Exercise and advice for people with Multiple Sclerosis

Multiple Sclerosis – Exercises and Advice

ADVICE

Everyone benefits from being physically fit. Research suggests that exercises in MS can:

· Improve overall health of people with milder MS.

· Help people with more severe MS stay mobile and active as possible.

· Help manage MS symptoms e.g. muscle stiffness, fatigue, balance.

· Decrease risk of heart disease.

In order to keep up exercise, ensure you do something you enjoy.  Physiotherapy is beneficial as the exercises will be focused on your specific needs and abilities. There are various types of exercise that may help specific MS symptoms. 

· Stretching/ passive stretching

· Improving range of movement

· Strengthening/ core stability

· Posture

· Balance

· Aerobic fitness

Sports, activities such as yoga, Pilates, body balance and physiotherapy can all provide a good balance of these various types of exercise.  It is important that you pace yourself to avoid over heating and possible fatigue.  It is important that you have a R.E.P. (Rest Exercise Programme).  Your physiotherapist will advise you on this.

Intensity of exercise

Evidence has shown that exercise intensity is a key factor to gaining improvements.

25 minutes sessions have been shown to get better results than shorter 10 minute ones.

However please be mindful of fatigue and speak to your physiotherapist if you have any concerns.

ALWAYS

 · Speak to GP before you take up exercise

· Warm up before and cool down after exercise

· Be careful if you are affected by heat sensitivity.

STRETCHES

Hold stretches for 30 seconds. Repeat 3 times

(30-60 seconds for older adults)

1. Lying on your back curl up into a tight ball and hold.

2. Lying on your back roll your knees from left to right.

3. Lying on your back take your knees apart and hold.

4. Lying on your back stretch your arms and legs out straight.

Try to keep your knees and elbows straight.

5. In lying or sitting, place a band around your foot and use your hands to pull up until you feel a stretch in your calf

(standing alternative, if you are able)

Stand with one foot in front of the other. Keep the back leg straight and bend the front knee until you can feel a stretch in the back leg.

6. Start by lying on your back. Grab the back of your thigh and pull it toward your chest. Extend your leg slowly while keeping your thigh to your body until you feel a stretch in your hamstrings. Keep the other leg straight.

(seated alternative)

Sit on a chair with one leg straight in front of you.
Place your hands on your thigh just above the knee cap. Lean forwards keeping your back straight. Straighten your knee assisting the stretch with your hands.

7. Start by lying on your back with your knees bent. Cross the ankle of the leg to be stretched over the other knee. Put your arms around the thigh.
Bring your thigh towards your stomach until you feel the stretch in your buttock.

(seated alternative) Sit up straight with your ankle on top of the other knee.
Bend your trunk forward and press the knee down until you feel a stretch in the hip muscles of the bent leg.

STRENGTHENING EXERCISES

N.B. All exercises should be done slowly and with control

Complete the following exercises lying on your back with your knees bent.

1. Flatten small of back and hold for 3 seconds

2. Flatten your back and lift bottom up, hold for 3 seconds

3. Flatten your back, lift bottom up and twist pelvis to left and right

4. Keep your back flat, slowly bend and straighten one leg and then the other.

5. Keep one knee pointing to ceiling and roll the other knee out to the side in a controlled manner, do not let your back lift up. Return to starting position.

6. Alternate punching into air with your left and right hand, you can add a small weight into this exercise if advised to.

7. Raise your arm straight above your head and return. Repeat on the other side. Add a weight if advised to.

Complete the following exercises lying on your side

1. Lying on your side, keep your heels together and bend your knees. Ensure your pelvis does not roll back then lift your top knee a couple of inches in a controlled manner. Slowly lower back to the start position.

2. Lying on your side, raise your upper leg (keeping your knee straight) approximately 3 inches, hold for 3 seconds (keep ankle flexed).

Complete the following exercises in a sitting position.

1. Slump, then sit up tall from your lower back, squeezing shoulder blades together as you sit up.

2. Sit on a chair with the soles of your feet on the floor. Alternately lift your feet off the floor in a marching fashion

3. Sit tall in a chair with your trunk upright. Slowly straighten one leg and hold it straight for 3 seconds then return to the floor. Repeat on both legs

4. Stand from a chair and return to sitting.
Place your feet under you, straighten your back (squeeze your shoulder blades together).  Stand up slowly, without the use of your hands. Slowly lower back into the chair without using your hands.

Complete the following exercises in standing with hands on a supportive surface if required.

1. Marching on the spot.

2. Take your leg out to the side, hold for 3 seconds (keep foot pulled up, toes pointing forward) then lower.

Repeat with the other leg.

3. Take your leg out straight behind you (foot flexed, knee straight).

 Repeat with the other leg.

4. Alternate knee bends, taking your heel to your bottom, then lower slowly.

5. Squats (using support only if needed), keeping your back straight bend both your knees then rise to standing again.

6. Step ups. Alternate leading leg

Balance

 · Step forwards, sideways and backwards, alternatively.

· Turn to look over left shoulder and then right shoulder.

· Stride standing, take a step, then hold. Tandem standing (one foot in front of the other, touching) then hold.

· Step around 180 degrees to right and then 180 degrees to left.

· Tightrope walking- imaginary line on floor.

· Standing on one leg.

 Aerobic Exercise

 · Fast step ups.

· Fast marching on spot/ running.

· Stepper/ cross trainer.

· Rowing Machine.

· Exercise Bike .

· Swimming/ aqua aerobics.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can bea difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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