The warmth of the pool can help to relax tight muscles and the water buoyancy can make exercise much easier for people who have muscle weakness. Many people feel more confident exercising in
water than on land because the water helps to maintain balance. Physiotherapists can provide an aquatic exercise program that is tailored to meet specific needs and physical abilities. Refer to INFO30 CS Healthy Living Series - Aquatic Exercise for more information. Yoga: Yoga includes gentle stretching, sequences, postures, breathing techniques, relaxation and meditation. The classical postures of yoga may be modified and adapted to suit individual needs. Yoga helps to relieve stress, encourages better breathing, aids sleep and may help balance. It also increases flexibility, concentration and can help to combat fatigue, and increase a feeling of well being. Refer to INFO29 CS Healthy Living Series - Yoga for People with MS for more information. Tai Chi: Tai Chi involves a series of circular and rhythmic movements performed slowly in a sequence to music. Tai Chi has been shown to help improve balance, strength, mental alertness and reduce pain and stiffness. Pilates: Pilates includes a range of low impact, gentle exercises targeting core and postural muscles designed to improve flexibility, strength and assist in the correction of poor movement patterns. Pilates exercises range in difficulty from beginner to advanced and can be adapted to suit each individual. Chi Ball: A structured class that combines Yoga, Tai Chi, Pilates and meditation exercises using a small ball as a focus for movement. Exercises can be modified for various ability levels.
Things to consider prior to commencing an exercise program Prior to commencing an exercise program there are a few things you should consider: 1. What type of exercise would I like to do (walking, cycling, group exercise class etc)? 2. Would I prefer to exercise on my own, in a group, with a friend? 3. Where are the services offered, when are they open and how much do they cost? 4. What time of day is best for me, what days of the week am I going to exercise and am I going to do 30 minutes continuous exercise or break this up into smaller bouts?
5. Am I confident to get started on my own or would I like an individualised exercise program set up by an experienced health professional?
Getting started with your exercise program It is important to start at a slow rate and increase your physical activity and exercise levels gradually. Too much too soon can lead to injury and giving up as it is too hard and causes distress! Remember to warm up beforehand. Warm up includes getting into the activity slowly for a few minutes and then gradually building intensity. Cool down at the end of the exercise regime. Cool down includes slowing down the activity to keep blood pumping through the muscles to cool them down and finishing with stretching exercises. You can complete aerobic, strength and flexibility exercises all in the same session or split them up into different sessions, the choice is yours!
Aerobic Exercise: It is recommended for MS that you build towards a minimum of 150 minutes of light to moderate aerobic exercise accumulated throughout the week. Additional benefits will be gained from additional activity. You can start as low as 2 – 5 minutes and slowly increase by 1-2 minutes each week, building towards 30 minutes continuous, or 2 – 3 sessions of shorter exercise periods (10-15 mins). Work at a light to moderate intensity (2-4 on the Borg scale). You should be puffing but still able to hold a conversation. A good indicator that you are not working too hard is that you are able to speak in short sentences whilst exercising. If you cannot speak due to breathlessness then you are working too hard. You will note that as your fitness increases you will need to work harder to get your heart rate up and work at the desired level. Adjust work levels accordingly. Find something you enjoy and if you like variety, mix it up with walking, cycling, swimming and even boxing.
Strength Training: It is recommended for MS that you complete 1-3 sets of 8-15 repetitions for each of the major muscle groups. As your muscles strengthen and enlarge, the resistance of the exercise needs to be progressively increased for further strength gains to occur. A rest period of 48 to 72 hours between strength sessions is recommended to optimise associated gains in muscle strength. Choose 6-8 exercises including a range of upper body, lower body and core stability exercises. Warm up for a couple of minutes with some general movements (i.e. marching on spot, swinging arms etc.) prior to commencing your strength training. To select the correct weight start low and progress as needed. You should be able to complete 8-15 repetitions at a given weight. During the last 2-3 repetitions you should find the exercise difficult, but not impossible to complete without compensating or cheating. Once you can achieve 2-3 sets of 15 repetitions easily you may progress to a heavier weight. When you increase your weight you may need to reduce your repetitions to 8-10 to maintain good form. Make sure you rest for 1-2 minutes between sets. When lifting a weight it is important to BREATHE. Breathe OUT as you lift or pull and breathe IN as you relax.
