Being Active

Exercise

Does the thought of exercising with MS seem difficult to you? You may think that you are too tired, too weak, or have too much pain. You might not know how to exercise with your limitations. Or you may worry that being more active might make you feel worse. These are all valid concerns, but paradoxically, being more active may have the opposite effect. Over time, regular physical activity can have enormous health benefits in addition to helping you manage your MS. Keeping yourself healthy provides a stronger foundation for managing MS.

Benefits of regular exercise include:

• Helping you sleep better
• Reducing your pain and fatigue
• Improving your cognitive function (thinking ability)
• Better balance and mobility
• Better mood

• What are some reasonable exercise goals for people with MS?
  The Multiple Sclerosis Society of Canada has set MS-specific exercise recommendations, but these have not been tested to see how they compare to the more widely-used recommendations for the general population. The Multiple Sclerosis Society of Canada indicates that adults ages 18-64 years with MS who have mild to moderate disability need:

  • at least 30 minutes of moderate intensity aerobic exercise 2 times per week PLUS
  • strength training exercises for major muscle groups 2 times per week.

  If these goals seem overwhelming to you, the good news is that a little bit of physical activity – even 10 minutes a day – can make a difference. The key is to start slowly and with activities that are easy for you to do. Over time, you can gradually increase your activity and start to do more.  Be sure to talk with your healthcare provider first before you change or increase the amount of activity that you do. This can help you make sure that your symptoms are under control and that it is safe to start. It can also help you avoid overexerting yourself, which can lead to a flare-up, or worsening, of your symptoms.

  Exercise intensity TIP: What do you mean by “moderate intensity?”

  You can tell when you are engaging in moderate intensity exercise if the exercise:

  • Makes you breathe quicker, but you are not out of breath
  • You break a light sweat after about 10 minutes
  • You can carry on a conversation, but don’t have enough breath to sing

  Myths and facts about physical activity and MS

  MYTH:

  People with MS should not and cannot be physically active.

  FACT:

  Studies have shown that people with MS benefit from being active. In fact, exercise is a key part of managing MS. Exercise is related to more energy, less pain, and better mood in MS.

  MYTH:

  You will feel worse if you are more active.

  FACT:

  Over time, being active may help improve your mood and physical function, although you may feel more pain or fatigue at first.

  Your muscles may have become deconditioned, or weaker, due to inactivity, but this may lessen as your body adjusts to being active again. Remember that over-exercising can also lead to more pain or fatigue. Talk with your healthcare provider about ways to help you be more active.

• Exercises for people with MS

  There are 4 types of structured exercise that have been shown to help people with MS. Keep in mind that these activities can be done at a gym, at home, or in your community.

  Aerobic exercise

  • ACSM recommendations: Adults should get at least 150 minutes of moderate-intensity exercise per week.
  • Multiple Sclerosis Society of Canada Recommendations: Adults with MS should get at least 30 minutes of moderate intensity exercise 2X per week.
  • Includes walking, water aerobics, and stationary cycling
  • Helps improve your circulation and strengthen your heart. Because it stimulates your cardiovascular system, this may help reduce fatigue if your muscles have become deconditioned.
  • It is best to gradually increase the amount of time you do aerobic exercise. For some people, this may mean slowly working up to 30 minutes per day, most days of the week.
  • People who cannot do the recommended minimum can still benefit from some activity; 10 minutes of activity is better than none!

  Flexibility, or stretching

  • ACSM recommendations: Adults should do flexibility exercise at least 2-3 days per week to improve range of motion.
  • Hold each stretch for at least 10-30 seconds to the point of tightness. Repeat each stretch 2-4 times.
  • Stretching may provide pain relief and make tight muscles more flexible
  • Flexibility is important for good posture, strength, and balance
  • Do not bounce while stretching or stretch to the point of pain
  • Stretching is most effective when muscles are warm. So, try flexibility exercises after aerobic activity.

  Resistance or Strength training

  • ACSM recommendations: Adults should do resistance training on each major muscle group (both upper body and lower body) 2-3 days per week.
  • Multiple Sclerosis Society of Canada recommendations: Adults with MS should do strength training on all major muscle groups 2X per week.
  • Very light strength training is best for older adults or those who are just starting to exercise.
  • Includes weight lifting, sit-ups, resistance bands or tubes, and body-weight exercises (e.g. squats)
  • Helps your muscles become stronger
  • It may help you function better and take part in more activities
  • It could counter muscle loss, and it may even result in muscle gain
  • Focus on strengthening and toning, and not on body building or ” bulking up”

  Neuromotor Exercises

  • ACSM recommendations: 20-30 minutes per day
  • Sometimes called “functional fitness training”
  • Can include various motor skills, such as coordination, gait, agility, and balance
  • Examples of neuromotor exercises are yoga and tai chi.

• Exercise tips
  Your results may differ from those of someone who doesn’t have MS or from what you were once able to do. Your results will depend on the condition you are now in and the intensity of your symptoms. As you begin your new exercise program, keep these tips in mind:

  • Start at a low level and slowly work up to moderate activities as you are able
  • On bad days, exercise as planned, but consider doing it at a lighter level or for less time
  • Talk with your healthcare provider before starting or changing your exercise program

  What if I am just not ready to begin exercising right now?

