It is widely acknowledged that regular exercise is important in maintaining optimum health, but what do you do when you have a condition that can give you ‘bad’ days and leave you feeling like exercise is the last thing on your mind? The important thing to remember is that doing something is better than nothing and ultimately, you may find that in the long term you will feel the benefits of anything you can do.
Exercise can improve cardiovascular fitness, muscle strength, mobility balance and coordination. It can improve mood, increase energy levels and help with weight management. It’s also a great way to meet people and socialise (1).
‘More strength, more energy (once recovered from exercise session) and a HUGELY positive psychological effect’
For people with multiple sclerosis (MS), finding the right type of exercise is important as MS affects people differently. There is no one type of exercise recommended for people with MS, it’s entirely down to what you enjoy and what you are able to do as an individual and if you enjoy it, you will want to continue and hopefully do more!
Don’t worry if you have never done any exercise before or it’s been years since you last did anything. Slow and steady is the best way to build up your stamina. Getting your endorphins rushing around your system will soon have you feeling better about things.
There is a wealth of choice when it comes to exercise and there has also been a huge rise in people taking up wheelchair sports – there are thousands of different opportunities for you (and your family) to get involved in. Work with your MS and how it affects you, to find an activity that you love.
‘It keeps me supple as I am a permanent wheelchair user. It improves my mood.’
Don’t forget that even if you feel that pounding the pavement, hitting the gym or taking up a new exercise hobby is just too much for you, there are gentler ways to exercise that will still make you feel that you are doing something.
If you are lucky enough to live near to an MS therapy centre, why not make use of the specialised equipment or exercise classes that they may have on offer? One particular piece of equipment that is a real support to people with mobility problems is a Thera bike (2).
Thera bikes have a motor that helps tired muscles to keep moving, even when you don’t feel like you can do it for yourself. To find your nearest MS therapy centre see our Choices leaflet, MS Therapy centres for details of all centres across the UK and check out the services they offer.
This leaflet contains details popular types of exercise, but it is by no means an exhaustive list.
Before starting any type of exercise, it’s advisable to talk to your GP, MS nurse or neurology professional.
‘Keeping as flexible as possible and building or maintaining strength helps, use it or lose it! I also enjoy classes with other MSers and share info and laughs.’
Exercise and fatigue
Fatigue is a common symptom of MS. It might sound counterintuitive, but moderate exercise has been shown to improve resistance to fatigue. Clearly, it’s best not to exercise through fatigue or to try to battle on when it would be better to rest, but in the longer term, adding some exercise into your daily life can pay dividends.
The National Institution for Care Excellence (NICE) published guidelines in October 2014 for the management of MS. In these guidelines NICE advised aerobic, balance and stretching exercises, including yoga may be helpful in treating MS-related fatigue (3).
Sometimes exercise can bring challenges for people with MS. Some people find that their MS symptoms can become temporarily worse during exercise because they are affected by the increase in body temperature. If you are affected by heat, take precautions to keep yourself as cool as possible – always carry a bottle of icy water with you and take rest breaks when needed. If outside, keep to shaded areas. You can also put a hand towel in the freezer and drape this around your neck. The neck has lots of blood vessels, so keeping them cool will keep you cooler overall. If working out in a room or gym, see if you can have a fan working near you to keep the air cool.
Research conducted at Sheffield Hallam University into the effects of exercise on fatigue in people with MS, found that participating in short bursts of moderately intense exercise, such as walking and cycling can improve resistance to fatigue (4).
‘I am much steadier when I have been exercising. I am stronger and have more energy. I sleep better. My digestion is better.’
At MS-UK we conducted our own survey on exercise and MS and here are the results
Moderate exercise such as walking, with or without a mobility aid, has been found to have many benefits. As well as keeping you physically fit, it has been shown to reduce the overall risk of chronic illnesses, such as heart disease, type 2 diabetes, asthma, stroke and some cancers (5).
Walking is free and simple. It can also be social if you walk with a friend, your partner or as part of a walking group. There are many local walking groups that you could join, as well as dog-walking clubs if you have a four-legged friend.
The general advice for walking is to make sure you are wearing a comfortable pair of trainers – nothing that may rub the foot and give you blisters, wear comfortable clothes and take a drink or snack with you. It’s best to start slowly – just a couple of minutes a day is a step in the right direction – and build up to longer walks.
One idea is to time a walk from your home and then try to better the time it takes to return. For example, walk away from your home for ten minutes while timing yourself and then try to return in nine minutes. In the following days you can then extend the time you walk away from your home, as well as improving the time it takes you to return. (And you can always stop for a drink and rest before you begin your return home.)
You can also measure the distance you walk by either estimating the distance or buying a pedometer. This is a small device that attaches to your belt to measure the number of steps you take. Pedometers are available quite cheaply in most chemists or supermarkets, or online. There are other devices which can be used in conjunction with an app on your phone or tablet to keep a track of your efforts. This is a great way to keep motivated.
The Department of Health recommends everyone walk 10,000 steps a day (around five miles) (6). This might sound like an intimidating total, but most people walk 4,000 steps a day doing normal activities, so adding a short walk of about 20 minutes to your routine can really make the difference. Wearing a pedometer will soon show how you have clocked up the miles.
