Many people with MS have understandable concerns about beginning an exercise programme. There are a number of issues that you might wish to think about, but they need not be barriers to starting exercise. Here we provide practical tips to help you get started and keep going with your chosen activity.
Everyone's MS is different, and you know best how your MS affects what you can do. However, you could ask yourself what is holding you back from being more active, and see if there are ways to overcome those issues.
Before you start to exercise
There are several common challenges facing a person with MS who wants to exercise. Fortunately, a bit of preparation can stop them become barriers to exercising.
Heat sensitivity is a common MS symptom. If you find that you get hot and uncomfortable when you exercise, try to cool the environment you are in. Take off a layer of clothing, open a window or go outdoors. A fan or a cold water spray might also be useful, as can having a cool bath or shower before you start to exercise.
Research shows that drinking iced water before exercising can help people with MS exercise for 30% longer and reduce fatigue following aerobic exercise.
If fatigue is a problem for you, you may want to focus on exercise to strengthen your muscles, or resistance exercise. It is important to acknowledge, both when exercising and in daily life, that it is not a good idea to 'work through' fatigue - you may end up feeling worse, often for days afterwards.
Temperature can also affect fatigue. Everyone can feel drained of energy in hot or humid weather, but with MS the effect is often exaggerated. See the tips above for ideas.
Choose an exercise that does not require extra effort for you. If you have problems with balance, choosing swimming or aqua-aerobics would allow the water to support you as you exercise.
Using a recumbent bike or stepper rather than an upright one can lessen fatigue. You will be using less energy to just stay on the equipment and be able to focus on getting benefit from the exercise itself.
If your mobility is limited, you can still get meaningful exercise, even without leaving the house. We have developed a series of exercises in partnership with specialist neuro-physiotherapist Liz Betts. These require no special clothing or equipment, and you can fit them in around your day.
You might find it difficult to make yourself breathe deeper and get your heart rate going if your balance is not so good or your legs tire very quickly. There are things you can do sitting in a chair.
Seated jogging: Get your arms and legs pumping as if you are running but stay seated. Even if you keep going for just one minute you will find your heart rate has gone up and you are breathing deeper. You can also split your arms and legs so that you can simply 'arm jog' or keep your arms still and 'march' with your legs.
Punching: Punch your arms alternately forward or upward. This one is good if you are feeling a bit stressed - you can imagine all sorts of people or situations that have made you feel a bit fed up and punch them away!
If you have MS, it might take you longer to recover from exercise than someone without MS. You have to learn to listen to your own body and be honest with what it is telling you.
The attitude of 'no pain, no gain' does not apply in MS. Whilst someone without MS can push themselves to exhaustion and then recover within half an hour, a person with MS should be prepared to stop before their body is telling them they have reached their limit.
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!
As you get used to exercising, you will likely find that your recovery rate improves.
There is a well understood connection between exercise and mood. Being active helps with symptoms of depression and low mood. However, it doesn’t take much to put any of us off doing exercise. Feeling low or fatigued might mean you avoid exercising, even though you know that it will help in the long run, and that you’ll feel better for it afterwards.
It could take some effort to get yourself past the mental barriers that are stopping you exercising. This is normal, but it will get easier once you start to feel the difference that exercise is making to your life and your MS.
Do speak to your doctor or MS team if you are struggling with depression or fatigue. They may be able to help you.
Some people find that not thinking about it, and just doing it helps. Have your bag ready packed for the gym, so you can just pick it up and go. Wear comfortable shoes so that you don’t have an excuse not to go for a walk. Encouragement from family or team-mates can help too.
The positive benefits of exercising do wear off if you stop. It is important to find exercise that you enjoy doing because then you will keep it going. It is also useful to think about the reasons why you might give up on exercising once you have started.
Everyone is individual and some people like to exercise in a group setting - in a class or as part of a team. Others like to work individually, maybe at the gym, swimming pool or at home. Find what is right for you.
- Set sensible targets. You might lose motivation if you don’t achieve your goals in a reasonable timeframe. Start small and then you can increase the challenge later.
- Other people can help keep you motivated. You might like to join an exercise programme, class, or an online community where you can share your goals and motivate each other. If you prefer to exercise alone, tell people about your targets and ask them to support you.
- Don’t worry if you miss a day, everything counts. Take pride in what you have achieved, and don’t be too hard on yourself if you get set back.
- Boredom is a real issue for many people. You might get tired of doing the same activity week after week, so be prepared to add some variety to your routine.
- Use an app or gadget to make it a game, maybe counting footsteps or distance travelled. Challenge yourself to improve a little each week. Start gently and build up gradually.
- Find a good time of the day or week to exercise. Build exercise into your daily life, like allowing extra time to walk instead of taking the car.
- Do it for a good cause! Raise money, awareness or just do something to make a difference, like picking up litter when you go for a walk or jog. You’ll find you keep going when others are counting on you.
This happened to me: Finding motivation
Helena writes: On a wet, cold day, I really don’t want to get out and run. I just want to curl up back in bed. But when I drag myself out, I do feel better later. I just have to remember that next time!
Getting exercise into your daily routine
Staying active doesn’t have to involve special clothes and equipment. Anything that makes you breathe a bit deeper and gets your heart rate up counts as ‘exercise’. It could be dancing, swimming, gardening or walking.
You can make small changes to boost your cardiovascular fitness - perhaps walk faster for part of your regular route (between landmarks such as seats in the park or shops on the High Street), climb the stairs instead of using the lift, dig the garden a bit more vigorously. The increase in speed or effort need only be for part of the activity but you should be aware of breathing deeper and feeling a bit warmer from the effect on your circulation.
It is good to have a trigger to remind you to exercise. Maybe do one of these exercises when the adverts or weather come on the television, or when waiting for the kettle to boil. Exercise in short bursts will still make a difference to your fitness.
When you start your programme, pick out a couple of exercises that you know you will be able to do and build up gradually. At first you could pick maybe two exercises and do them every day at least once - perhaps in the morning and in the afternoon. Then pick a day in the week and a good time in the day. Select a few more different exercises and go through a longer programme.
There's no point in setting your target so high that you will not be able to reach it. You may find you can do more repetitions of each exercise but it is sensible to start with a low number and build up gradually. When you want to increase the number of exercises only add one or two repetitions for at least three days before you do anything more.
Make sure you check how you feel - especially for signs of increased fatigue - before challenging yourself further.
Finally, when you are exercising, it's important to breathe! A lot of people hold their breath when they exercise and that's not a good idea!
- Med Sci Sports Exerc. 2018 Apr;50(4):643-648 Summary Cold Water Ingestion Improves Exercise Tolerance of Heat-Sensitive People with MS.
- Clinical Therapeutics 2018 Jan;40(1):16-25 Full article (external link) Exercise as a Countermeasure to Declining Central Nervous System Function in Multiple Sclerosis.
- Rehabil Psychol. 2018 Feb;63(1):104-110. Summary Do multiple sclerosis symptoms moderate the relationship between self-efficacy and physical activity in people with multiple sclerosis?
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