Get Active with MS. Goals for Today s session? Program Outline. What is physical activity? What is physical activity?

Transcription

1 Get Active with MS Goals for Today s session? Program Outline Benefits of Physical Activity Physical, Psychological & Social Symptoms & factors affecting ability to be active Guidelines to increase Physical Activity Where to access further information What is physical activity? What is physical activity? Swimming Strength Training? Walking Incidental exercise Walk to work Gardening -- Gym & home based Yoga Walking the dog House work Sport 1

2 Benefits of Physical Activity Physical benefits Everyone benefits from Physical Activity Physical Psychological Social Same for PWMS as general population Reduce complications due to inactivity Maximise current physical abilities Maximise symptom recovery Increased energy levels Psychological benefits Social benefits Improved confidence & sense of well being Increased alertness, concentration and psychological stamina Reduced depression Group participation Social interaction MS specific groups Shared experiences MS Symptoms Factors that affect ability to Exercise Blurred or double vision Loss of balance or coordination Weakness in arms/legs Sensory changes Heat intolerance Sexual dysfunction Fatigue Cognitive, mood, behaviour changes Problems with speech and swallowing Pain Bladder/bowel dysfunction Tremor Spasticity Temperature Sensitivity Fatigue Cognition 2

3 Temperature Sensitivity Managing Heat Sensitivity Up to 80% of pwms are heat sensitive Proportion are cold sensitive Nerve conduction is impeded by increased temperatures Causes Environmental, Infection, Exercise Exercise can cause a temporary increase in symptoms Exercise in a cool environment Maintain hydration Wear cool, loose clothing Wear cooling vests, neck ties, wrist bands etc Avoid or stop exercising when unwell or feverish Stopping or decreasing activity should reduce the temporary increase in sensory symptoms Fatigue Managing Fatigue Lifestyle (Work,family,social) Lack of quality sleep Decreased Activity Fatigue MS specific fatigue (Neuromuscular & Lassitude) Depression Other health issues Quality not Quantity Start small & increase slowly Alternating Exercises (upper/lower body) Knowing Limitations Pacing & Rest Breaks Adequate Recovery Balancing Physical Activity & life activities Excessive/ too much activity Cognitive Changes Managing Cognitive Changes Memory New learning Concentration Attending supervised session Using diagrams/pictures/program cards Diarising activities Incorporating into weekly routine Following structured program 3

4 What if I have an exacerbation? Break Take a break Reduce intensity Restart at a reduced intensity and gradually build up. Review appropriateness of current program Types of Physical Activity Fitness Fitness Strength Stretching Balance Relaxation Aerobic Elevated heart rate Examples: walking, cycling, swimming, rowing Fitness guidelines Strength Choose an exercise that you enjoy and you are likely to participate in regularly (1-3 times per week) Exercise in a cool environment Maintain hydration before, during and after exercise Warm up 2-5 minutes prior to exercise and cool down for 2-5 minutes after. Allow at least one day between each training session Resisted Activities Secondary weakness Examples: Weights, body weight, theraband, water resistance. 4

5 Benefits of Strengthening muscles Evidence based guidelines for Strength Training Maintain & Improve Strength Improve ability to perform daily tasks or work demands Improve and maintain functional abilities Restore strength that has been lost due to reduced activity Dalgas et al 2008 : MS and physical exercise Initially supervised Fixed/ machine weights preferable Intensity range 8-15RM Initially RM progressing to 8-12 Sets 1-3 Rest period 2-4 minutes 2-3 days/ week Exercise program should include 4-8 exercises Larger muscle groups first Stretching Benefits of Stretching Aims to maintain muscle length and flexibility Examples: daily stretching, yoga, pilates, postural exercises Reduces discomfort from spasm and contractures Improves balance and ability to perform daily tasks Helps to maintain muscle length and joint range in the long term Stretching guidelines Balance Hold a stretch for seconds, repeat 2-3 times Do not bounce - sustain the stretch. Stretch only within comfort. Challenges to the ability to remain upright Examples: Tai Chi, core strengthening, vestibular therapy, balance retraining, Gait re-education 5

