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Personal exercise training for people with MS

Open Door - Spring 2001 pages 8-10

According to popular myth, people who are disabled may be offered hydrotherapy while their non-disabled friends go swimming. Similarly, physiotherapy is for the disabled and working out at the gym is for "normal" people. Michael Hills, a sport and exercise science consultant in Bridgwater, seeks to dispel this myth.

Introduction

The aim of this article is to demonstrate how a well-constructed and monitored exercise programme has been extremely beneficial for a female client with MS. I don't want to make rash claims that exercise is a 'wonder cure' for everyone with MS or present myself as an 'expert' in MS. It is my approach, as an exercise scientist, that may benefit others.

This study highlights some key areas that should be considered when people with MS are hoping to begin exercising. I have described these key points as hurdles. I hope to show that with correct planning and supervision these hurdles are not insurmountable.

Background

Mary (name changed) was diagnosed with MS five years before coming to the Centre when in her late forties. Mary's initial symptoms included an inability to walk straight and impaired vision. This developed into feelings of extreme exhaustion "as if I'd just climbed a mountain" and weakness so severe that she felt unable to lift a cup and saucer. Her chest felt like someone had been repeatedly punching her and her only relief was to lie flat and not move.

Before attending the Centre, Mary had been seeing a physiotherapist who had prescribed exercises, which improved her strength. She had also been able to begin swimming once or twice per week. Although her condition was much improved compared to the initial stages, she was still unable to be active for any more than half a day, and frequently had to rest. She could not walk far and struggled to climb stairs; she found driving physically hard and suffered bouts of severe dizziness especially when moving her head.

Hurdle 1 - Apprehension

Mary was extremely nervous about starting activity. Her greatest fear was to suffer a relapse and a return of her initial symptoms. Also, as with many people, she was not familiar with gyms and was concerned about the "lycra brigade". She perceived gyms to be full of young, fit people exercising extremely hard and looking beautiful!

Our approach to overcoming this hurdle for Mary, as with most prospective clients, was mainly educational. A 'show round' is vital for all clients before joining a gym - to meet members of staff, to see the equipment and facilities and to appreciate the format of exercise sessions. It helped Mary realise that, in our case, the 'lycra brigade' is non-existent! She found the 'show round' reassuring and decided that she would like to begin a programme of exercise.

Hurdle 2 - Getting started

The next major hurdle is deciding how to start. With the variable nature of MS it is hard to know how different individuals will respond to exercise. An initial consultation is vital in order to make sensible recommendations. This should include a detailed medical history, a discussion of the clientâ??s objectives, an explanation of what the program involves and a gentle introduction to exercise. This session gave us a greater understanding of Mary's condition and helped reassure her.

Following her initial consultation Mary was introduced to an exercise session. We offer highly supervised exercise sessions in a format that allows personal training to take place within small groups of up to eight people. All clients work to a personal programme while still being part of the group session. Activities include using cardiovascular machines, resistance and aerobic exercises in a circuit format, abdominal and lower back conditioning exercises. The main advantage of this system is the extremely high level of supervision that it offers.

Mary initially began with very low intensity cardiovascular exercises on a stationary bike, treadmill and elliptical cross trainer. She also took part in low intensity circuit based activities. Although the duration was flexible, Mary initially exercised for up to one hour. Our approach was to begin very gently, monitor Mary's progress and adjust the programme accordingly. The aim at this stage was to introduce Mary to a regular exercise programme and improve the level of function that she had.

Hurdle 3 - Setbacks

Even using this "softly, softly" approach, progress was not smooth. Following the first few sessions, Mary was feeling very tired and suffering muscular pains. This caused her to become more apprehensive. After discussion, it was decided to reduce each session to a maximum of half an hour. These caused no further problems and within a fortnight Mary had returned to the full hour.

There is a vital lesson to learn here. Any exercise programme must be well monitored and adaptable. Clients must not exercise too hard and at the first sign that this is happening the programme must be changed. At all times Mary and the Centre staff remained wary of a relapse and only allowed slow progress.

Hurdle 4 - Progress

This is the most positive hurdle. As Mary continued she felt better, fitter and stronger and her confidence grew. At a review after 12 sessions (8 weeks), Mary talked very positively about her exercise experience - saying it was "wonderful". She had far more energy and stamina and seldom needed to rest and lie down during the day. She had no problem climbing stairs or being active throughout a whole day and driving no longer presented a problem.

Mary has been coming to the Centre for over 18 months with no relapse. She has continued to exercise for one hour a week as well as swimming once or twice per week. Measures of her fitness continue to show improvements in flexibility and aerobic capacity coupled with Mary's self-reported increased well-being. The nature of MS means she still fears a setback but the longer she goes without one the more positive and confident she feels.

Summary

Of course, for a treatment to be proven, very large numbers of people have to be involved. Similarly, without any form of control, it is impossible to rule out a placebo effect. It is difficult to say conclusively that the exercise and not some other unrelated factor caused Mary's progress. Regardless of this, Mary's experience demonstrates the importance of individuals taking control and doing something to increase their function - despite MS.

Tips:

  • Check with a relevant health professional before starting.
  • Visit the gym - have a look round and meet some of the staff. If you feel uncomfortable or unsatisfied in any way - DO NOT JOIN!
  • Ensure the programme starts with an individual consultation.
  • Ensure the programme starts very gently (low intensity) with short exercise sessions.
  • Ensure the programme is flexible and allows for the changing nature of the condition.
  • Ensure a good level of supervision and plenty of opportunities to check progress. This will mean the intensity and duration of exercise can be modified as appropriate.
  • If in doubt about any aspect of the programme - STOP and ask for assistance.
  • Find activities that you like - ENJOY IT!

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