  Maybe you have been sedentary for so long that you can’t imagine beginning to exercise. Or, maybe you are afraid that even the slightest bit of exercise will cause a spike in your symptoms.  Whatever your reason for being hesitant about starting to exercise right now, you might start by increasing your level of “lifestyle physical activity” first.

  Lifestyle physical activities are things that you do or enjoy as a normal part of daily life, such as cleaning the house or playing with children. The important thing is to try to be active, and to give yourself credit for what you may be doing already.  As you become more active, you can try to work up to more challenging activities gradually. Any increases in exercise intensity should occur gradually.

  As you move from left to right across the activity spectrum below, you will see that the activities listed require more energy and physical effort.  Depending on how you feel, it might be realistic for you to build up to activities in the mild and moderate ranges. Using the lists below as a general – but not complete – guide to the types of activities you can chose from in each category.  As you become more active, you can try to work up to more challenging activities gradually.

  Examples of Physical Activities
  Least intense			Most intense
  Reading Sewing Napping Typing Using the computer Watching TV Writing	Cooking/baking Golfing (with a cart) Playing a musical instrument Slow dancing Walking slowly	Calisthenics Cycling slowly Gardening Golfing (without a cart) Swimming slowly Walking at a normal/brisk pace	Basketball Running Skiing Tennis Soccer Swimming or cycling vigorously

• Scheduling tips

  Whether you want to increase your lifestyle activities or start a structured exercise program, you may have trouble starting and sticking with a plan. It may help if you:

  • Talk with your healthcare provider about starting or changing your exercise program
  • Think about ways you can change less active times into more active ones. Use the Being Active Work Sheet to help you do this
  • Pick a set time each day to be active and put it on your schedule. This will help you commit to it
  • Plan to be active at times of the day when you feel your best or think it may help you the most. For example, it might be helpful to stretch in the morning if you feel stiff
  • Start by scheduling small amounts of activity so you don’t overdo it
  • Find a friend or family member to join you

  For more tips about being active, see Everyday Tips For You. Being active on a regular basis is a challenge for many people. It can be a special challenge for people with MS. Becoming more aware of your challenges may help you move past them.

  If you are afraid that being more active will cause a new flare-up, then:

  • Consider whether you may have done too much too soon in the past
  • Plan ahead and pace yourself, using the tips in Pacing Yourself to find the right activity level for you
  • Try thinking about being active as a way to help you feel better

  If you are not sure about what to do or how to start, then:

  • Think about your past and present activities
  • Pick one thing to do and start slowly
  • Keep track of what you do, how long you do it, and how you feel before, during, and after it
  • Look at ideas available through MS organizations (see our resources, below)
  • Talk to your healthcare provider about options, including physical therapy

  Don’t forget that everyone with MS has different abilities. Every day may be different. Just do what you can each day and build from there.

• Special Considerations for Exercising with MS
  Heat­ People with MS are often heat-sensitive.  While heat won’t necessarily trigger an exacerbation, over-heating can make your symptoms much worse.

  • Be careful about exercising outdoors, as heat and humidity are more variable compared to indoors.
  • Be extra aware of how your body feels. If you notice any symptoms that you didn’t have before exercising, slow down or stop exercising until you cool down.
  • Keep your core temperature cool by using cooling garments, placing ice on your neck, and drinking icy cold water.
  • Hydrate before and after exercise.
  • You may tolerate resistance/strength training exercises better than aerobic exercises if you are particularly sensitive to the heat.

  Balance If you struggle with balance and worry about falling, you need to be especially careful about your personal safety.

  • Avoid slippery floors, poor lighting, throw rugs, and other tripping hazards
  • Place a chair or other stable piece of furniture nearby to steady yourself if needed while you exercise
  • Choose exercises that present less risk of falling, such as a stationary bike or water exercises.
  • Remember your balance may improve that the stronger you get through regular exercise

  A note about too much sitting

  Exercise is very important to overall health and MS symptoms management.  But, it is not enough to engage in exercise; you must also make sure to limit your inactive time.  Adults today are too “sedentary”, which means that we tend to sit in quiet activity, such as watching TV or working on the computer for longer than is healthy. So, even if you meet the recommended 150 minutes of exercise per week, you need to make sure to monitor and limit the amount of time you sit. Take breaks to get up and walk or stretch during long sedentary periods or stand instead of sitting if you can.

A note for family and friends

You can help with exercise

Many people with MS are not active. They may not know what to do, what they can do, or how to start. Here are some tips that may help people become more active:

• Help identify activities they enjoy
• Encourage them to track their progress, using the My MS Toolkit work sheets
• Let them know that you would like to help them deal with concerns
• Help them create a good balance between rest and activity, using the Activity Pacing tips in this module
• Being physically active and exercising is important to everyone’s health – including yours! In addition to encouraging the person you care for to exercise, be sure to take care of your own health.  You may be able to find physical activities that you enjoy together, such as taking walks or doing stretching or yoga together.

Resources

The National Multiple Sclerosis Society and the MS Society of Canada websites have many practical resources for people with MS who are interested in exercising. These resources provide not only information but also links to webinars, exercise videos, adapted exercises, and other programs to help you in your goal of increasing activity.

National MS Society – Exercise

National MS Society – Intro to MS for Fitness Professionals

MS Society –  Exercise and Physical Activity

The American College of Sports Medicine offers detailed recommendations on quantity and quality of exercise.