I want to thank Nadja, Vicki, and Susan from the on-line MS community for their contributions and additional information about the topic of exercise for MS patients. Each of these individuals offers their unique knowledge and perspective on this topic. Thank you for going above and beyond my expectations when I asked for your expertise in writing about exercise and MS.
Nadja is a blogger, MS patient, and yoga instructor who offers this wisdom about exercise:
"My attitude about exercise and stretching is deeply rooted in my philosophy as a yoga teacher and practitioner. I was raised as a competitive runner and gymnast but after the time all the pressure of competing took its toll and those activities lost a great deal of their charm. In yoga we promote a non-competitive environment and I love that. Practicing yoga means being free of judgment about yourself and the others around you. It is ok to challenge yourself but first and foremost, in any exercise, you must listen to your body.
I think it is important for people with MS to stay active and exercise regularly to detoxify the body and mind. Just moving can lift a lot of anxiety and depression. Even those in a wheelchair can do small amounts of exercise. Yoga is one of the ideal activities forMSers because it offers something for every level.
In yoga you should never feel real pain so if you are in pain or overheated, you need to back off. The same is true for any exercise, especially for those with MS. Whatever stretches you do, it is important to work into them slowly and fill the pose with breath. Start easy and build as you go."
Next up is Susan Dorne, otherwise known as "Schmoozin Susan" who writes for Stu's Views and M.S. News and who is a practicing occupational therapist. Susan is going to address why exercise is good for those of us who have Multiple Sclerosis.
The Importance of Exercise and Stretching with MS
Multiple sclerosis can bring about many symptoms including weakness, spasticity, loss of range of motion, lack of mobility and pain. I know, I have had MS for 13 years and have been challenged with these symptoms. Besides taking medication, exercising and stretching can make a big difference.
Many people with MS find it hard to think about exercise especially when they are dealing with fatigue. For me, there are some days when I credit getting out of bed as my form of exercise for the day! But once I start to stretch and do a little exercise, I can truly feel a difference.
There are several benefits to exercise. Exercise can increase strength in weak muscles, maintain strength in existing stronger muscles, improve range of motion, increase flexibility, and improve your endurance. As muscles strengthen, it can help with balance, coordination, and walking. Stronger muscles and increased endurance will also help with activities of daily living (eating, hygiene/grooming, bathing/showering, dressing, and personal care) even if using adaptive equipment. An added benefit to exercise is the release of natural proteins called endorphins. These "feel good" chemicals help in managing pain, reduce fatigue, and help with depression. Not only will you feel better physically, your mental outlook will also improve.
Stretching is important prior to exercise to avoid injury. It is also particularly beneficial for managing spasticity as it helps with the stiffness that occurs. Some people find stretching in the morning as a great way to get the muscles warmed up for the day. Others find stretching at night better as spasticity tends to worsen at night while the body is at rest. Find the time that works best for you and don't hesitate to change your routine depending on what your needs are. I suggest having a second person assist you and have that person trained for proper techniques and handling.
The amount and type of exercise you do depends on your abilities, especially if you are just starting. Since everyone is different, it is best to talk with your doctor or healthcare professional prior to starting, especially if have never participated in an exercise plan before. You may be given a prescription for physical therapy and/or occupational therapy where you will receive a complete assessment and appropriate suggestions for functional activities and exercises based on your symptoms, limitations and personal goals.
Not only can exercises be performed at home, in a clinic or gym, and with or without equipment, there are other options to achieve benefits. Setting up a walking program, swimming, participating in yoga or tai chi, gardening, dancing, bowling, and even simple housework activities provides opportunities for exercise. Most activities can be modified to accommodate your physical needs to facilitate your participation. Exercising does not require a lot of time or expense. You can utilize items around the house such as chairs (without wheels) for sit to stand exercises, or to sit while doing arm and leg exercises; use the chair back for support for standing exercises; food cans or bottles can be used for weights (no glass) for arm exercises; even clothespins can be used to squeeze for finger strengthening. No matter what you do, it is important to note that you do not want to perform any exercises or activity that causes pain, adds stress, gets you overheated or jeopardizes your safety in any way.
It's never too late to start to exercise. Begin by setting realistic expectations and a schedule that will make it easiest for you to keep. Modify what and when you do things to avoid boredom or discouragement. Lastly, I encourage you to involve another person or get a group together. This will help keep you motivated and will add to your safety if assistance is needed.
Susan Dorne, OT
And last but never least is Vicki Bridges who writes about exercise which can be done by MS patients who may have a more progressive form of MS and are using a wheelchair.
