Section 2 of 7

GETTING THE QUESTIONS OUT OF THE WAY BEFORE YOU START

Before we embark on the exercises, let’s look at some general questions.  First of all…how do I exercise and cope with the fatigue?  It is important to mention fatigue here, before looking at the exercise programme, as the one is inextricably linked to the other.  Fatigue is a very common feature of MS - the overwhelming feeling of exhaustion which seems to be so difficult to explain, let alone to manage, in day to day life.

It can be a difficult subject to deal with among friends and family.  “You look so well.  Why can’t you wash the dishes?”  “Why can’t you come out to the pub with us?”  It is essential to remember that fatigue is an integral part of MS, a real and recognised symptom, not something you should have to apologise for.

The first thing to acknowledge is that it is not a good idea to “work through” fatigue; you may end up feeling worse, often for days afterwards.  Fatigue is difficult to come to terms with because it involves changing your routine to accommodate your MS and it can feel as if you are giving in and letting it get the better of you.  The other way of looking at it is that you are learning to manage your MS and are undertaking a form of energy conservation.  If you can save energy by changing your routine, be it work or leisure, by learning to recognise when you are feeling weary, then it will make a great deal of difference to your everyday life and you can often keep going for longer in the day.

Sometimes something as simple as sitting down with a cup of tea after lunch and learning to be nice to yourself, can make the difference between being sociable in the evening and having to go to bed early and missing out on family and friends.  Some people need to rest for longer but don’t because they think they’ll fall asleep and waste the rest of the day – but you could always play safe with an alarm clock or kitchen timer!  If you have a tendency to get back or neck ache you might actually be better lying down to allow your joints to rest completely.  Basically you need to find what suits you; there are no hard and fast rules.  For some it is a regular rest midday, for others it is frequent sit-downs in between activities – or a combination of both – whatever your own method of giving the body time to “recharge the batteries”.  Another way of coping with fatigue is to try and control the temperature.  Everyone can feel drained of energy in hot weather, but with MS the effect is often exaggerated, particularly in more humid conditions.  The use of fans or cold water sprays, especially when exercising, can be helpful.

 how do I fit it all in?

 Don’t despair because quite a few exercises can be fitted around normal daily activities.  For example, some standing exercises can be done at the kitchen sink in the time it takes for the kettle to boil.  Some of the sitting exercises can be done while watching the TV or listening to the radio.  Tying in exercise with daily routine means that it becomes an integral part of the day, as automatic as cleaning your teeth.
 

MS doesn’t go away.  People who break their leg know that if they do their exercises all should be well.  Most people with MS don’t want to – and don’t feel they have time for – half an hour of exercise every day.  It would dominate life so much there would be no time or energy left for anything else.  However, most can manage to do one or two exercises incorporated into the daily routine.  It doesn’t then become too much of a drudge, it’s more likely to be remembered and less likely to make you feel guilty about not doing anything.  Then - if you want to - you could do a fuller range of exercise once or twice a week.
 Before you work out your own programme of exercise, there are two things to consider which come into most daily routines: standing and walking.

Standing is a very important activity and it is worth spending a little time each day looking at how we do it.  I have already mentioned the importance of correcting our posture in standing but we also need to recognise that for some people it can be an invaluable exercise in its own right.  For people who spend most of their time in a wheelchair it is good practice to stand at regular intervals in the day, if at all possible.  Even if you don’t think you stand very well, any standing is better than no standing at all.  It allows you to weight-bear through the legs and feet; it stretches your muscle groups; it allows the chest and abdomen to expand and re-align their contents.  I can guarantee that you will breathe deeper and your bladder and bowels should function better!

Walking can also be an important part of our daily routine but we can all get out of the habit of not walking enough or of thinking about how we are walking.  It’s easy to forget that we are walking every time we get up out of a chair because most of the time we are more concerned about where we are going and what we want to do when we get there.  A lot of people with MS have found, though, that if they have a special place where they really concentrate on how they are walking, then it will carry over into “general” walking.  A hallway might be best because it gives a decent distance to work on.  You may find that you try to think about how you walk whenever you walk through a particular door - some people even put stickers on the doorframe to remind them to concentrate.  Are your hips level and your feet pointing forward? Is one leg dragging? If you have difficulty in knowing what to look for, your local physiotherapist should be able to help.

what sort of exercise?

There is no right or wrong exercise, but there are some simple guidelines to help you decide what is right for you.  Remember everyone is an individual and you need to find what suits you best - and only you can know the answer to that.  Firstly, if you try an activity and it does not make your symptoms worse, then it is most likely to be fine for you.  You have to learn to listen to your own body and to be honest with what it is telling you.  Some people have a misguided belief that if you push hard enough and it hurts then it must be doing some good.  If you spend more time recovering from an activity than doing it, you may not have the balance quite right!
If you like to play badminton and can enjoy a game without provoking any symptoms, then carry on.  But if your symptoms become worse or you take a couple of days to recover then either it is the wrong activity for you or you modify it and play for less time.  Or it may be that you could try something that is just as competitive but a little less strenuous!

how do I decide on my programme?

The next section describes a range of exercises which you can adapt to your own needs.  They vary from fairly easy to quite difficult and so you will probably find not all of them will be right for you.  They have been divided up according to their starting position, which may help you to decide how to fit them in with your daily activities.  In the beginning you might consider enlisting help from a physiotherapist who will be able to give you some tips and pointers.  When you start your programme don’t go mad and try to do all the exercises at once, particularly if you haven’t done much recently.  Pick out a couple that you know you will be able to do, building up gradually.  There’s no point in setting your target so high that you will not be able to reach it. 

From a standing start…

Pick one exercise to do when standing in the kitchen, maybe waiting for the kettle to boil or before you wash-up.
Pick one exercise to do when sitting, perhaps at the table before you have your meal or while watching the TV.

Do both exercises every day at least once - perhaps once in the morning and once in the afternoon.  Repeat each exercise 3-5 times.  Then pick a day in the week and a good time in the day - not when you feel at your lowest! Select 6-8 different exercises and go through them repeating each one 3-5 times.

If you are less mobile…

If you use a wheelchair most of the time or can only stand for short periods, choose one sitting exercise and perhaps one arm exercise to do daily.  Repeat each exercise 3-5 times.  If you can, try to stand daily.