6 Guidelines for balance training Relaxation Practice balance exercises in a safe spot to prevent falls and injury Start with exercises that are difficult but just possible, then progress to harder exercises as you improve Examples of forms of relaxation include Yoga and Meditation Reduced stress Reduced muscle stiffness Improved ability to concentrate Improved quality of sleep Decreased impact of fatigue Water based exercise Exercise Myths Benefits of the water environment: Buoyancy Weightlessness Hydrostatic pressure Resistance Precautions Water Temperature depends on activity level - Ideally C There is no evidence that exercise Reverses demyelination caused by MS Prevents demyelination caused by MS Brings on a relapse in MS Getting Started Types of Activities What physical activities do you like doing? What are your goals? How much time are you likely to be able to exercise in an average week? Fit exercise into your weekly routine and set aside time Yoga Swimming Horse riding Cycling Netball Tennis Lawn Bowls Surfing Jogging Sailing Gym Dancing Athletics Feldenkrais Cricket Squash Pilates Walking Rowing Golf Hiking Skiing Basketball Chair based 6

7 Guidelines for Getting Active Getting help with getting active Individualised program Quality not quantity Start small Consider the environment Reduce or stop if unwell MSA (ACT,NSW, Vic) physiotherapists Private physio with neurological or rehabilitation experience Hospital outpatient or neurological physio Fitness instructor or exercise physiologists You may need to see your GP for medical clearance prior to starting an exercise program MS Group Programs Community Resources Maximising your Strength (Gym based) Absolutely Aqua/SWEAT aqua (Water exercise) Tai Chi Yoga Myotherapy/Massage Confident Living Program And more.. Local Council SportRec Access Line: 1800 BE IN IT ( ) Access for all Abilities Officers: (03) For-All-Abilities Local Sporting Groups Neighbourhood Houses Community Health Centres Remember Contacts Physical activity is beneficial for PwMS Physical activity is well tolerated by PwMS Start slowly and gradually increase activity Choose enjoyable/motivating activities Modify activity levels if unwell If it takes longer than 1 hour to recover you have done too much (Freecall) (03) msconnect@msaustralia.org.au 7

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11 Set Goal Example : This week I plan to exercise for 10 minutes, 3 times per week. This week I plan to have a rest ½ hour rest break after lunch each week day. Your Goal Goal 1 This week I plan to.. (action) I will do this for... (how long) for.. (how often) You may set more than one goal if you want. Good Luck!

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13 Aquatic exercise and m ultiple sclerosis The benefits of aquatic (water) exercise Many people with m ultiple sclerosis (MS) enjoy participating in aquatic exercise. An aquatic exercise program is suitable for people of all abilities, can be adapted to your needs, and has a range of health benefits. You don t need to be a strong swim m er to participate in aquatic exercise. The warm th of the water can m ake exercising easier for people who experience sym ptom s of m uscle tightness or weakness. Som e people feel m ore confident exercising in water than on land because the water helps them to balance. O ther benefits of aquatic exercise: im proves strength and flexibility im proves fitness and energy levels reduces pain reduces swelling in arm s or legs relaxation, socialisation and fun Why exercising in water can be easier than on land W ater holds special properties m aking exercise seem easier and m ore achievable than on land. B uoyancy. W hen standing on land, gravity pulls your body towards the ground. B y contrast, water helps push the body up, m aking you feel lighter and m aking it easier for you to m ove your arm s and legs. This is known as buoyancy. It helps reduce the force and im pact on your joints and can relieve aches and pains. B uoyancy can also help you keep your balance while exercising. Hydrostatic pressure. The deeper you are in the water, the m ore pressure the surrounding water exerts on your body. This pressure can be helpful for reducing swelling in the arm s and legs, which can som etim es be a problem for people who spend a large part of their day in a wheelchair. Turbulence refers to the irregular m otion or swirling m ovem ent of water. B y varying turbulence, the level of challenge can be increased or decreased. For exam ple, perform ing faster or larger m ovem ents in water increases the intensity, whereas using a floatation aid (e.g. a pool noodle) helps decrease it. Turbulence can be useful for practising exercises designed to im prove your balance, as it is easier to catch yourself from falling in water than it is on land. Resistance. W ater is denser than air and provides greater resistance to m ovem ent. Moving your arm s and legs against resistance is sim ilar to lifting weights. For exam ple, exercises can be m ade m ore challenging by holding paddles or other water devices to increase the level of resistance. INFORMATION FOR PEOPLE LIVING WITH MS Updated January 2011 Multiple Sclerosis Limited

