Exercise and physiotherapy - MS Society UK

Second edition, January 2011 Reviewed September 2013

21

MS Essentials For people living with MS

This publication is available in large print (22 point) and audio CD Call 020 8438 0799 or email [email protected]

Exercise and physiotherapy

Everyone benefits from being physically fit, including people with multiple sclerosis (MS). However MS affects you, there are exercises that can be helpful – to stay as healthy and fit as possible and to improve some of your symptoms and their effects. It is not always easy to find the time, but exercising regularly will keep your body working to its full potential. To make it easier, it is important to find exercise that suits you – something you enjoy and find worthwhile. MS affects each person differently and you will have your own likes and dislikes. While one person enjoys classic sports, another may prefer t’ai chi or yoga. All kinds of physical movement can be of benefit. Even gardening, cleaning and walking short distances use your muscles and help you to stay fit.

Contents 02 The benefits of exercise 03 What sort of exercise should I be doing? 05 Are there precautions I need to take because of my MS? 07 How can a physiotherapist help? 09 Exercises for specific MS symptoms 11 How can I fit exercise into my life? 12 Times when you may not be able to exercise 12 Exercise for those more severely affected by MS 14 Further information

Physiotherapy can also be particularly useful to help you find exercises that meet your specific needs and abilities. A physiotherapist may suggest exercises that concentrate on a particular area of the body that you wish to improve, or help you manage a specific effect of your MS. However MS affects you, appropriate exercise can make a difference to managing and living with the condition.

Learn a range of gentle exercises and stretches with our Exercising with MS DVD – presented by former Olympic champion Sally Gunnell OBE. Watch online at www.mssociety.org.uk (search ‘exercise’). Order your free copy from shop.mssociety.org.uk or the Information Team (020 8438 0799).

Getting fit and keeping fit helps the body and mind to stay as healthy as possible. This is true for people with MS who have milder symptoms and for those who are more severely affected. And there is no evidence that exercise makes MS worse in the long term, or that exercising causes relapses.1, 2 In fact, research has suggested the opposite – that exercise can: •

improve the overall health of people with milder MS

•

help people with more severe MS to stay as mobile and active as possible 1

What sort of exercise should I be doing?

There is no single exercise that could be called an ‘MS exercise’. MS affects people in different ways, so what’s suitable will vary from person to person. You may find that what you want from an exercise regime changes over time. Whatever exercise you choose, be careful not to overdo it. The types of exercise listed below help the body keep fit in a variety of ways. For the kinds of exercises that may help specific MS symptoms, see page 9.

1

•

improve walking mobility in people with MS 3

•

help some people manage their MS symptoms, such as fatigue, muscle stiffness, balance difficulties, anxiety, depression, and bladder and bowel problems 2, 4, 5

•

decrease the risk of heart disease

•

Strengthening exercises include lifting and moving small weights, but can also involve using the body’s own weight to strengthen muscles and bones. If you have tremor or spasms, pulling against an elastic exercise band might be easier than using weights.

•

Aerobic exercises, such as cycling, running or rowing, use many different groups of muscles and work the heart and lungs. Exercises that work just the arms or just the legs can also be helpful.4 This is sometimes known as ‘cardiovascular’ exercise. The key to aerobic exercise is to maintain a moderate level of activity for a reasonable length of time – at least twenty minutes, if possible. Whatever you are able to do, though, remember that exercise at any level is better than none at all.

•

Stretching helps keep muscles supple and relaxed. It is important to stretch before and after strengthening or aerobic exercises.4 It can also be a useful form of exercise on its own.

•

Range-of-motion is often used together with stretching. It involves moving joints so that they go through as full a range of movement as possible. For example, moving the arms, legs, wrists and ankles in wide reaching circular patterns.

•

Passive stretching can help where MS has made it hard to control particular muscles, or has restricted the use of an arm or leg. Passive stretching involves a physiotherapist or carer helping to move your arms or legs to create a stretch and move the joints.

•

Posture exercises help keep your feet, knees, pelvis, shoulders and head properly aligned to reduce strain on the muscles and bones in the body. This could involve strengthening muscles around the back, chest and stomach areas. This gives support to the body and helps with balance and position when standing up and when sitting down.

4

Avoiding the knock-on effects of MS •

Loss of muscle strength and fitness If a muscle is not used for long periods it will lose strength and may become painful (known as ‘deconditioning’). This in turn may make any mobility or weakness problems worse. These problems cannot always be avoided completely, as they are symptoms of MS. But, by finding the right exercises, perhaps with the help of a physiotherapist, you can stop problems becoming worse than they need to be.

