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

Henriette Poulsen is a physiotherapist who spent ten years working at an MS therapy centre, before returning home to her native Denmark. In her blog, MS ideas and exercise, Henriette answers some common questions people with MS may have about exercising.

Fortunately, we are long past the time when exercising with MS was not recommended. However, there are still many issues in relation to exercising when you have MS, and fatigue is one of them. 

Fatigue is a common problem for people with MS. The thought of exercising can seem overwhelming if a large part of your energy is already spent on the daily hamster wheel with things like family or work. This makes it all the more important to keep in mind that exercise actually helps. Research shows that those who exercise on a regular basis are less tired. In the long run, exercise will give you more energy. Of course, you may need to adapt and listen to your body but try not to lose sight of the future gain.

There may be certain types of activities you can plan for good days, while on the less good days, your plans will be different with a less intense routine. Spend some time finding an activity that you like and try to ask yourself, “Why is it important for me to exercise?” What would it mean to you if you had more energy? What would you do with it?

It depends on your exercise goal and why you fall.

If the goal of the exercise is to get better balance, feel free to challenge yourself at exercising while standing – but it must be safe for you!

• When exercising in a standing position, make sure you are near something sturdy, just in case you need to hold it or grab it. 
• Pay attention to the surface you are standing on. Does it require too much of you? 
• How can you make it easier for yourself so that you are still challenged, but within a safe context?

Be aware that activities that challenge you on various elements at once, will be much harder. During physio, you may have been asked to count backwards from 100 while balancing on a wobble board. The added cognitive element will challenge your balance much more than if you were to concentrate only on balancing. This does not mean that it is a bad exercise – it just needs to be performed in a safe environment.

Some physical movements will require more of your balance than others. Exercises that involve rotations of the body or challenge your vision come to mind. When performing these sorts of exercises, don’t forget to take breaks. Otherwise, you might fall due to fatigue. 

Of course, there are benefits to exercising in a standing position, such as strengthening the bones through weight-bearing and reducing spasticity, but it must be safe. When home exercising, I would advise being more careful with your own safety, whereas when you are with a physiotherapist, you can more easily be challenged to a higher degree. In any case, consult your local physiotherapist, who knows you well. 

Some exercises may be more targeted towards cardio, flexibility, or strength training. If that is the case, you may benefit from exercising in a sitting position if you feel insecure standing. You could try things like seated Zumba or Pilates for example. In any case, allow yourself time to try out different types of exercise and activities. It can take time to find what suits you in terms of personality, symptoms, and mobility.

You’re not alone. I know many people who only remember to exercise the night before they see the physiotherapist, if at all. Try to make it as easy as possible for yourself. You could:

• Set an alarm on your phone to remind you when it is time to exercise
• Put up a picture of your exercises in a place where you see them regularly
• Try to build your exercises into your usual routines or habits. For example, could you do a static wall squat while brushing your teeth?

You might also benefit from an exercise friend. This could be someone you exercise with, either in person or online, or be more of a motivational partnership. For instance, you could send a text asking how many high knee lifts your friend reached today. 

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