16 Things To Remember When Exercising With MS

Exercising with MS can be tricky. You don’t know where to start, what to do, what’s good for you, what’s bad for you. You know you should be exercising but sometimes you feel a bit clueless. You can get help, guidance  and support in my Facebook Group, but before that, check out these tips!

Below I’ve tried to summarise some simple guidelines for people with MS in all stages of the condition.

  1. Start ASAP! The best time to exercise is as soon as you’ve been diagnosed. Not easy when you’ve just received such bad news and it’s understandable that you may want to hide away and escape your emotions, but the biggest challenge I face is working with people who’ve been diagnosed and done nothing to counter the progression of the illness, leaving them in a far worse state than they would have been if they’d trained regularly since their diagnosis.
  2. Employ the 80:20 rule. By this I mean that 80% of your exercise should be resistance (weight training) and 20% should be cardiovascular. Too often people who do seek exercise after a diagnosis go straight to the treadmill or exercise bike. These are both good for you but you really need to focus on exercises which promote muscle growth or maintenance as that’s the area where the condition will affect you the most.
  3. Allow recovery time. As with any fitness regime, you should factor in sufficient recovery time between workouts, however you may require even longer. A good way to manage this is to break up your muscle groups and work each separate muscle group once a week.
  4. Align your diet with your activity levels. If you are particularly active, you’ll need to eat more fuel. If you spend most of your time in a wheelchair it’s likely you’ll need far less fuel so reducing your portion sizes or number of meals per day might be a sensible option. The main indicator is your waistline. If it’s getting bigger you’re eating/drinking too much. If it’s getting too small or if you’re low on energy you may be eating too little. (sorry, I appreciate the irony of the phrase “low on energy”)
  5. Build Strength prior to a relapse. The best preparation for a relapse is to increase your strength and muscle mass before it occurs. That’s why I encourage the 80:20 rule 😉
  6. Rebuild strength after a relapse. Don’t leave it long before you recommence your training regime after a relapse. your aim should be to try and get back to your former strength levels, or improve upon them if you can.
  7. Be consistent! Perhaps everyone’s biggest challenge? Consistency is one of the three main drivers behind improvements in health and fitness. There’s no point doing a few weeks of intense training followed by a few weeks of nothing. Make it a habit. Except when you’re having a relapse. You’re allowed to take a break then 😉 – but note point 6!
  8. Aim to progress!  The 2nd of the three main drivers behind fitness improvements is progression. When you train, you should be trying to improve upon your last performance. Lift more weight, do more reps, cycle faster or for longer. Progression is what make sour bodies adapt. Don’t let MS make you believe that you can’t improve. Unless you were at peak fitness in the first place, there’s always room for improvement – with or without MS.
  9. Don’t ignore weak muscles! You should probably focus on them actually. If there’s an imbalance between left and right, it’s sensible to work each limb individually but be sure to work each part of the body to it’s full potential.
  10. Use adaptive apparatus. If you struggle with grip for example, you can try dumbbells with velcro straps, wrist weights or grip assist bands for pulling exercises. One of my clients uses these to help with lat pull downs and seated rows in the gym. I even use them when I’m deadlifting. Need to work on my grip strength!
  11. Improvise! Sometimes you need to think out of the box a little. With one client who has limited leg strength, I use her son’s skateboard as an exercise. No, I don’t send her skateboarding around the park. She sits in her wheelchair with her foot on the skateboard and pushes it back and forth. It’s a small but significant way to get some activity though her lower body muscles.
  12. Don’t ignore the core! Working the core is always important – if you don’t know that, where have you been for the past 15 years? However it’s particularly good for helping with bowl movements in situations where you may be slightly constipated, and helps with seating stability if you’re using a wheelchair.
  13. Practice moves which help transference. Getting from wheelchair to bed or the sofa can be challenging so ensure the correct muscles are being worked by doing tricep dips or other “pushing” exercises.
  14. Watch your weight! Equally, getting from one place to another becomes increasingly difficult if you’re carrying unnecessary weight. Keeping your body fat levels low ensures that you’re as light and efficient as possible and should help you remain mobile for as long as possible.
  15. Regulate your temperature! Having MS often means that you’ll have a super tight temperature window in which you feel comfortable. Manage your recovery periods carefully to allow cooling time between exercises. If it’s cold outside, take a break outdoors to cool down for a sec. Make sure you choose clothing which has moisture management properties (Dri-FIT, Climacool etc.) and drink plenty of water! You can try and lurk under the air-con between sets, and finally, taking a wet towel into the gym with you can be a great way to cool you down too!
  16.  Last of all, remember that in most cases, the same rules of fitness apply for everyone! You may just need to think outside the box and adapt the principles a little.

If you found this helpful, I provide more info in my Facebook group where you can ask questions, gain advice and support from others in a similar position, get regular updates from me and notifications of any new posts I write.