•

Weight gain or loss Unwanted change in weight is an issue that affects many people with MS.6 Exercise can help with weight control, especially when combined with a healthy, well-balanced diet. Your GP can also refer you to a dietitian to help with any weight issues you have.

Exercise and Physiotherapy © MS Society 01/11

•

2

Osteoporosis Weakened bones, including osteoporosis, may be a risk for people with MS who do not get much exercise or have taken long courses of steroids.7 Gentle activity strengthens the bones and can help prevent these problems developing.4 For example, if you regularly use a wheelchair, a physiotherapist may suggest you stand for a few minutes at regular intervals through the day, perhaps supported by a frame for balance. This is known as ‘weight-bearing exercise’ and can help prevent osteoporosis. There are also exercises that can be done sitting down that can help.


The benefits of exercise

3

Exercising does not have to mean playing a sport – you can get exercise simply by being active. Walking, gardening, dancing, boccia, and playing with pets can all provide exercise. Just like the different sports available, these kinds of activities vary in the type of ‘work out’ that they provide. Combined with sports or a programme of physiotherapy exercises, they can be helpful in keeping fit.1 If you can’t or don’t want to join a gym or exercise outside, there are a number of online exercise websites which offer downloadable and streamed workouts for you to do at your own pace. A number of exercise DVDs have routines you can follow at home, some of which are MS specific. See ‘Further reading’ at the back of this booklet for more information. There are also a number of virtual reality computer games which can be played at home and can help you keep moving, for example Wii Fit.


Water-based exercise

4

Water can be a particularly good environment for many exercises – not only swimming – and water aerobics classes are offered at lots of sports centres. Water supports the body, reducing the risk of falls and lessening the stress placed on joints and muscles.1 Strengthening, stretching and aerobic exercise can all be done in a pool, and you can tailor activities to your own needs. Some people who are sensitive to heat also find it good to exercise in cool water. Others may even find that a warm pool is beneficial.8 As with any exercise, you need to find the right environment for you. Some local pools offer a ‘warm water day’ each week and have special sessions for people with disabilities. Some areas of the UK offer free swimming for the over 60s. Check with your local pool or leisure centre.

Are there precautions I need to take because of my MS?

There are precautions that everyone should take when exercising and, depending on how MS affects you, there may be particular things you need to think about.

Speak to your GP If you have not exercised for a while, or are thinking of significantly increasing the amount you do, you should speak to your GP beforehand, to be sure what you do is safe. Your GP may recommend you see a physiotherapist. Just like anyone else, if you have other health issues, such as asthma, a heart condition or osteoporosis, these need to be taken into account with any exercise plans.

Start slowly with any new regime Don’t try to do too much, too soon. Starting slowly with a new regime lets your body get used to the new activity and also helps you judge whether that choice of exercise is comfortable for you. Over time, you will be able to gauge what your limits are. You may notice your limits change as your abilities and fitness levels change, so adjustments here and there might be beneficial.

Warm up and cool down To guard against injury or making any existing muscle problems worse, you should always warm up, with gentle stretching, before any strenuous activity. If you are doing aerobic exercise, you should start slowly, to build the heart rate gradually. To avoid muscles becoming tight and stiff, stretching should also be done as a ‘cool-down’ afterwards.9

Adapting to MS symptoms The symptoms you experience may have an influence on the exercise you choose to do, but having MS does not mean that you automatically need to stop doing activities and exercise you enjoy. For example, if you experience vision problems you might opt for alternative forms of exercise or adapted sports where eyesight is not so important. Muscle stiffness or painful sensations could make contact or movement uncomfortable, but by working with a physiotherapist you might find more comfortable, but still effective, activities. Some people with MS experience difficulties with memory and with understanding complex explanations (known as ‘cognitive problems’) and may find it useful to have written notes and diagrams from a physiotherapist or trainer. A family member or carer might also be able to learn the exercises with you to help remember them accurately.


Sports, activities and physiotherapy can all provide a good balance of these various types of exercise. If your situation changes, you might want to try a new sport, adjust what you do already, or work with a physiotherapist to discover specific exercises that could benefit you. Adapted sports and complementary therapies are popular options that many people try. There is a huge range of sports available to people of all abilities. For further information about complementary therapies such as t’ai chi, Pilates and yoga, see the MS Society publication Complementary and alternative medicine.

