Many individuals with MS experience some hesitation and ambivalence about attending an exercise class or facility, either for the first time or when symptoms might be impacting their ability to move freely. When working with individuals with MS it is important to help them feel comfortable and welcome regardless of their limitations.
Important reminders for participants at the beginning of each class:
- Encourage participants to advise the instructor about medications being taken that could impact attention, balance, memory and concentration.
- Classes are not competitive in nature. Each participant needs to know his/her own limitations and to exercise at his/her own pace.
- Short breaks during the class are appropriate and recommended.
- Encourage any person who experiences new challenges with their exercise routine or who has an increase in symptoms to consult with his or her healthcare provider.
Start by asking your students how they are doing, symptoms they are experiencing and anything with which they anticipate needing help. These questions may be a good place to start.
- Could you please describe the typical amount and types of exercise per day or week you have engaged in during the past several months?
- What types of symptoms are you experiencing today?
- What limitations do you think MS imposes on your participation in an exercise/movement program (e.g. fatigue, heat sensitivity, numbness and visual disturbances)?
- What do you think you many need extra help with or attention to today?
- What concerns do you have?
- Are there any exercises that your physician has cautioned you against doing?
- What are your short-range and long-range goals in designing your own personal exercise program?
- What is your favorite exercise format (group classes, individual classes, walking or tread mill, self-motivated individual gym regimen, swimming, yoga, etc.)?
Functional levels and movement modifications
The following levels are intended to assist in designing exercise programs and class formats that address the needs of a group with mixed functional levels.
As a general guide most of your students would probably fit into the first two levels, however, it is important to understand and feel comfortable making modifications across a range of ability levels. It is important to remember that symptoms of MS are different for each individual and may change daily or weekly. Many common symptoms, including fatigue, heat sensitivity, numbness and visual disturbances, can fluctuate considerably over the course of a day, week or month.
Level 1: These individuals may have no symptoms or mild symptoms. They will generally walk independently or use a cane. However, they may be experiencing symptoms that are not outwardly visible to the instructor.
Level 2: These individuals have more motor-physical limitations. Symptoms may also be affecting postural alignment. They may be more dependent on assistive devices such as walkers and wheelchairs for mobility. They have good transfer skills, but may need additional help getting into a chair, onto the floor, or into the pool. They may require assistance with balance while participating in a class.
Level 3: These individuals have greater functional impairment and may experience paralysis and spend most of their time in a wheelchair. These participants may need personal attention and may require an assistant.
In general, exercise at low or moderate levels of intensity are best tolerated by people with MS. This means that the time spent performing an exercise may be gradually increased while holding the intensity at a stable level. This may help reduce early fatiguing, overheating and possibly reduce the risk of fall and injury. When people with MS begin to feel fatigued, it is generally better to heed their body’s signals of exhaustion and shift to a cool-down phase of exercise, or non-fatiguing exercise, rather than trying to push past their limit of endurance. Gradually increasing an exercise program over several months will allow more physical activity without more fatigue.
Be sure to discuss any specific limitations with each student if possible so that they can modify the movement to best meet their needs. Should you see changes in an individual’s functional level, consider a discussion with your student to connect them with the appropriate rehabilitation professional.
Because MS impacts each person so differently, there are a variety of considerations to take and ways to modify activities. The following table
discusses how symptoms may impact exercise and considerations for modification and movement.
Equipment usage and analysis
Equipment can enable an individual to complete a movement action or position, when range of motion, flexibility or individual symptoms would otherwise prohibit it. In this way, full benefits of the exercise or position are achieved without stress, strain or injury. Equipment can also be used to increase or decrease intensity and add challenge or variety to activities. Certain equipment and/or modifications may be required one session and not the next session for reasons such as fatigue or spasticity. This may be normal and necessary to help the participant successfully engage in the exercise.
An important first step in selecting the appropriate exercise equipment is to determine the needs of the student. Next, evaluate specific pieces of equipment to determine which type will best address these needs. Consider the following:
- Establish intended use/application
- Assess for correct body mechanics during use
- Assess fall risk and identify other contraindications/risks
- Determine benefits
- Determine the ability of the client
- Identify tool limitations (cost, availability, intended ability level, etc.)
- Determine desired action or benefit you wish to impart
Once you have made a selection, knowing how to use it correctly is essential. Equipment that is effective as an exercise tool can also be ineffective and damaging when used inappropriately. When used correctly, exercise equipment can be an excellent tool for modification/adaptation or intensification of movements.