14 Aquatic exercise and m ultiple sclerosis continued Guidelines for joining an aquatic exercise program Always get m edical clearance from your doctor to ensure that it is safe for you to exercise in a pool. Inform your physiotherapist or water instructor about any m edical and physical conditions you have that could be affected by the heat or pressure of the water. Find an aquatic exercise class or program that suits your current ability. A private or hospital-based physiotherapist can assess your current fitness and level of ability and refer you to a suitable aquatic exercise program. C hoose a pool that is heated between 25 and 35 degrees C elsius. C ooler pools are best for people who are heat-sensitive or for fairly intense exercise, such as swim m ing laps or running in the water. A warm pool is good for low-intensity or passive exercise (e.g. walking and assisted m ovem ents) and spasticity (m uscle stiffness), which worsens in cooler water. Lim it your tim e in the water to 20 to 30 m inutes, initially, to avoid becom ing fatigued or overheated. It is easy to over-exert yourself when exercising in water. O ften, you cannot accurately feel how tired your body is until you step out of the pool. If you have difficulty with fatigue or heat sensitivity, start with an easier program and gradually build it up each week. Monitor your body tem perature. C ore body tem perature can rise slightly in warm water, causing new sym ptom s to appear or old sym ptom s to worsen tem porarily (e.g. blurring of vision or weakening of legs). Tem porary changes usually resolve within 24 hours. Let your instructor know if sym ptom changes persist. Ensure you drink before, during and after exercising in the pool to avoid becom ing dehydrated. Avoid long sessions in the pool. Always em pty your bladder and bowel before starting your pool program so you don t need to stop for a toilet break. Have at least one other person with you, who is a good swim m er, as a general safety precaution. You m ay need assistance from another person when you are in the water, depending on your level of ability. Avoid strenuous exercise during a relapse (exacerbation) or period of illness. C onsider taking a break from your aquatic exercise program or talk to your instructor about how you can m ake it easier until you recover. Your aquatic exercise program m ay need to be adapted following a relapse (MS exacerbation) or illness. C onsider a spigot (sm all plug), if using a catheter. A spigot tem porarily seals off the catheter and can be helpful when participating in aquatic exercise. A nurse specialising in continence issues can provide inform ation. Assess your level of water confidence. You don t need to be a swim m er to participate in aquatic exercise; however, it is im portant that you have som e level of water confidence. W ear floatation aids or have som eone assist or supervise you until you are confident in the water. For inform ation about MS and MS Australia AC T/NSW/Vic services: MS C onnect : Em ail: m sconnect@ m saustralia.org.au Web: saustralia.org.au/actnswvic D isclaim er: Information contained in this fact sheet, prepared by Multiple Sclerosis Limited, is intended to provide useful and accurate information of a general nature for the reader but is not intended to be a substitute for legal or medical advice. Multiple Sclerosis Limited is not recommending medical or legal advice and readers must seek their own medical or legal advice as may be appropriate. P rinting and photocopying this publication in its original form is permitted for educational purposes only. R eproduction in any other form without written permission is prohibited. 2 INFORMATION FOR PEOPLE LIVING WITH MS Updated January 2011 Multiple Sclerosis Limited 2011