I’m also working on an online fitness programme for people with MS to use in the home or gym. I use the Facebook group to gather feedback on what aspects people would most like to see in the programme. If you think you have some valuable input, I’d be very grateful to hear it. Join my Facebook Group here.

p.s. don’t forget to share or tag people in the original post. The more people I can help, the better!

The same rules still apply to all people, disability, or no disability.

One of the things which struck me when I first started personal training for disabled people was their attitude towards fitness. There was a lack of awareness overall. The simple concept that “the same rules apply” wasn’t getting through to people.

Everything I preach is based on simple rules:

  • Weight is gained when more fuel is consumed than necessary.
  • Weight is lost when less than the required amount of fuel is consumed.
  • Muscles grow in size when they are stressed to the point of failure.
  • Strength increases when heavy loads are pushed or pulled.
  • Stamina increases when they body is worked for longer than is comfortable.
  • Flexibility is increased when muscled are stretched to their limit, repeatedly for longer periods of time.

The rues are the same, but sometimes they way you achieve them differs. All of the common exercises are designed with able bodied people in mind. The point of the exercise remains the same; To achieve one of the above goals. But sometimes we need to start with a blank canvas to figure out new, bespoke ways to cause the desired effects. The end goal is the same and all it takes is a little thought and consideration.

Tips for Exercising with a Disability

Extracted from my interview with Disability Horizons

What things do you need to consider when training someone with a disability?

When training someone with a disability you really need to think outside of the box. The same fitness principles apply, but you can’t just dish out the usual tricks. An obvious example is the fact that a wheelchair user can’t simply go for a run, and many people think that running is the only form of cardiovascular exercise out there. In these cases, it’s about working out ways to raise the heart rate without using the legs. Often a simple circuit switching between abdominal exercises and upper body exercises can achieve the same result.

Sometimes it’s about taking a step back and working on simple movements, such as standing up from a seated position. For those with a weak lower body this is a great exercise and, when done in the right quantity, can work on both strength and cardiovascular aspects of fitness.

In many cases, fitness training is simply about showing people that they CAN do exercise despite their disability. The first thing I try to do when meeting someone is focus on what they CAN do, not what they can’t do.

What advice do you have for disabled people who wish to be fit and healthy, but don’t know where to go or where to start?

For disabled people who wish to get fit and healthy, the biggest thing to remember is that there’s always something you can do. Whether it be related to exercise or related to diet and lifestyle. You just need to follow the basic principles of health and fitness and make them work for you.

And if you’re really stuck, look for local classes for people with similar conditions, or try to locate a suitably qualified personal trainer.

What are your top exercise tips for disabled people?

Cardio doesn’t mean just running! Anything which gets your heart rate up is a cardiovascular exercise. It can be done with weights, arms, abs, legs or a combination of all of those. It just needs to be consistent or repetitive. The higher the heart rate, the more fuel you will burn.

Focus on strength exercises 50% of the time and cardio 50%. Often people either focus on purely cardiovascular fitness such as running, handbike etc, or the other extreme and just do weight training without a cardiovascular aspect. Your health will benefit more if you do both strength and cardio. Cardio keeps you alive and healthy, limiting the risk of cardiovascular disease. Strength keeps you strong, functional and helps prevent weight gain and boosts your immune system.

Remember the fundamental rules – and the same rules of health and fitness apply to both disabled people and non-disabled people.

These are:
a) For weight loss, burn more fuel than you consume and vice-versa for weight gain.
b) For strength gains lift more weight than you are used to lifting.
c) For endurance perform an activity for longer than you are used to doing.
d) In every case, you must progress. Doing the same thing repeatedly won’t result in any increase of fitness. Go longer, lift more, move faster train more frequently.

What are your top 5 tips for keeping fit and healthy?

The right diet! If you have excess body fat it’s because you’re eating/drinking more than you need or you have done in the past. Diet is for weight control, exercise is for fitness.

Book regular exercise sessions into your diary. It’s far more likely that you will be consistent this way.

Carry out a varied workout. Weights and strength should make up as much if not more of your regime than cardio.

Be consistent. Exercise is a way of life. It’s not something you pick up and put down when you’re feeling in or out of shape.

Find someone to train with. Whether it’s a friend, family member, work colleague or a personal trainer. You’re far more likely to succeed if you have a companion.

Exercising with Early Stage Multiple Sclerosis

I’ve got early stage MS. I know I need to exercise, but I don’t know what to do.

MS can be a very cruel condition with an outlook which is less than optimistic, but what can you do to minimise the impact of the illness? In the following text I hope to show you what to do and why it’s important that you get it right.

Firstly, exercise for someone with MS is as important, if not more important than it is for everybody else. I say that, but really it is far more important. You need to do it right because I see far too many medical professionals telling people who have recently been diagnosed with MS that they need to “exercise” without any guidelines on what type of exercise to do.

Without the right guidelines, many people head straight for the treadmill or the exercise bike. This seems logical but it’s not where your focus should be.