5

Heat sensitivity


Many people with MS – though not all – are sensitive to heat.8 Some people also say that humidity can affect them too. Illness or infection, hot weather and exercise can all raise the body’s temperature, which can make existing MS symptoms feel temporarily worse or bring about fatigue, weakness or vision problems. This is known as ‘Uhthoff’s phenomenon’ and it probably occurs in MS because heat makes it harder for messages to pass between the brain and the rest of the body.10 Uhthoff symptoms fade away after the body cools down again and these temporary changes need not be a reason to avoid exercise.1 Some people adjust the exercise they choose, to be sure they are safe even if Uhthoff’s symptoms occur. Others find effective ways to stay cool and keep effects to a minimum. Here are some practical things you can try if you are heat sensitive:

6

•

Avoid overly hot swimming pools. How warm is ‘too warm’ will vary for different people, but as a rough guide, try to find a pool where the water temperature is below 29 degrees Celsius.1

•

You might want to break up exercise sessions into smaller sections, with regular breaks, to stay cool.

•

Drinking ice drinks, wearing a ‘cooling vest’ and taking a cool bath before exercising might help you avoid temporary ‘Uhthoff’s’ symptoms and allow you to exercise for longer.8 ‘Cooling sprays’ can also provide temporary relief from hot conditions.

•

Some people find that a cooling bath or shower after exercise can help speed up recovery.

•

Wherever you exercise, try to keep the space well ventilated. A fan might help. Be careful if applying ice or cold packs directly to the skin, or when using cooling garments or cold water to cool the body. MS can cause changes to the way you experience temperature, distorting the feeling that would normally tell you when something is too hot or too cold. Care should be taken not to damage the skin. Your GP, physiotherapist, occupational therapist or MS nurse can help make sure cooling techniques you try are not harmful.

How can a physiotherapist help?

Physiotherapy is often recommended when there is a specific problem or ongoing symptoms that affect day-to-day activities, mobility and independence. It can help whatever your level of disability, but can be particularly valuable when physical symptoms progress or you are recovering from a relapse. A physiotherapist works with you to assess your physical difficulties and help you to improve your movement and other functions of the body. Exercise is one of the key ways in which they do this. If MS is affecting the sports or activities you are able to do, they might suggest new ways to stay fit, or ways to adapt your preferred exercises to suit your situation. A physiotherapist can also suggest particular exercises to treat and manage specific problems such as difficulties with mobility, balance, posture and fatigue. Bladder problems, pain and muscle spasms and stiffness can also be targeted by physiotherapy. Where appropriate, physiotherapy might involve the physiotherapist working ‘hands-on’ with you. For example they may hold and move your limbs for passive stretching and range-of-motion.

Sports equipment and aids Some people with MS benefit from using sports equipment and aids when exercising, and some of these may be suggested by a physiotherapist. For example, exercise bikes and rowing machines can offer quite strenuous exercise in a controlled environment – which could be useful if vision, coordination or balance problems make these kinds of activities difficult outdoors. A standing frame can be an aid to weight-bearing exercise and weights strapped around the wrists or ankles might help strengthen arms or legs. Aids and equipment can also help compensate for difficulties with balance, muscle weakness or other symptoms. For example, trekking poles and walking sticks can help you keep balanced if you go walking. If you have more strength in your arms than your legs, a hand-cycle might be an option – this is a bike powered by ‘pedals’ for the hands instead of the feet, and both indoor and outdoor versions exist. Some people say they benefit from a technique called ‘whole-body vibration’. This involves standing on a vibrating platform (sometimes two platforms, one for each foot) for several minutes at a time. A number of small studies have looked at the possible benefits of this kind of vibration, including posture, mobility and muscle tone. However, they have not found conclusive evidence that it helps people with MS.11, 12, 13 At the moment it is not a widely used therapy and you should speak to your GP or physiotherapist if you are considering it.


You may want to use sports centres, exercise classes or personal trainers at gyms. If you do, consider any adjustments you might need the centre or trainer to make to take account of your MS. This could include access to the facilities and whether the trainer has an understanding of MS. Has anyone else with MS in the area worked with the same trainer? The local branch of the MS Society might be aware of suitable groups or trainers. If you have a physiotherapist, they may be able to talk with trainers to help them understand MS.