Wheelchair Exercises by Vicki Bridges
I have secondary progressive MS, and as a result I have been progressively losing my ability to move. The National MS Society (NMSS) reminds us that MS steals movement from us all. Here is what NMSS has to say about exercise, but a wheelchair adds another factor.
Sitting all the time does not automatically exempt us from the need to exercise, but it does exclude standard exercises or aerobics. Wheelers still need to make an extra effort to remain as healthy and fit as possible. There are problems trying to maintain an exercise routine from a chair, but it is not really hopeless. The practice of weight-bearing exercises may not be practicable, but there are all kinds of other opportunities.
Why exercise? It is important to maintain balance even from a seated position -- that is, trunk balance to sit with good posture as well as the mind-body relationship. It is also important to maintain arm and hand strength and agility. Good balance, agility, strength, and fitness all contribute to a good quality of life.
When I first faced life in a wheelchair, I found a program called Sit and Be Fit on public television. This program has since evolved into a series of CDs. Many of the exercises seem too slight to make a difference. Every movement counts, however, so do not discount them. If you have no control over your feet or legs, there are some you cannot do, but the Sit and Be Fit series offers enough choices for most people of differing abilities. It's worth checking out.
Over the years I have found more options. I currently use an Amigo scooter. I tried a manual chair, but I do not have the strength to move it myself. The difference between a manual and power chair makes a big difference in exercising. Just getting around in a manual chair is a bit of exercise itself. Many people play sports in manual chairs, though they may be specially designed for the sport. (Did you see the wheelchair rugby during the paralympiics?). A Chair is hardly a hindrance to an athletic or fit person.
Exercise is important to maintain a good level of fitness. I wrote a couple of posts on Down the MS Path that addresses this topic. The first was Fitness from a Chair, addressing the topic in a general way. The second, Resistance Exercise Anyone?, was written after I saw research about the proven value of resistance exercising for MSers. Here are some other good articles I found on the Internet:
I have talked to doctors and therapists for ideas, and researched the Internet to see what other wheelers have said, and I have developed my own regimen. Of course, my routine may not work for everyone; they may be too much or maybe not enough. These ideas, however, may be a good starting point. This is my exercise day.
Early in the morning (that's 5 a.m. here) I watch Inhale, a yoga program on the Oxygen network hosted by Steve Ross. No, I cannot do the positions, especially since I am still in bed. I can, however, stretch while I listen. I grasp a bar on the headboard or use my good arm to help with the stretches. Stretches, isometrics, and breathing exercises are all the yoga I can handle any more. It's not much, but every movement counts. I have Steve Ross on TV because I like his voice and encouragement along with the background music. The idea of yoga is helpful because I agree with the philosophy. This is a nice way to begin the day. I usually go back to sleep a little more relaxed. This is a good way to start the day.
Here are a few specific exercises I do throughout the day, no particular time, just sometime during the day.
- Lean forward, lean to the left and right, then sit back up. This sit up is best using abdominal muscles to pull up. It is always best for strength and balance to use pelvic area muscles for all movements.
- Hold both arms straight out, raise them as high as possible, lower them, raise them back to shoulder level. Both arms at the same time are helpful for balance, but one at a time is okay.
- Spread and stretch your fingers, touch the tip of your little finger with the tip of your thumb, clench your fist. Spread and stretch your fingers, touch the tip of your ring finger with the tip of your thumb. Do the same with each finger.
- Hold and squeeze a rubber ball.
- Bend your hand straight down, straight out, then up. Holding your hand straight, move it right from the wrist, then left.
- My best exercise is lifting myself. These are like seated push ups. With hands firmly on each chair arm, I do a series of 10 lifts every time I go to bed, at night or just for a nap. Some days ten lifts are too many. If I am tired or just not feeling my best, less than ten are okay. In fact, any lifts at all are good.
The important thing with MS is to remember is to keep moving. The longer you can continue to control movement, the longer you can continue to move (just another way of saying 'use it or lose it'). With MS, moving is a good way to stay fit. If you can't do something right now, don't give up. Try it again later, or maybe even tomorrow. MS is funny that way.
Notes and Links:
** Disclaimer: Before anyone begins a new exercise program, they should start by asking a doctor or therapist, because specific needs and capabilities may suggest adjustments. These are my exercises.
Sit and Be Fit = http://exercise.lovetoknow.com/Sit_and_Be_Fit_Exercise_Videos
Inhale = http://www.oxygen.com/TvShows/
resistance exercise= http://vvbms.blogspot.com/2006/09/resistance-exercise-anyone.html
fitness from a chair = http://vvbms.blogspot.com/2007/04/fitness-from-chair.html
Published On: March 26, 2009