Swimming can be especially helpful because your bodyweight is supported by the water and the water helps to stabilise someone with balance problems. Weaker muscles can operate in this environment and will strengthen from the resistance created as you move through the water. As swimming involves many muscles in your body, it can also help to increase coordination (7).
There are now many more swimming pools and leisure centres offering special sessions for people with disabilities or those who require particular help and it may be worth trying one of these sessions first, if you need to. You could contact your local council to see what they have to offer in your area.
As a precaution, it is best to ascertain the temperature of the water beforehand as some people with MS are affected by temperature. The most comfortable temperature is about 30°C (86°F).
Pilates is an all-round stretching and strengthening regime, designed to improve muscle strength, posture and flexibility. Pilates is a type of exercise programme based on correct body alignment. The focus is on coordination, moving properly and core strength. Good breathing patterns are also important (8).
Pilates is a very popular choice of exercise and incorporates elements of yoga, stretching and muscle strengthening using the body’s own weight.
Pilates is a low-impact, gentle form of exercise, but some classes are floor-based so consideration must be given as to whether this is suitable for you. Some instructors specialise in Pilates for people with reduced movement and even seated classes. Some gyms offer Pilates classes to their members. These tend to be in larger groups, and you may prefer a smaller group where you can receive more individual attention from the instructor. Look for instructors accredited by a recognised Pilates training body, such as the Pilates Foundation, Body Control Pilates or Stott Pilates. See Further Information for more details.
‘I go to Pilates at the MS treatment centre. They target strengthening the core, pelvic floor and hip muscles. It made a massive difference to my balance and strength. Be proactive not reactive. It’s easier to retain strength than to lose it and try to regain it.’
Tai Chi is meditation with movement. It concentrates on relaxation and correct breathing, while performing graceful, circular, flowing exercises, sometimes to music. It is especially helpful for people with MS who may not have the stamina to exercise at a high speed and another advantage is that you can exercise without overheating (9).
Tai Chi can help in MS by improving balance, combating fatigue and giving you more energy. It can also help with spasms, muscle strengthening and is very relaxing. Regular practice can also help with depression and maintaining a calm and more serene inner state. Tai Chi is a good method of self-development, focusing the mind and giving you a greater sense of wellbeing.
Tai Chi is based on a range of movements in a standing position, but it is possible to do some of the moves sitting down, e.g. the arm movements and breathing exercises. Talk to your Tai Chi instructor about how these movements can be adapted for you.
The Taoist Tai Chi Society of Great Britain run Health Recovery classes for people with MS from their centres based in Colchester and Maldon, Essex and Newport, South Wales.
Yoga is about a unity of mind and body. It is as much about your breathing and your outlook on life as it is about postures. It can calm the mind and energise the body, as well as helping to counter-act stress, fatigue and depression (10).
It has a good effect on the endocrine glands, circulatory and respiratory systems and improves wellbeing. Yoga also tones the digestive organs and other glands in the body such as the thyroid and adrenals.
Like Pilates, yoga is suitable for all ages, and all fitness levels. Yoga is a low-impact, gentle form of exercise, but tends to be floor-based so consideration must be given as whether this is suitable for you.
‘Strengthening my core has meant I can turn over at night and means I can stand for longer.’
Adaptive yoga such as chair yoga is suitable for people who cannot stand or have mobility difficulties. While seated on chairs, students can do versions of twists, hip stretches, forward bends, and mild backbends (11).
Joining a gym
Having MS should not be a barrier to joining a gym, if that is what you want to do. Gyms offer a range of equipment, exercise classes and some have swimming pools. Your home town will have a range of gyms with different offerings. Some gyms charge a membership fee; either monthly or annually. Some gyms operate on a ‘pay as you go’ basis so you only pay a fee on the day you use the facilities. Many council-run facilities have concessionary day rates for people in receipt of benefits.
For gyms which work on a membership basis, it’s worth asking the manager about whether you can suspend your membership if you were unable to use the gym for a few weeks if you had a relapse. Most gyms would be happy to do this, but it’s worth double-checking before signing the contract. Of course, if you use a ‘pay-as-go’ facility, this is not a concern.
‘I am physically stronger especially my upper body. This has meant that I can pick up my rollator and put it in the boot of the car with ease. It has improved the strength in my leg muscles which is keeping me on my feet.’
If you are experiencing symptoms, or a change in symptoms relating to mobility, muscle weakness, spasticity or balance, you can ask your GP or neurology professional for a referral to a neurologically trained physiotherapist, or neuro-physio.
A neuro-physio can assess you and suggest a range of exercises or assisted movements to help with your symptoms and support you in coordinating movement, improving posture or targeting areas of muscle weakness (12).
Download this free Exercise Choices booklet and try some of the seated exercises for home use including some specific exercises for drop foot.
‘Stretching exercises at home really make a difference to how I feel on getting up next morning.’
The continuity of exercise is a big thing with any neurological conditions, good movement patterns need to be established daily and re-affirmed.
Exercise can help in many ways. Whether you get involved in a local exercise group or activity centre, or look online for exercises there is a lot of information out there. It may just inspire you to make the changes needed, or at least start thinking about it.
For more information on all of the above please see the following links. If you would like to discuss anything mentioned in this booklet then please call our helpline on 0800 783 0518. If you would like a plain text version of this booklet please email firstname.lastname@example.org