7

Your GP, neurologist or MS nurse can refer you to a physiotherapist. You may also be able to refer yourself. The guidelines on how MS should be treated in the NHS recommend physiotherapy to help with many symptoms of the condition, including walking difficulties, muscle spasms and stiffness, swallowing difficulties and muscle weakness. However, access to a physiotherapist varies from place to place and you may not receive ongoing treatment on the NHS, but instead be given a limited number of sessions. For some, it might be offered following a relapse, for others it may be suggested when there is a change in symptoms such as increased muscle stiffness or mobility problems. A physiotherapist will sometimes teach you exercises that can be continued between appointments, possibly with the help of a family member or carer. Ideally, your progress with these exercises should be monitored from time to time to assess what works for you and what does not. Changes can then be made to ensure the programme is effective.


Physiotherapy is most commonly available as an ‘out-patient treatment’ – where you visit the hospital just for the treatment appointment and then leave again. Alternatively, if fatigue, spasticity or other symptoms associated with MS prevent you from travelling to the local hospital, a physiotherapist may be able to visit you in your own home. Some areas also have MS or neurological ‘rehabilitation teams’ that include specialist neurophysiotherapists. It is always worth asking your GP, neurologist or MS nurse if there is a team in your area and whether you can be referred to them.

8

Local access to physiotherapy is sometimes available at nonspecialist rehabilitation clinics, or sessions may be organised by your local branch of the MS Society. Many Multiple Sclerosis National Therapy Centres and Multiple Sclerosis Centres Scotland also have physiotherapy clinics – see the useful organisations on page 16 for details. Your local MS Society branch can be found in your local phone book. They are also listed on the MS Society website, or you can contact the MS Society UK Information team on 020 8438 0799. Physiotherapy is also available privately. If you are considering paying for physiotherapy, registered therapists who specialise in neurology can be found through the Chartered Society of Physiotherapy. Their details can be found at the back of this booklet.

Exercise for specific MS symptoms

As well as improving your general health, exercise and physiotherapy may help with specific MS symptoms. A physiotherapist can assist you to find the most effective level and style of exercise for your symptoms.

Fatigue Fatigue is one of the most common problems for people with MS.14 It seems to almost go against common sense to exert yourself if you have fatigue. But exercise can bring improvements in strength, fitness and mood – all of which might help you to manage your fatigue.2 However, it is important to balance exercise with rest and to keep cool while you exercise, especially if you find that getting hot during exercise makes fatigue worse. Good posture can also help your body to work more efficiently, causing less strain and using less energy. This too may help with managing fatigue.14 One clinical trial showed that yoga helped reduce some people’s levels of fatigue.15 For further information see the MS Society publication Fatigue.

Balance and walking difficulties People with MS often find balance is a problem, and there can be a number of reasons for this. Changes in sensation, vision problems and MS-related damage in the brain or spinal cord can all upset someone’s balance.16 This can cause problems with walking, as can loss of strength in the legs, muscle stiffness or spasms. Carefully designed physiotherapy programmes can help people improve their balance and ability to walk.1 These might concentrate on stretching, strengthening and posture. Research does suggest that the positive effects wear off quickly if the exercise programme is stopped.1 To maintain improvements, a physiotherapist might find exercises that you can continue between check-ups, either on your own or with the assistance of a member of the family or carer. Some people feel that exercises that focus on balance and breath control help their walking and balance. Popular examples are yoga, t’ai chi and Pilates. Clinical trials have found some benefits from t’ai chi, including improved walking speed.17 One small study looking at the effect of Pilates-based core stability training in people with MS who can walk found that it improved their balance and mobility.18 While it generally does not cause people any serious problems, be careful not to strain joints or muscles when doing exercises like t’ai chi. Outdoor walking and aerobics may also help with balance.1 For further information see the MS Society publication Balance and MS.


How do I get physiotherapy?

9

Muscle spasms and stiffness affect almost 50 per cent of people with MS, though the effects vary from person to person. At least 20 per cent of the people affected in this way will experience muscle spasm.19 Physiotherapy, including stretching and range-of-motion exercises, is a key part of treating and managing these symptoms. These are gentle stretching exercises that move each joint as far as possible in all directions. Normal daily activities do not take joints through their full range of motion. Yoga may also improve your flexibility and reduce muscle stiffness.1 And research has found some benefits from t’ai chi exercise, including reduced muscle stiffness.17, 20 Pilates may also help, although there has been limited research in this area. A small study on people who did not have MS showed Pilates improved flexibility.21 For further information see the MS Society publication Muscle spasms and stiffness.