Don’t get me wrong; cardiovascular exercise is as important for somebody with MS as an individual without, but the areas which need most attention are strength and hypertrophy (a term used to describe increases in muscle mass).

Whether you have remit/relapse MS or progressive MS, the effects of both can be controlled to some degree with a good weight training regime to encourage muscle growth/maintenance and in turn strength gains/maintenance. I say gains/maintenance because at times you may be gaining strength & muscle mass and at other times it may be about limiting the loss of strength and muscle mass.

Why weight training over cardio?

Cardio vascular exercise or cardio for short, is a term used to describe a workout for the heart (cardio) and blood vessels (vascular). The heart works hand in hand with the lungs so consider it a given that increasing the strength of your heart and circulatory system will increase the strength and performance of your lungs. Cardio can consist of any exercise as long as that activity requires enough fuel to increase the heart rate to a level at which it is not used to performing. A common misconception is that cardio means only running, cycling, cross training or other such repetitive movements. All of those forms of cardio require good leg control but if you have MS you may not have good leg control. That’s not to say that you can’t do cardio though. Remember, I said that cardio is any activity which encourages a high heart rate. It’s often more about how you perform the exercise than the type of exercise you do. For example, perform a range of upper body weight training exercises in a row without breaking between sets and your heart rate will go through the roof!

Yes, a healthy heart and lungs is good for anyone, but with MS the real challenge lies in keeping the limbs and core strong enough to perform everyday tasks. The best way to do this is through weight training or what we call in the industry resistance training. Cardio will offer mild strength gains in the areas of the body which come under the most stress but lifting weights or resistance training will offer far better results when managing every day activities is your goal.

Again, the above is still too little information to really help someone who is just starting out. We need to look at what areas of the body to work, how to work them and how frequently to work them. Weight training can be done in many different ways to work towards many different targets. So we need to focus on using strength and muscle gain techniques in the gym or home or whatever environment you choose. What you do may also vary depending on which part of the body you’re working, and how much control you have over those muscles. I’ll try to make the following explanation as simple as possible.

In my opinion, the first rule of weight training is that you should always be chasing. That may sound like a quote from a sales bible, and it probably is, but its true in the gym too. By this, I mean that you should always be trying to do more than you can currently do. The body doesn’t just get better at stuff unless you actively try to get better at stuff. A simple example would be to say that if you can lift a 10kg weight ten times, you should be trying to lift it 11 times, or trying to lift 11kg ten times. If you can do that, it’s too easy so you should be trying the next level up. You keep chasing until you reach the point where you can’t achieve what you set out to do. Once you reach that point, you keep trying until it becomes possible. This is what makes our bodies change. They respond to the stresses we put upon them.

If you’ve just been diagnosed with MS or are experiencing it in its early stages you’ll want to focus on increasing strength and muscle mass so that if and when it does hit that particular area, you are starting from a higher place, thus reducing the deterioration of strength and muscle mass.

Any muscle which isn’t being used reduces in size quickly and significantly. If a neurological disorder strikes to the point where muscles can’t be controlled, those muscles will shrink. We call this atrophy and with atrophy comes further reductions in strength. If the neurological control comes back, the muscle remains in a weaker state due to its reduction in size. So by starting with bigger and stronger muscles, the loss in size and strength will be offset slightly compared to someone who already had small and weak muscles.

So build muscle mass and strength during the good times. Keep working the muscles as much as possible during the bad times and focus on regaining strength during remission periods.

Avoid passive exercises as they are likely to be a waste of your time. By “passive” I mean exercise machines which do the work for you. If you are on an automatic bike which is moving your legs for you, it’s not helping you get stronger. If you are in a standing machine which holds you in an upright position, it’s doing the work for you, not helping your muscles gain the strength you need in order to stand up. You need to be doing exercises where YOU do the work. You need your own neurological system to be making your own muscles contract. That’s the only way to make progression. There is one exception here which is the electronic muscle stimulators. These cause your muscles to contract by sending an artificial signal to the muscle. This will help the muscle but not necessarily the neurological system. Only worth using in scenarios where you have absolutely no control of your own in order to encourage muscle growth.

Functional movements which encourage stability are essential. The less we do the worse our balance gets anyway. Couple this with a neurological disorder and we’ve got problems. So think about what kind of movements require stability as well as strength because the way the muscles work for each discipline are different. Lunges, single leg deadlifts, kneel-to-stand are all good examples of exercises which will challenge you in terms of balance.

Summary:
• Build muscle mass and strength during the good times
• Keep working the muscles during bad times
• Regain strength during remission periods
• Work weak muscles as regularly as possible
• Train strong muscles 1-2 times per week
• Always lift as much as you can for a given number of reps
• Stick between 6-12 reps at 3-5 sets (the fewer reps, the heavier the weight and the more sets)
• Recover for between 30 seconds and 3 minutes between sets (the fewer the reps, the longer the recovery)
• Avoid passive exercises (they won’t make you stronger)
• Work on exercises which require stability

Adhere to the above rules and you’ll really feel the difference.