Flexibility Exercise: It is recommended that flexibility exercises be performed at least 2-3 days per week, with additional benefits in joint range of motion occurring with daily flexibility exercises. Stretches are best done when your body is warm – i.e. just after warm up and cool down. Hold each stretch for 10-30 seconds in duration when you feel tension in the muscle but not pain. Stretches should be repeated 2-4 times, aiming for 60 seconds of total stretch time.
Never bounce! This can cause tiny tears in your muscles and make them stiff and sore. It may also encourage spasms.
Neuromotor Exercise Training It is recommended that adults with poor mobility should perform neuromotor exercises to enhance balance and prevent falls on 3 or more days per week. Balance, coordination and agility exercises need to be completed in a suitable, safe environment so make sure you have something sturdy to hold onto if you start to lose your balance. Avoid practicing these exercises when you are fatigued. Neuromotor exercise training will be most effective when individually tailored according to your current level of fitness, balance and MS symptoms. Talk to your physiotherapist or exercise physiologist for assistance.
Exercise considerations for MS 1. It is important to minimise your body temperature as any increase can result in a temporary increase in physical MS symptoms and fatigue. Strategies to assist in minimising body temperature include: Exercise in the cool part of the day or in a cool environment. Exercise at reduced intensity or with regular breaks. Wear loose and light clothing, preferably cotton. Wear a cooling vest or wet cloth wrapped around the wrist or neck. Drink water ½ to 1 hour before commencing exercise. Keep well hydrated during and after exercise. Exercise in a well ventilated or air conditioned area. increase but in most cases disappear by 20 – 30 minutes after exercise. 3. Do not exercise if feverish or feeling unwell. 4. Consult the doctor before exercising if having a relapse. 5. To help manage fatigue, alternate between upper and lower body exercises and take rest breaks as needed.
2. Sensory symptoms (pins and needles, numbness, blurred vision) may
IMPORTANT NOTE: It is important you give yourself a chance to rest in between and after exercise! This allows the systems to recover and you will be able to continue functioning without undue fatigue! Refer to INFO09 CS Balancing Exercise and Fatigue for more information.
Other things to remember 1. Wear loose comfortable clothes and supportive shoes. 2. Empty your bladder prior to exercising. 3. Wait at least 1 – 1½ hours after eating before exercising. 4. If you stop exercising for any period of time you will need to recommence at a lower level. 5. You should always start your exercise session with a warm up and finish with a cool down. 6. Exercise should result in muscular discomfort but not pain. If you start experiencing pain it is recommended that you cease your exercise program and seek medical advice.
Tips for Getting Started and Maintaining Motivation 1. Find an activity and time of day that suits you. 2. Set a goal and work towards it. Start with short term goals and make them realistic, e.g. set the goal of walking 3 days per week. Even if you only walk for 5-10 minutes you have still met your goal. Well done Reward yourself with something you enjoy (not always food!) when you achieve your goals, e.g. go to a movie, buy your favourite magazine or a new piece of clothing, have a massage. 3. Start out slowly. 4. Record your progress Keep a physical activity/exercise record (see below for ideas) Review your diary frequently (at the end of each week/month) and reward success. If you haven’t met your goals think about ways to improve and set new goals.
If you didn’t reach your goals it’s ok! It often takes time to become regularly active. Have another go!
Week or day 1 2
Best time of Day 5.30pm 5.30pm
Activity Chosen Walking Walking
Goal Set (how long, how often) 10 min- Mon, Wed, Fri 15 min- Mon, Wed, Fri
Reward Planned Magazine -
Achieved (yes/no) Yes Yes on Mon and Fri. Sick on Wed Yes Yes
3 4
5.30pm 7am, 5.30pm
Walking Walking, Aqua Aerobics
15 min, Mon, Wed, Fri 15 min Movie walking Mon, Wed, Fri and Aqua Aerobics on Tuesday
5. Manage setbacks appropriately Once you start to exercise regularly you may find things come up that interrupt your routine. That’s normal. The key is view these setbacks as temporary and return to your program as soon as possible. It is a good time to review your goals and exercise program and see if any changes need to be made. E.g. try a new activity if you are facing boredom, try exercising with a friend / family member with similar ability, review the time that you are exercising – is it practical?
