Considerations for fitness professionals
Maintaining a safe and effective workout is important. When working with a student with MS take these things into consideration:
- An exercise class or personal training is not intended to replace rehabilitation therapy.
- Frequency, intensity and time (FIT) considerations are important—adjustments to these parameters will help individuals achieve their goals.
- Plan flexible rest breaks to avoid excessive fatigue or overheating.
- Provide a cool, well-ventilated environment.
- Be prepared to repeat instructions for those who may be experiencing cognitive problems.
- Remember that the student’s symptoms of MS may change from one session to the next; adjust exercise programs accordingly.
- Should a student fall, notify appropriate staff before attempting to assist. If in a group setting, make sure other participants maintain a safe space and do not attempt to assist.
Keeping your student motivated
Consider how determination, motivation and self-discipline can help individuals stay on track. Often, people become frustrated by a lack of results from fitness programs and may lose desire to continue. Many people begin fitness programs with unrealistic goals and expect quick results. To prevent frustration, explain to your students how the body works and the time needed for changes to be noticed.
Encourage your students to seek out new ways to maintain interest in fitness, so that fitness becomes a way of life, and to set realistic goals with rewards when they are achieved. It can be difficult to stay motivated and committed to exercising, despite good intentions. Tips for a successful fitness program:
- Make it fun. Taking part in enjoyable activities that are appropriate to the student and relevant to his or her goals will ensure commitment to an exercise program and will maintain motivation. Provide opportunities in class for students to interact with one another and encourage a workout buddy. In addition, vary the routine in order to prevent boredom and plateaus.
- Stay cool and keep hydrated. Ensure students drink water before, during and after a workout to avoid dehydration. To avoid overheating, working out in a cool environment, wearing cool breathable clothing, and using cooling devices can help.
- Provide a challenge. Over time the body conditions itself for a particular activity. When a workout is no longer challenging, students should gradually increase the intensity of a workout to continue to improve strength and endurance when it is no longer challenging. A student can increase the duration of a cardio workout in small increments (add 2 minutes to a walk) or increase the intensity to a strength training program by adding repetitions or sets (3 sets of 10 repetitions to 3 sets of 12 repetitions).
- Make it complete. Fitness is more than just a cardiovascular workout. Make sure all aspects of fitness are incorporated to make a well-rounded exercise program. Aerobic activity should be done at least two to three times a week, strength training at least twice a week, and flexibility and relaxation should be included throughout the week.
- Start slowly. Doing too much too soon only leads to sore muscles and unwillingness to do the same routine again. If a workout causes soreness, then too much is being done. Tell your students to work out for a shorter time, use less weight or decrease the intensity, and over time gradually add more. Educate them on the difference between pain and discomfort that arises from muscular effort.
- Listen to the body. Remind them to challenge themselves but to pay attention to their body and adjust a workout accordingly. Each workout may be different due to variable symptoms, time of day, how each person is feeling that day or possible injuries. If an activity elicits or aggravates an existing symptom, students should stop, rest, or modify the activity.
- Pacing. During any strenuous exercise it is important to work at a level at which one can still breathe and talk. Students should assess their body throughout an exercise session to avoid overexertion, which can result in extreme fatigue lasting for up to a few days.
- Make fitness a habit. Working out must be thought of as a “life-long” habit and a behavioral change. You would not consider brushing your teeth as an option, so encourage your students to treat exercise as another part of their daily routine.
- Set realistic goals. Work with your students to begin with a basic program, including all components of fitness. Students should set short-term goals that are attainable, and then set new goals when those have been reached. Recognizing when students are improving and maintaining progress on their fitness goals will help build confidence and promote motivation over time.
- Exercise throughout the day. An hour block of time for exercise can seem overwhelming or even impossible so encourage students to be active throughout the day. Research has shown that you can see benefits when exercising three times a day in 20-minute increments. Adding exercise to daily activities, like taking the stairs, doing calf raises while standing in line, tightening your glutes and thighs at a red light, commuting to work on foot or by bike (including adaptive cycles) is an easy way to incorporate activity in small increments that together count toward a total fitness program.
If an individual is having difficulty initiating or maintaining an exercise/physical activity program, recommend that they consult with a healthcare or fitness professional with expertise in MS who can provide specific exercises to increase success and adherence. Always remember, of course, to recommend that people consult with their physician if they have any questions about whether a new exercise program is right for them or if their symptoms change.
Common barriers to exercise adherence
A variety of barriers prevent individuals from starting and/or continuing an exercise program and enjoying the benefits. The following are the most common barriers for people with MS. Learn more about these barriers.
- Fatigue- Fatigue can be either primary- caused by demyelination and the slowing nerve conduction in the central nervous system- or secondary, caused by deconditioning, poor sleep hygiene, or inadequate nutrition among other factors. Fatigue can impact performance within a work out session or when comparing effort from the current work out session to a previous session. This may result in slower exercise progression. Increased rest between sets of weightlifting, for example, may be required.
- Heat Sensitivity- Having the client sustain a cooler core body temperature can help to improve workout performance. This can be achieved by cold beverages, cool environment, fans, and some of the MS specific cooling products.
- Equipment - Standard gym equipment may not suit the needs of all clients with MS. There may be considerable variability in mobility abilities. For examples, some people may use a walker, cane, or a power wheelchair for mobility. Consideration must be giving to the ability of equipment to be modified.
- Limited Energy- The energy required to get to the gym, walk to the equipment and navigate between machines may be a significant workout for some people with MS. These distances and the fatigue that they may pose to the client should be calculated and included in the workout
- Transportation- The ease and access of transportation to and from the gym needs to be considered.
The Americans with Disabilities Act of 1990
established basic civil rights for people with disabilities, especially in the areas of employment and public accommodation. If you are serving people with MS, every effort should be made to assure that access and safety are assessed. Ramps, wider doorways, accessible bathrooms and other accommodations help those with disabilities who use mobility equipment such as walkers, scooters or wheelchairs to take advantage of your services.
Accessibility is very important not only to provide access to individuals with varying mobility difficulties, but also to minimize the risk of injury to all individuals within the facility. In addition to the accessibility of a facility, be sure to think about the location of a class within the facility, the distance from the parking lot to the room, location to restrooms in relation to work-out location, and the temperature of the facility. Within a specific space or class, teachers should be mindful of the location of restrooms, drinking fountains, chairs, phones, alarms, etc. in order to direct students immediately should they be needed.