MS and exercise: part four - a Q&A with physiotherapist, Henriette

In this final post from her blog series, Henriette Poulsen is answering some common questions people with MS might have about exercising. Henriette is a physiotherapist who spent ten years working at an MS therapy centre, before returning home to her native Denmark.

It is never too early to start exercising. I’ve worked with many patients with MS who thought that I had other, more important, patients to do physio with. Of course, different people will need a different approach to exercise depending on their mobility and goals but that does not mean that early intervention is not important. 
If you’re newly diagnosed, you may choose to only see a physiotherapist at certain times or even want to take full responsibility for your own exercises for a period of time.

It depends on your goal. For example, if your goal is to walk 20 metres without a break, start by measuring how far you are able to walk comfortably at the moment. Regularly walk the distance that you can comfortably do and every time you finish, note how you feel afterwards. This might be with a few written lines and/or an emoji. When you feel ready to try a little more, gradually increase the distance. Remember to continue recording how it went so that you know when you are ready to increase the distance again.

You can also try other methods for measuring progress. Why not walk the 20 metres and record how many breaks you needed? The goal will then be to lower the number of breaks over time. 

Another tip is the use of a visual analogue scale. It is a line with a numerical assessment that is often used to detect pain. However, it can also be used in relation to other areas such as satisfaction, self-confidence and exertion. If you have a specific route that you often walk, you can measure the effort that the route requires, on a scale from zero to 10. How hard was it for you to walk the route in terms of effort? Plot it down on the line. Once you have done this for a week, you will get a picture of your performance over time. If you feel ready, you can increase the route. Use the scale to assess whether you increased the distance too little or too much but keep in mind that progress is not linear and you will get some fluctuations. 

Regardless of how you measure your progress, remember that there will also be bad days where you cannot walk as much as you would like. Allow room for them. By keeping a record, it helps you to decide if you are pushing yourself too much or too little. Do keep in mind that maintaining skills can also be a goal.

It’s never wasted effort to exercise, no matter how small an amount you do. In this case, it is perhaps even more important to write things down and be specific. That way you know what you are working towards and you will be able to enjoy even the small successes. 

If you are emptying the dishwasher, for example, start with a sub-goal such as putting the cutlery away. Then you can increase your target to something like putting the plates in the cupboard. 

Keep in mind that failure can often lead to progress. If you fail to reach your initial goal, then the goal may be too difficult for you. Try to look positively at this – you now have the chance to adapt the goal and another chance to reach it. If you can shift your perspective to focus more positively, it will be easier for you to deal with small mistakes. For example, if you are exhausted for days due to your exercises, then you are not doing anything good for your MS. Learn from the mistakes and change your goal so that you can work towards it more easily.

For more of Henriette’s tips and thoughts on motivation take a look at her blog MS ideas and exercise.

• MS and exercise: part one - a Q&A with physiotherapist, Henriette
• MS and exercise: part two - a Q&A with physiotherapist, Henriette
• MS and exercise: part three - a Q&A with physiotherapist, Henriette
• MS ideas and exercise - Henriette's latest blog post