Remember: Eating well is important to good health and increasing exercise and physical activity levels. Refer to INFO43 CS Healthy Living Series Diet for more information. For more information or if you would like individualised exercise program from a physiotherapist or exercise physiologist please contact the MS Society.
INFO34 CS MS Healthy Living – Exercise for People with MS Last updated: October 2012 (Tracey Grosser, Exercise Physiologist, Health Solutions) MS House, 110 Reservoir Road, MODBURY SA 5092 Ph: 8396 0044 Email: [email protected] Fax 396 0184 Website www.ms.asn.au Toll free 1800 812 311
Further Information INFO30 CS Healthy Living Series - Aquatic Exercise INFO29 CS Healthy Living Series - Yoga for People with MS INFO09 CS Balancing Exercise and Fatigue INFO43 CS Healthy Living Series Diet H01 CS PT Information for Personal Trainers and Gym Instructors
References Global Recommendations for Physical Activity and Health, World Health Organization, 2010. http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf
Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidelines For Prescribing Exercise, American College of Sports Medicine, 2011. Be Active: Walk yourself Happy – Getting Started booklet http://www.sahealth.sa.gov.au/wps/wcm/connect/de0ef5004cde47c2800a90a49 6684d9f/beactive+booklet-Public+Health-HPB20120914.pdf?MOD=AJPERES&CACHEID=de0ef5004cde47c2800a90a496684 d9f
Getting Ready for Action, Lifestyle Management Team, MS Society of NSW, 2003.
MS Practice//For Health Professionals: Strength and cardiorespiratory exercise for people with Multiple Sclerosis, MS Australia, June 2009. www.msaustralia.org.au
MS SERVICES – HEALTHY LIVING SERIES
Why be physically active? Physical activity includes any body movement that results in energy expenditure. This includes any leisure time or recreation physical activity, transportation (e.g walking or cycling), occupational (e.g work), household chores or playing games in the context of daily family and community activities. Exercise relates to any structured or planned activity above and beyond your usual daily activities.
The benefits of participating in regular exercise and physical activity for people with MS are many and varied. There is an increasing body of research that supports regular, sensible exercise as a strategy to help in the long term management of MS and improve symptoms such as fatigue, weakness, pain, in-coordination, balance difficulties and depression. Research shows that
many people with MS can improve their fitness to similar levels as those without MS. In addition, regular exercise and physical activity can: Help prevent high blood pressure, stroke, heart disease, improve circulation and optimise heart and lung function. Reduce the risk of developing type II diabetes and some cancers. Assist in maintaining a healthy weight. Help maintain healthy bones and joints and increase muscle strength, endurance, coordination and balance. Promote psychological well being, improve quality of sleep and restore alertness.
How much exercise should I be doing? A regular exercise program including aerobic, resistance, balance and flexibility exercises is recommended beyond activities of daily living to improve and maintain health and physical fitness. It is recommended that:
Adults should accumulate at least 150 minutes of moderate-intensity aerobic exercise throughout the week OR accumulate at least 75 minutes of vigorousintensity aerobic exercise throughout the week OR an equivalent combination of moderate and vigorous exercise. This is the minimum recommendation and additional health benefits may be reached with increased exercise levels.
Aerobic activity can be broken down into smaller bouts of activity, with a minimum of 10 minutes in duration. Muscle strengthening activities should be included on 2 or more days per week, involving the major muscle groups. Adults with poor mobility should perform neuromotor exercises (see below for more information) to enhance balance and prevent falls on 3 or more days per week.
Flexibility exercises should be included for the major muscle groups on 2 days per week to maintain joint range of movement. When adults are unable to meet the recommended amounts of exercise due to health conditions, they should be as physically active as their condition and ability allows.
For those who are currently physically inactive, participating in exercise levels below the recommendations can still provide some health benefits and symptom management of MS. It is encouraged to start slowly and gradually progress to higher levels of exercise and physical activity.
The total time spent doing sedentary activities (sitting watching TV, using computer, seated at work) should be minimised and aim to include short bouts of physical activity or standing time during these activities, irrespective of exercise levels.