Bladder and bowel problems People with MS can experience a variety of bladder problems. Some people experience an urgent or very frequent need to go to the toilet – known as ‘urgency’ and ‘frequency’. Others find that exercising, sneezing or coughing causes leakage. This is called ‘stress incontinence’. Strengthening the muscles that support the bladder – the ‘pelvic floor’ – may help some people with these bladder problems.22 A continence advisor, MS nurse or physiotherapist can help you with pelvic floor exercises. Bowel problems are less common, but can be awkward and distressing.23 Keeping physically active may help some people with bowel control. One study found that people with MS had improvements in their bowel functions following a 15-week course of aerobic training.5 For further information see the MS Society publications Managing bladder problems and Managing the bowel in MS.


Low mood, anxiety and depression

10

MS can affect your emotions as well as your body. If issues such as low mood, anxiety or depression do arise, exercise may help. Regular aerobic exercise has been shown to be beneficial in relieving mild to moderate depression.4 T’ai chi has also been reported to offer social and emotional benefits.17, 20 On top of this, you may find that exercise is a good opportunity to meet new people.

How can I fit exercise into my life?

To be effective, exercise needs to be a regular part of your life. It is therefore important to find the right activities and exercises for you – ones that you enjoy doing, suit your lifestyle and match your physical needs. When considering different sports and activities, you might want to ask yourself the following questions: •

When are the best times for me to exercise? Symptoms and drug side effects may vary through the day, so you might need to consider this when planning to exercise.

•

What motivates me? Some people prefer competitive sports, or exercising in a group. Others work better alone, with personal goals to achieve.

•

Is there good access to the facilities I need? As well as being able to get around the changing rooms, gym or hall, think about transport to and from the venue. Voluntary groups, such as the local MS Society branch can sometimes help.

•

What are the costs? Some activities are free, but if you pay for exercise classes, sports clubs, special clothing or equipment, there could be costs to consider. There may be groups running cheaper classes in your area, perhaps linked to the MS Society local branch. And remember that effective exercising does not have to be expensive. For example, a physiotherapist can help you find ways to get the same physical workout at home as you might achieve in a members’ gym. Many local sports centres have reduced rates if you receive benefits such as Disability Living Allowance. In some areas, doctors prescribe exercise as well as medicines and arrange for you to exercise for free at a local fitness centre. There are many local initiatives called Inclusive Fitness Initiatives (IFI) that could help you to access fitness. Most of these are in England, although there are some in other areas of the UK. The IFI website has details of all accredited initiatives – contact details are at the back of this booklet. If MS symptoms change, you may have to adjust the exercise you do. However, if you feel able to carry on with existing exercises, then there is no reason to automatically stop. But listen to your body – it’s important to be realistic. An unrealistic exercise plan can be frustrating and energy-sapping and actually make it harder to stay motivated. By contrast, if you find something that works for you, it can be inspiring and energising. You might find the MS Society DVD Exercising with MS useful. It presents a range of simple, gentle exercises and stretches you might want to try. They are suitable for people with varying levels of ability. See the front cover of this booklet for how to see it.


Muscle spasms and stiffness

11

Times when you may not be able to exercise

There may be times when you do not feel able to exercise, or when it would be wise to do less than usual. If you experience a relapse you should not try to carry on exercising until after symptoms have ‘levelled out’ and you have completed any steroid treatment.1 A physiotherapist can guide you to maintain muscle tone and mobility following a relapse, and help get you back into a routine as you recover – a process known as ‘rehabilitation’. The symptoms of MS can change from day to day as well as over longer periods of time. If you notice any symptoms changing, or if new symptoms appear, you may need to adjust how much you do. For example, if you have a week or two where fatigue is worse than normal, you may decide to rest a little more and exercise a little less – to conserve energy for other tasks. If this goes on for longer, a physiotherapist might suggest new ways to exercise so you can stay fit despite the fatigue. Remember that there may also be reasons quite separate from your MS that stop you from exercising; for example, if you catch a cold. It is often a good idea to rest and recover from an illness rather than push yourself too hard. Whatever your reasons for taking a break from exercise, remember to start again slowly. If you need to, set yourself lower targets to begin with and build up gradually to a level you can manage realistically.

Exercise for those more severely affected by MS

Exercise is good for everyone, including people with high levels of disability. If you are quite severely affected by MS, you may need to work with a physiotherapist to tailor exercises that meet the specific needs you have and ensure they are comfortable for you. By doing this, you should be able to find exercises that help you manage your symptoms and limit the knock-on effects of MS. For further information see the MS Society publication Support for people severely affected by MS.

kinds of duties because of legal restrictions. To get the assistance you need, it may help if you ask for stretching and range-of-motion exercises to be written into your social services (social work in Scotland) ‘care package’. This means they will be recognised as essential parts of the care you need, and should therefore be provided.

