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108 Lowther Street
Lemoyne, PA 17043
717-774-2202
(for persons with MS)
Why Exercise?
Charles Yanofsky, MD with Janice Yanofsky, LPT
No matter what your level of physical ability everyone with multiple sclerosis should have an exercise regime. Exercise is important for anybody, but for the MS patient it is crucial.
“Hold on!”, I hear you saying, “MS’ers face formidable obstacles that other people don’t.” Troubles include fatigue and heat and weakness, side effects of medicines and exacerbations that set you back. Some of you tell me how you need to call upon all your resources just to get through an ordinary day. Fatigue is self-perpetuating. You’re tired so you don’t exercise, then you get out of shape, become immobile and don’t feel like exercising. Also for most people we have strategies that combat fatigue. Heat sensitivity can be circumvented rather easily. Changes and setbacks typically alter the way you exercise, but shouldn’t stop you from improving your health. Just consider these benefits:
Physical exercise improves your mental outlook. It provides a routine and organizes your day. Over the long haul you’ll enjoy added stamina, that is if you don’t overdo it. You find yourself having more energy and strength for other endeavors. Exercise provides you with a set of concrete attainable goals mirroring the striving, pain and gain of everyday life, expands possibilities and physical wherewithal. Then there’s the well-known endorphin factor or exercise high, the “can do” effect. It’s hard to over-estimate the positive fallout of a good exercise program. It can get you out of the house, expand your horizons. Exercise is a defense against anxiety and depression. It improves sleep, burns calories, raises “good” HDL cholesterol, decreases the effects of aging and chronic disease such as atherosclerosis and diabetes. Considering all these benefits why don’t more folks do it?
Because it’s hard and takes initiative and no matter who you are, you won’t always feel like exercising. Even so, it’s better to get out and exercise when you don’t feel like it! (except if you’re actually sick of course.) You may feel incredibly good by the end of your routine, even on a day when you feel terrible and then there’s that payoff down the road, when your overall health improves. You may feel fat or unmotivated. Don’t worry at all about inauspicious beginnings. From whatever level you start, there are tremendous payoffs.
There are four main types of exercise. Resistive exercise, aerobic exercise, stretches, and routines for agility and speed. Agility and speed routines are mostly for competitive professionals and will be ignored for our purposes. However, certain techniques such as Tai Chi, most excellent to ‘train the brain’, increase balance and flexibility. Resistive exercises use weights, springs or bands. They increase muscle power, and ability, help large muscles burn fat and larger muscles are enablers for aerobic exercise. Most people know there are two kinds of resistive exercises, isotonic and isometric. In isometric exercise the muscle is applying force but not changing its length. Force varies but you are not moving a joint with isometrics. Isotonic exercise is the reverse. Length varies but force remains the same. Either of these methods burns calories and is effective for toning and building muscle groups and improving your appearance. But for MS’ers isometric exercise might provide some advantage avoiding a sudden injurious muscle stretch. When you do contract muscles this should be smooth and gradual, never jerky and irregular.
You have to be careful with resistive exercises. If you overdo muscle building you might end up tightening your muscles, accentuating spasticity. Overly tight or spastic muscles are vulnerable to injury when subject to rapid increases in length and that increases muscle and tendon pulls. Resistive exercises are also helpful in combating osteoporosis. One should not do resistive exercise alone.
Your best bet is a mix of resistive exercises with stretches and aerobics. Stretches are especially beneficial for muscle groups you intend to exercise. They provide an excellent defense against injuries caused by sudden muscle elongations and help fight spasticity. Here is one trick for tight muscles. Contract the muscle forcefully against resistance (an isometric contraction). Then gently try to stretch it right away. Voilà! The muscle will lengthen more easily! Try it on a tight muscle. It works.
Stretches develop and maintain range of motion in joints, especially for those who are sedentary and are helpful to combat spasticity and muscle tightness and prevent contracture and ankylosis. Increasing flexibility also prevents joint injury and muscle pulls and decreases pain.
Aerobic exercises work the heart and lungs and build stamina. If you want to get more bang for the buck you have to exercise larger muscles which consume a lot of calories and oxygen and make you breathe faster and harder. It’ll make you tired but over the long run an aerobic program will pay off in energy, a “can do” feeling and well being. You are doing aerobic exercise when you find yourself breathing hard and your heart pumping, and building up a good sweat. Aerobic activities are stair climbing, walking, jogging, dancing, swimming, bicycling. It’s best to vary activity because you’ll be exercising different muscle groups. Doing exactly the same routine day after day, your body finds the most efficient way of accomplishing the exercise and will benefit less. On the other hand if you keep up with a routine and you know what to expect, you’re most likely continue to exercise. Most important, start slow. Do things that are well within your range. Don’t push yourself too hard. If you do that you’re likely to feel exhausted or even injure yourself and quit. No question about it, the best time to exercise is in the early morning. It will organize your day. Avoid strenuous work at the end of the day because this can affect your sleep. Sleep patterns often improve with regular early exercise. Rest periods are also critical between routines. Everyone needs to start slow and increase gradually. This is especially true for folks with heart and lung disease who may need the guidance of their physician. I’ve seen lots of people do much more exercise than is good for them. Sometimes they are trying to prove how healthy they are, much to their own detriment. The primary motivation should be to increase your physical and mental well-being and stamina.
Which exercise is the best? The one you personally like the most and one you’ll be willing to do. For some walking outside is a bore. Others love to get out in the weather and breathe fresh air, maybe get together with other people. For people who can’t walk a simple sit to stand brings in a lot of muscle groups. For muscles that are weak, try turning into a position that eliminates gravity. In swimming you dissipate heat and it works well if there is a problem with lower extremity function. Swimming seems to be the ideal aerobic exercise for a person with MS, but you need to find a pool that’s not too warm. The simplest exercises, those that require the least equipment and preparation, are often the best. In general personal trainers are not necessary, but you’d be advised to work with a good therapist and tailor a program with the right personal mix of resistive, aerobic exercises and stretches. Find something you like and try to do it regularly. 30-60 minutes four days a week is probably ideal. Be careful you’re not exercising beyond your capacity. If you have a setback or exacerbation, don’t be discouraged. Keep trying. You should not be pushing your limits constantly. Your goal is to keep doing what you are doing and to continue in the activity over the long haul. Exercise is for everyone and will improve your life, whatever your level of physical capacity.