What is Aerobic Exercise? Aerobic exercise is the type of exercise you need to make your heart, lungs and blood vessels work more efficiently. walking, swimming or cycling. Aerobic exercise has to be done at a certain level (intensity), so that you breathe harder and faster than at rest but without overdoing it. A good guide is that during moderate intensity exercise you are puffing, but still able to keep talking. The 10 Aerobic activities include things like brisk
point Borg scale (see below) has been designed to measure rating of perceived effort and is a valuable tool for gauging intensity of aerobic exercise. A light to moderate intensity aerobic exercise program is recommended for people with MS (24 on Borg scale). An exercise program should be tailored to each individual according to their current level of fitness, MS symptoms and of course your interests! physiotherapist or exercise physiologist if you are unsure. Borg 10 Point Scale Talk to your
What is Strength Training? Strength training is important to improve the ability of the muscle to contract, coordinate movements, utilise energy sources and maintain independence. Research shows that many people with MS have the same ability to improve their muscle strength and control as people without MS. MS does not directly affect the muscles, they weaken because the nerves are unable to get the message down to activate them fully. This can result in people with MS decreasing their levels of activity, leading to further weakening and disuse of the muscles and worsening fatigue. Keeping the muscles in their own right fit and strong helps prevent or break the disuse, weakness cycle.
You may wish to go to a gym and have a gym assessment for your strength program. Alternatively you can start at home with some hand and leg weights, Many strength
resistance band or using your own body weight as resistance.
exercises can be interspersed with general activities; you can even do them in front of the TV or during a coffee break! A physiotherapist, exercise physiologist or experienced personal trainer can help set you up with a home program or gym program.
Handout H01 CS PT Information for Personal Trainers and Gym Instructors may be a useful reference.
What is Flexibility and Stretching? Movement required for daily activities such as walking, getting out of a chair, getting dressed and sitting with good posture can become difficult if joints become stiff and muscles become tight. Stretching is important to help maintain the range of motion around your joints and has also been shown to help with controlling spasms/cramps and pain associated with MS.
What is Neuromotor Exercise Training Neuromotor exercise training incorporates motor skills such as coordination, balance, agility, and gait and has been shown to improve balance, strength, agility and reduce the risk of falls. This is type of training is especially important for people with MS who have balance and gait difficulties or a history of falls. Tai Chi has been shown to be an effective way to include neuromotor exercises into your training program.
Other exercise options (Aquatic Exercise, Yoga, Tai Chi, Pilates, Chi Ball) When planning your exercise program there are other forms of exercise that may be of interest to you and have also been shown to provide health benefits. Aquatic Exercise: The aim of aquatic exercise is for clients to improve or maintain their joint mobility, muscle strength, balance and general well-being by performing exercises in water independently or within a group. The warmth of the pool can help to relax tight muscles and the water buoyancy can make exercise much easier for people who have muscle weakness. Many people feel more confident exercising in
water than on land because the water helps to maintain balance. Physiotherapists can provide an aquatic exercise program that is tailored to meet specific needs and physical abilities. Refer to INFO30 CS Healthy Living Series - Aquatic Exercise for more information. Yoga: Yoga includes gentle stretching, sequences, postures, breathing techniques, relaxation and meditation. The classical postures of yoga may be modified and adapted to suit individual needs. Yoga helps to relieve stress, encourages better breathing, aids sleep and may help balance. It also increases flexibility, concentration and can help to combat fatigue, and increase a feeling of well being. Refer to INFO29 CS Healthy Living Series - Yoga for People with MS for more information. Tai Chi: Tai Chi involves a series of circular and rhythmic movements performed slowly in a sequence to music. Tai Chi has been shown to help improve balance, strength, mental alertness and reduce pain and stiffness. Pilates: Pilates includes a range of low impact, gentle exercises targeting core and postural muscles designed to improve flexibility, strength and assist in the correction of poor movement patterns. Pilates exercises range in difficulty from beginner to advanced and can be adapted to suit each individual. Chi Ball: A structured class that combines Yoga, Tai Chi, Pilates and meditation exercises using a small ball as a focus for movement. Exercises can be modified for various ability levels.
Things to consider prior to commencing an exercise program Prior to commencing an exercise program there are a few things you should consider: 1. What type of exercise would I like to do (walking, cycling, group exercise class etc)? 2. Would I prefer to exercise on my own, in a group, with a friend? 3. Where are the services offered, when are they open and how much do they cost? 4. What time of day is best for me, what days of the week am I going to exercise and am I going to do 30 minutes continuous exercise or break this up into smaller bouts?