Strength and posture Having good posture can make a significant difference to your comfort and health if you spend a lot of time sitting or lying down. Some people also find that muscle spasms and difficulties with swallowing trouble them less if they adjust their posture.24, 25 Breath control can also be helped by an upright posture which allows the lungs and throat to open more easily. Muscle strength is important for good posture, and, to ensure muscles are strong, a physiotherapist may suggest strengthening exercises. These can work alongside stretching and range-ofmotion exercises which make moving from one position to another easier, for example, using the toilet, or getting into bed.

Finding exercise in everyday activities There may be everyday tasks and movements that can provide useful exercise. Sweeping the kitchen floor, wiping down a table top or reaching and stretching for things can all be good exercise. It all depends on working to your abilities. A physiotherapist, or occupational therapist, might suggest subtle adjustments to get the maximum physical benefit from the activities you do. By altering the layout of things you have around you, for example, you may be able to create stretches for your arms. Keeping something that is in regular use at full reach creates some exercise each time it is needed, for instance (but take care that it is safe to do so). Fitting exercise into your daily life like this makes it easier to do a little every day and get the benefits of regular stretching, strengthening and movement.

12

As mentioned on page 10, these exercises can help with muscle stiffness. In particular, they can prevent joints from ‘locking up’ and muscles from becoming painful and deconditioned through lack of use. If passive stretching and range-of-motion exercises are helpful, your family and carers might be able to assist you with this in between physiotherapy sessions. A physiotherapist can work with them to demonstrate how such exercises should be done and to give carers confidence to help. However, paid carers or carers from social services are not always able to carry out these



Passive stretching and range-of-motion

13

UK Information Team 020 8438 0799 [email protected]

MS Society publications The MS Society has publications on a wide variety of topics, including information for people just diagnosed, types of MS, managing relapses, and social care services. Find out more and order at www.mssociety.org.uk/publications or call 020 8438 0799 (weekdays 9am-4pm). MS Society website and members’ magazines Keep up to date with news relating to MS with the MS Society website www.mssociety.org.uk and UK members’ magazine, MS Matters. Members in Northern Ireland, Scotland and Wales also receive national magazines. To join the MS Society call 020 8438 0759 or go to www.mssociety.org.uk/joinus MS Helpline The award-winning MS Helpline offers confidential emotional support and information to anyone affected by MS, including family, friends, carers, the newly diagnosed or those who have lived with the condition for many years. Information about MS is available in over 150 different languages by speaking to a Helpline worker via an interpreter. Call freephone 0808 800 8000 (weekdays 9am-9pm, except bank holidays) or email [email protected] MS Society National Centre, Information Centre Based at the MS National Centre in London, the Information Centre is equipped for visitors to read or locate books and journals or view videos and DVDs. To request publications, research articles or other information about MS, visit www.mssociety.org.uk/library or call 020 8438 0799.


Local information centres

14

There are MS Society local information and support centres in many locations around the country. These centres are staffed by volunteers who can help you with information about MS and services in your area. Call 020 8438 0799 for the details of your nearest centre. Local branches The MS Society has a network of over 300 local branches across the UK. The branches – run by trained volunteers – provide information about MS and local services, a chance to meet others affected by MS and take part in a range of activities. For more information, check the MS Society website or call 020 8438 0944.

Further reading MS Essentials Factsheets: Posture and movement. Reviewed and edited by neuro-physiotherapists, these factsheets aim to help people make the most of their physical abilities and move safely while maintaining as much independence as possible. They also recommend ways to maintain good posture – the essential foundation for good movement. Physical activity for neurological conditions by Dr Helen Dawes. Published by Oxford Brookes University (2010). A handbook to help people with neurological conditions, including MS, to exercise more easily and safely. Includes advice on how to plan an exercise routine. Available on loan from the MS Society Information Centre in London. See opposite for contact details. Exercises for people with MS by Liz Betts. Published by the Multiple Sclerosis Trust (2004), ISBN: 1-904156-05-3. This book includes diagrams and explanations of exercises that can be done when lying down, sitting, kneeling or standing. It also has tips on good posture. Available to download from the MS Trust website: www.mstrust.org.uk Yoga tips for people with multiple sclerosis by Sue Lee. Published by Class Publishing, London (2009), ISBN 1859592287. Includes a series of straightforward yoga exercises and breathing techniques to benefit people with MS, aimed at helping to ease and manage problems such as muscle stiffness and spasticity. Stretching for people with MS. An illustrated manual by Beth E. Gibson. Published by the National MS Society (2007). Diagrams and descriptions of exercises that you can do alone. This booklet is available to download from the website of the American MS society, www.nationalmssociety.org Stretching with a helper for people with MS. An illustrated manual by Beth E. Gibson. Published by the National MS Society (2007). Diagrams and descriptions show a range of exercises including passive stretching and range-of-motion. This booklet is available to download from the website of the American MS society, www.nationalmssociety.org