15 Exercise and m ultiple sclerosis The benefits of exercise Regular recreation, active living and a personalised exercise program can help you to live w ell w ith M S. Exercise does not trigger a relapse (exacerbation) of M S or adversely affect the disease process. Regular exercise can help m anage som e of the sym ptom s of M S and decrease the effects of physical inactivity. Regular physical activity can benefit everyone not just people living w ith M S. B enefits include: reduces fatigue and increases stam ina and fitness levels im proves flexibility of joints im proves coordination and balance im proves and m aintains m uscle strength and tone helps in the m anagem ent of m ild spasticity (m uscle stiffness) im proves posture and reduces back and neck pain m aintains blood pressure at norm al levels and decreases the risk of heart disease reduces the risk of obesity, diabetes and osteoporosis elevates m ood and reduces stress and depression builds self confidence and sense of w ellbeing increases alertness and concentration provides opportunity for social interaction and support Special exercise considerations in MS Fatigue and MS. People w ith M S usually experience fatigue sooner and take longer to recover than people w ho do not have M S. Fatigue m ay occur and continue for several hours or even into the next day. Start w ith low intensity exercise and duration and build up slow ly. If fatigue lasts longer than 30 to 60 m inutes, m odify your exercise session by reducing the intensity and duration. Tem perature. Sm all increases in environm ental or body tem perature can tem porarily increase physical and sensory sym ptom s. Try to keep cool w hile exercising by w earing loose clothing, drinking w ater before and during exercise, exercising in an air-conditioned or w ell ventilated area, and w earing a w et cloth or cool band around your neck. Sensory sym ptom s. Som etim es the intensity of or num ber of sensory sym ptom s (e.g. num bness, tingling, pins and needles or blurred vision) can increase during exercise. These changes can be unavoidable but, if tolerable, you can continue exercising. An increase in sym ptom s usually resolves w ithin a short tim e after the exercise session. You m ay need to decrease the level of exercise intensity if tem porary w orsening of sym ptom s does not resolve w ithin 30 m inutes after exercising. INFORMATION FOR PEOPLE LIVING WITH MS Updated August 2011 Multiple Sclerosis Limited

16 Exercise and m ultiple sclerosis continued Starting an exercise program C onsult your doctor, a physiotherapist or trained fitness instructor before com m encing a new exercise regim e. Ask your doctor w hat form of exercise is best for you and if there are any health risks w hich m ay affect your ability to exercise safely. A physiotherapist or trained fitness instructor can help you m anage the physical sym ptom s of M S (e.g. m uscle w eakness, spasm, fatigue, pain, altered balance, or trem or) and can design an exercise program suited to your individual needs and preferences. Exercises and equipm ent m ay need to be adapted to ensure your safety. Precautions m ay need to be taken to m inim ise any health risks or tem porary w orsening of sym ptom s. For exam ple, avoid strenuous exercise during a relapse (exacerbation) of M S, an infection or fever, or if you are feeling generally unw ell. You m ay need to reduce or stop exercising at these tim es, w hich can be discouraging. H ow ever, you can restart your exercise program at a low er intensity and duration and gradually build up your levels of fitness, flexibility and strength again. Tips for staying m otivated C hoose an activity you enjoy, that is convenient and m eets your budget. Set sm all and realistic exercise goals, beginning slow ly and doing m ore as you becom e fitter and stronger. Establish a contract w ith som eone you know and w ho w ill encourage you to stick to your agreed exercise plan and goals. Plan ahead and schedule tim e for exercise in your diary. Find a variety of w ays to exercise, so that you continue to find exercising fun and enjoyable. D on t overdo it. W hen you feel fatigued, stop, rest or change exercises. Avoid overheating by w earing light clothing and exercising during the cooler parts of the day or in a cool environm ent. U se a buddy system. Arrange to exercise w ith your fam ily, a friend or as part of a group. Record your progress and achievem ent of your short-term exercise goals. Rew ard your efforts, particularly in the first 6 to 12 w eeks, w hich can often be the m ost difficult w hen starting a new exercise program. For inform ation about MS and MS Australia AC T/NSW/Vic services: MS C onnect : Em ail: m sconnect@ m saustralia.org.au Web: w w w.m saustralia.org.au/actnsw vic D isclaim er: Information contained in this fact sheet, prepared by Multiple Sclerosis Limited, is intended to provide useful and accurate information of a general nature for the reader but is not intended to be a substitute for legal or medical advice. Multiple Sclerosis Limited is not recommending medical or legal advice and readers must seek their own medical or legal advice as may be appropriate. P rinting and photocopying this publication in its original form is permitted for educational purposes only. R eproduction in any other form without written permission is prohibited. 2 INFORMATION FOR PEOPLE LIVING WITH MS Updated August 2011 Multiple Sclerosis Limited 2011