5. Am I confident to get started on my own or would I like an individualised exercise program set up by an experienced health professional?
Getting started with your exercise program It is important to start at a slow rate and increase your physical activity and exercise levels gradually. Too much too soon can lead to injury and giving up as it is too hard and causes distress! Remember to warm up beforehand. Warm up includes getting into the activity slowly for a few minutes and then gradually building intensity. Cool down at the end of the exercise regime. Cool down includes slowing down the activity to keep blood pumping through the muscles to cool them down and finishing with stretching exercises. You can complete aerobic, strength and flexibility exercises all in the same session or split them up into different sessions, the choice is yours!
Aerobic Exercise: It is recommended for MS that you build towards a minimum of 150 minutes of light to moderate aerobic exercise accumulated throughout the week. Additional benefits will be gained from additional activity. You can start as low as 2 – 5 minutes and slowly increase by 1-2 minutes each week, building towards 30 minutes continuous, or 2 – 3 sessions of shorter exercise periods (10-15 mins). Work at a light to moderate intensity (2-4 on the Borg scale). You should be puffing but still able to hold a conversation. A good indicator that you are not working too hard is that you are able to speak in short sentences whilst exercising. If you cannot speak due to breathlessness then you are working too hard. You will note that as your fitness increases you will need to work harder to get your heart rate up and work at the desired level. Adjust work levels accordingly. Find something you enjoy and if you like variety, mix it up with walking, cycling, swimming and even boxing.
Strength Training: It is recommended for MS that you complete 1-3 sets of 8-15 repetitions for each of the major muscle groups. As your muscles strengthen and enlarge, the resistance of the exercise needs to be progressively increased for further strength gains to occur. A rest period of 48 to 72 hours between strength sessions is recommended to optimise associated gains in muscle strength. Choose 6-8 exercises including a range of upper body, lower body and core stability exercises. Warm up for a couple of minutes with some general movements (i.e. marching on spot, swinging arms etc.) prior to commencing your strength training. To select the correct weight start low and progress as needed. You should be able to complete 8-15 repetitions at a given weight. During the last 2-3 repetitions you should find the exercise difficult, but not impossible to complete without compensating or cheating. Once you can achieve 2-3 sets of 15 repetitions easily you may progress to a heavier weight. When you increase your weight you may need to reduce your repetitions to 8-10 to maintain good form. Make sure you rest for 1-2 minutes between sets. When lifting a weight it is important to BREATHE. Breathe OUT as you lift or pull and breathe IN as you relax.
Flexibility Exercise: It is recommended that flexibility exercises be performed at least 2-3 days per week, with additional benefits in joint range of motion occurring with daily flexibility exercises. Stretches are best done when your body is warm – i.e. just after warm up and cool down. Hold each stretch for 10-30 seconds in duration when you feel tension in the muscle but not pain. Stretches should be repeated 2-4 times, aiming for 60 seconds of total stretch time.
Never bounce! This can cause tiny tears in your muscles and make them stiff and sore. It may also encourage spasms.
Neuromotor Exercise Training It is recommended that adults with poor mobility should perform neuromotor exercises to enhance balance and prevent falls on 3 or more days per week. Balance, coordination and agility exercises need to be completed in a suitable, safe environment so make sure you have something sturdy to hold onto if you start to lose your balance. Avoid practicing these exercises when you are fatigued. Neuromotor exercise training will be most effective when individually tailored according to your current level of fitness, balance and MS symptoms. Talk to your physiotherapist or exercise physiologist for assistance.
Exercise considerations for MS 1. It is important to minimise your body temperature as any increase can result in a temporary increase in physical MS symptoms and fatigue. Strategies to assist in minimising body temperature include: Exercise in the cool part of the day or in a cool environment. Exercise at reduced intensity or with regular breaks. Wear loose and light clothing, preferably cotton. Wear a cooling vest or wet cloth wrapped around the wrist or neck. Drink water ½ to 1 hour before commencing exercise. Keep well hydrated during and after exercise. Exercise in a well ventilated or air conditioned area. increase but in most cases disappear by 20 – 30 minutes after exercise. 3. Do not exercise if feverish or feeling unwell. 4. Consult the doctor before exercising if having a relapse. 5. To help manage fatigue, alternate between upper and lower body exercises and take rest breaks as needed.