Further information

15

All these DVDs and videos are available on loan from the MS Society library. Contact the UK Information Team. Move it for MS! The fun way to exercise with Mr Motivator. Published by the MS Trust. (2007) A DVD of exercises developed by an MS physiotherapist in conjunction with Mr Motivator, made especially for the MS Trust. Available from the MS Trust. Telephone 01462 476700 or go to www.mstrust.org.uk Pathways: exercise video for people with limited mobility. Produced on video and DVD by Mobility Limited (1993) in the USA. The video demonstrates exercises that can be done alone or with a carer. Yoga with Sue Lee. Four yoga routines (DVDs) designed to loosen the entire body and improve posture and breath. There are also a number of exercises online at www.yoga4pwms.co.uk Leanne’s chair workout by Leanne Grose. Published by Ilc Media (2007). A DVD of exercises for people who use wheelchairs. Not MS specific. Single chair yoga – volume 1 by Lakshmi Voelker. (2007) A yoga DVD for people who use wheelchairs. Not MS specific. Available from www.getfitwhereyousit.com Yoga for MS and related conditions by S. Crotzer. Published by Pathways Notes Canada (1993). Exercise DVD for people with limited mobility.


Useful organisations

16

Inclusive Fitness Initiative (IFI) Supports the fitness industry to become more inclusive, increasing participation by disabled people www.inclusivefitness.org Telephone 0114 257 2066 Textphone 18001 0114 257 2066 Multiple Sclerosis National Therapy Centres A federation of therapy centres around the UK. They offer a variety of therapies. Some centres offer physiotherapy clinics and water-based exercise. PO Box 126 Whitchurch SY 14 7WL Telephone 0845 367 0977 www.msntc.org Multiple Sclerosis Therapy Centres Scotland Duncrievie House College Road Methven Perth PH1 3PB Telephone 01738 840357 www.mstherapycentres.org.uk

References 1 Brown, T. R. and Kraft, G. H. (2005) Exercise and rehabilitation for individuals with multiple sclerosis. Physical Medicine and Rehabilitation clinics of North America, 16, 513-55. 2 Rietberg, M. B. et al. (2004) Exercise therapy for multiple sclerosis. The Cochrane Database of Systematic Reviews, Issue 3, Art. No. CD003980.

Chartered Society of Physiotherapy The professional body for physiotherapists in the UK. They can provide details of registered physiotherapists who specialise in neurological conditions such as MS.

3 Snook, E. M. and Motl, R. W. (2009) Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabilitation and neural repair, 23, 108-116.

14 Bedford Row London WC1R 4ED

4 White, L. J. and Dressendorfer, R. H. (2004) Exercise in multiple sclerosis. Sports Medicine, 34(15), 1077-100.

Telephone 020 7306 6666 www.csp.org.uk

5 Petajan, J. H. et al. (1996) Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology, 39(4), 432-41.


Exercise DVDs and videos

17

7 Caldis-Coutris, N. et al. (2002) Nutritional management of multiple sclerosis. Canadian Pharmaceutical Journal/RPC, 135(5), 31-40. 8 Karpatkin, H. I. (2005) Multiple sclerosis and exercise. A review of the evidence. International Journal of MS Care, 7, 36-41. 9 The Chartered Society of Physiotherapy (2000) Warm up to exercise CSP 277. London, CSP. 10 Frohman, E. M. et al. (2000) Neuro-opthalmic signs and symptoms. In: J. S. Burks and K. P. Johnson (eds.) Multiple sclerosis. Diagnosis, medical management and rehabilitation. New York, Demos. p341-76. 11 Schuhfried, O. et al. (2005) Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clinical Rehabilitation, 19, 834-42. 12 Wunderer, K. et al. (2009) Effects of whole body vibration on strength and functional mobility in multiple sclerosis. Physiotherapy Theory and Practice, 26, 374-384. 13 Schyns, F. et al. (2009) Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance. Clinical Rehabilitation, 23, 771-781. 14 MS Society (2009) Fatigue. Second edition. London, MS Society. 15 Oken, B. S. et al. (2004) Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology, 62(9), 2058-64. 16 Herndon, R. M. and Horak, F. (2000) Vertigo, Imbalance, and Incoordination. In: J. S. Burks and K. P. Johnson (eds.) Multiple sclerosis. Diagnosis, medical management and rehabilitation. New York, Demos. p333-9.


17 Husted, C. et al. (1999) Improving quality of life for people with chronic conditions: the example of t’ai chi and multiple sclerosis. Alternative Therapies, 5, 70-74.

18

18 Freeman, J. A. et al. (2010) The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies. Multiple Sclerosis, 16, 1377-84. 19 National Institute for Health and Clinical Excellence (2003) NICE Clinical Guideline 8. Multiple Sclerosis: management of multiple sclerosis in primary and secondary care. London, NICE. 20 Mills, M. and Allen, J. (2000) Mindfulness of movement as a coping strategy in multiple sclerosis. A pilot study. General Hospital Psychiatry, 22, 425-31.

21 Segal, N. A. et al. (2004) The effects of Pilates training on flexibility and body composition: an observational study. Archives of Physical Medicine and Rehabilitation, 85, 1977-81. 22 MS Society (2009) Managing bladder problems. Fourth edition. London, MS Society. 23 Dasgupta, R and Fowler, C. J. (2003) Bladder, bowel and sexual dysfunction in multiple sclerosis. Management strategies. Drugs 2003, 63(2), 153-66. 24 Haselkorn, J. K. and Loomis, S. (2005) Multiple sclerosis and spasticity. Physical Medicine and Rehabilitation Clinics of North America, 16, 467-81. 25 Logemann, J. A. (2000) Dysphagia. In: J. S. Burks and K. P. Johnson (eds.) Multiple sclerosis. Diagnosis, medical management and rehabilitation. New York, Demos. p485-90.

Authors and contributors This edition edited by Jude Burke Previous edition written by James Bailey and edited by Sarah Westlake With thanks to: Paul Bradbury, Dr Alasdair Coles, Cath Heynes, Alison Johnson, Liz Norton, Max Oates, Dr Carolyn Young and all those people affected by MS who contributed to this publication. Disclaimer: We have made every effort to ensure that the information in this publication is correct. We do not accept liability for any errors or omissions. The law and government regulations may change. Be sure to seek local advice from the sources listed. Suggestions for improvement for future editions are welcomed. Please send them to [email protected] © Multiple Sclerosis Society 2011 First edition, September 2006 Second edition, January 2011 (reviewed September 2013) This title will be reviewed within three years.


6 MS Society (2008) Diet and nutrition. Third edition. London, MS Society.

19

MS Society Multiple sclerosis (MS) is the most common disabling neurological disorder affecting young adults and we estimate that around 100,000 people in the UK have MS. MS is the result of damage to myelin – the protective sheath surrounding nerve fibres of the central nervous system. This damage interferes with messages between the brain and other parts of the body. For some people, MS is characterised by periods of relapse and remission while, for others, it has a progressive pattern. For everyone, it makes life unpredictable. The MS Society is the UK’s largest charity dedicated to supporting everyone whose life is touched by MS. We provide a freephone MS Helpline; grants for home adaptations, respite care and mobility aids; education and training; support for specialist MS nurses; and a wide range of information. Local branches cater for people of all ages and interests and are run by people with direct experience of MS. The MS Society also funds around 80 vital MS research projects in the UK. Membership is open to people with MS, their families, carers, friends and supporters. You can help the work of the MS Society by: • • •

becoming a member making a donation offering your time as a volunteer

Contact information MS National Centre 372 Edgware Road London NW2 6ND Telephone 020 8438 0700 MS Society Scotland National Office Ratho Park 88 Glasgow Road Ratho Station Newbridge EH28 8PP Telephone 0131 335 4050 MS Society Northern Ireland The Resource Centre 34 Annadale Avenue Belfast BT7 3JJ Telephone 028 9080 2802

MS Society Cymru Temple Court Cathedral Road Cardiff CF11 9HA Telephone 029 2078 6676 National MS Helpline Freephone 0808 800 8000 (weekdays 9am-9pm) www.mssociety.org.uk Multiple Sclerosis Society. Registered charity nos 1139257 / SC041990. Registered as a limited company in England and Wales 07451571. ES21/0913