2. Sensory symptoms (pins and needles, numbness, blurred vision) may
IMPORTANT NOTE: It is important you give yourself a chance to rest in between and after exercise! This allows the systems to recover and you will be able to continue functioning without undue fatigue! Refer to INFO09 CS Balancing Exercise and Fatigue for more information.
Other things to remember 1. Wear loose comfortable clothes and supportive shoes. 2. Empty your bladder prior to exercising. 3. Wait at least 1 – 1½ hours after eating before exercising. 4. If you stop exercising for any period of time you will need to recommence at a lower level. 5. You should always start your exercise session with a warm up and finish with a cool down. 6. Exercise should result in muscular discomfort but not pain. If you start experiencing pain it is recommended that you cease your exercise program and seek medical advice.
Tips for Getting Started and Maintaining Motivation 1. Find an activity and time of day that suits you. 2. Set a goal and work towards it. Start with short term goals and make them realistic, e.g. set the goal of walking 3 days per week. Even if you only walk for 5-10 minutes you have still met your goal. Well done Reward yourself with something you enjoy (not always food!) when you achieve your goals, e.g. go to a movie, buy your favourite magazine or a new piece of clothing, have a massage. 3. Start out slowly. 4. Record your progress Keep a physical activity/exercise record (see below for ideas) Review your diary frequently (at the end of each week/month) and reward success. If you haven’t met your goals think about ways to improve and set new goals.
If you didn’t reach your goals it’s ok! It often takes time to become regularly active. Have another go!
Week or day 1 2
Best time of Day 5.30pm 5.30pm
Activity Chosen Walking Walking
Goal Set (how long, how often) 10 min- Mon, Wed, Fri 15 min- Mon, Wed, Fri
Reward Planned Magazine -
Achieved (yes/no) Yes Yes on Mon and Fri. Sick on Wed Yes Yes
3 4
5.30pm 7am, 5.30pm
Walking Walking, Aqua Aerobics
15 min, Mon, Wed, Fri 15 min Movie walking Mon, Wed, Fri and Aqua Aerobics on Tuesday
5. Manage setbacks appropriately Once you start to exercise regularly you may find things come up that interrupt your routine. That’s normal. The key is view these setbacks as temporary and return to your program as soon as possible. It is a good time to review your goals and exercise program and see if any changes need to be made. E.g. try a new activity if you are facing boredom, try exercising with a friend / family member with similar ability, review the time that you are exercising – is it practical?
Remember: Eating well is important to good health and increasing exercise and physical activity levels. Refer to INFO43 CS Healthy Living Series Diet for more information. For more information or if you would like individualised exercise program from a physiotherapist or exercise physiologist please contact the MS Society.
INFO34 CS MS Healthy Living – Exercise for People with MS Last updated: October 2012 (Tracey Grosser, Exercise Physiologist, Health Solutions) MS House, 110 Reservoir Road, MODBURY SA 5092 Ph: 8396 0044 Email: [email protected] Fax 396 0184 Website www.ms.asn.au Toll free 1800 812 311
Further Information INFO30 CS Healthy Living Series - Aquatic Exercise INFO29 CS Healthy Living Series - Yoga for People with MS INFO09 CS Balancing Exercise and Fatigue INFO43 CS Healthy Living Series Diet H01 CS PT Information for Personal Trainers and Gym Instructors
References Global Recommendations for Physical Activity and Health, World Health Organization, 2010. http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf
Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidelines For Prescribing Exercise, American College of Sports Medicine, 2011. Be Active: Walk yourself Happy – Getting Started booklet http://www.sahealth.sa.gov.au/wps/wcm/connect/de0ef5004cde47c2800a90a49 6684d9f/beactive+booklet-Public+Health-HPB20120914.pdf?MOD=AJPERES&CACHEID=de0ef5004cde47c2800a90a496684 d9f
Getting Ready for Action, Lifestyle Management Team, MS Society of NSW, 2003.
MS Practice//For Health Professionals: Strength and cardiorespiratory exercise for people with Multiple Sclerosis, MS Australia, June 2009. www.msaustralia.org.au
