When it comes to exercise and MS, how do you know when to push and when to rest? 

It’s confusing because sometimes that little extra push got you out the door for the walk that helped you to feel better. But the next day, it was too much and took days to recover.

You want to manage MS to prevent it from progressing, but when it’s so unpredictable, it makes it hard to create a consistent plan. 

Let’s talk about how to navigate around this. 

My Journey with Exercise

I have to admit, I’ve always enjoyed physical activity and even working out. 

It started with gymnastics as a kid. I loved the floor routines, the uneven bars… I did not like the balance beam, but the rest of it was so much fun. 

I loved challenging my body to do different things and watching my body grow stronger. 

Then I cheered for eight years, was a catcher in softball, and in high school I was on the track and lacrosse team. 

Then Billy Blanks came into my life and loved receiving his VHS videos in the mail. He was the original Netflix in my eyes! 

Once I got into my 20s, I started running 5K races and even completed a sprint triathlon in my 30s, and I even started learning how to box – never from a competitive standpoint, but again, I just loved it. 

I also started taking my yoga practice more seriously and eventually became a certified personal trainer and yoga instructor. 

Physical activity has always felt a part of my life and to a certain extent part of me – my identity. 

Then Came Multiple Sclerosis

So when I was sitting in the doctor’s office hearing the words “You have MS” it was one of the first thoughts that came to my mind. 

What’s going to happen to my body? Will I not be able to workout anymore?

Now, of course, at the time, I knew very little about MS, so I was imagining that a mobility aspect of MS would prevent me from working out. 

Who knew that fatigue was far more common with MS than mobility issues and that it could be just as limiting in life. 

And it’s what can create so much confusion and doubt around exercise and MS. 

Exercise + MS: Old School Thinking

Back in the day, doctors told their MS patients, “Don’t exercise, it will drain your already limited energy.”

That was the old school way of thinking. 

Exercise + MS: New School Thinking

Now, doctors are telling us, “In order to boost our energy and maintain mobility, you have to exercise.”

It’s the complete opposite approach. 

First hand Experience

But for those of us living with MS firsthand, both experiences seem to be true. 

Somedays it feels like exercise gives you that boost of energy that you need. 

Other days it feels like it sets you back and takes you days to recover. 

The same workout on two different days yields two completely different outcomes. 

Welcome to the unpredictable world of MS, right? 

The topic for this episode was actually prompted from a discussion that we were having in my online course that I ran in the fall.

We were in the lifestyle module and several members were talking about how they struggle to know their limits. 

Sometimes they feel like they’re not pushing themselves enough and they start to beat themselves up because they just don’t have the motivation to do anything. 

And then these same people were finding that they also struggled with knowing how much to do when they did workout so that it didn’t completely drain their energy for several days. 

I’m going to go out on a limb here and say if you’re listening to this podcast right now – certainly this far into this episode that you can relate at least on some level. 

So I want to share with you the advice that I gave in hopes that it might help you as well. 

First let’s do a quick rundown on the best types of exercise for MS. 

Deeper look at best types of exercise for MS. 

Ideal Exercises for Multiple Sclerosis

The ideal exercise program when you’re living with MS should include: 

• Stretching
• Balance training
• Strength training 
• Aerobic / cardio 

But definitely not all at once! 

I’m going to talk about your tolerance for each in a moment, but let’s take a quick look at each one first. 

Stretching

Did you know that nearly everyone with MS develops shortened muscles, especially in the calves, hamstrings + glutes?

I read that in Dr. Wahls book and almost immediately thought, well that stinks because the backs of my legs have always been tight. I was a runner, so my hamstrings were always tight. Now MS is going to make them even shorter?

I guess I need to stick with yoga!

My point here, stretching is important because our muscles are more prone to shorten and in doing so it can create an imbalance in the body.

And stretching has a lot of benefits including:

• Improved digestion – some stretches can even alleviate constipation
  
• Reduction in everyday injury – carrying the groceries, laundry basket – all the functional movements throughout the day.
  
• Feeling better in your body which in turn can help to improve sleep.

I actually learned in a previous appointment with my neurologist that holding stretches for longer periods of time were most effective with MS.

And of course a daily practice creates lasting results. 

Balance Training

Aging alone decreases our ability to sense where we are in space. MS accelerates this decline.

We can slow this decline with balance training

If you’ve been in any of my live training or coaching programs before you may have heard me guide you through a balance exercise that I previously taught in my yoga classes. You can also hear me guide you through it on the podcast version of this blog post.

Strength Training

Declining strength is a primary factor for: falls, injuries and loss of mobility.

Whereas strength training:

• Increases bone density and strength – reduces risk of falls and fracture
  
• Improves balance, posture and coordination
  
• Strengthens muscles around the joints and reduces inflammation
  
• Generates the largest gains in nerve growth factors.

Remember body weight can be strength training too.

Aerobic Conditioning

Aerobic Conditioning is cardio or basically anything that gets the heart rate up,

• Walking
• Hiking
• Swimming
• Biking

Cardio can boost energy by stimulating mitochondrial growth – the energy centers in your cells.

Contrary to popular belief, you need to spend energy to make energy.

Aerobic conditioning can boost mood by releasing feel good hormones – serotonin and dopamine.

So those are the ideal forms of exercise for us. 

Exercise Tolerance with MS

Now let’s talk about discerning your tolerance. 

The first thing we have to do is understand your starting point. 

Where are you at right now?

Personally I used to work out 5 days a week – even after my MS diagnosis. 

But this fall I went through a really intense season in life and I had to scale back. 

So I need a little more of a gentle ramp up. 

These are the three questions that I shared with my client who was struggling to understand her tolerance. 

Now she was pretty active, she was going for 2.5 mile walks, going to pilates and going to zumba class. 

That’s a lot, but she wasn’t getting consistent results from them. 

Meaning that some days she felt great, other days she felt completely drained. 

3 Checkpoints for Exercising with MS

So I encouraged her to start creating workout checkpoints.

• How do you feel during a workout?
  
• How do you feel after a workout – later that day?
  
• How do you feel the next day? Do you feel recovered?

We need to look at this as a day-to-day check in because there are a lot of factors that can influence your tolerance for exercise including: 

• Sleep
• Food
• Mood
• Stress
• Weather.

So having continual check-ins is helpful. 

Start Small

I also think it’s important to always start small. 

You can always increase more tomorrow. 

For example the one workout class that I like to do, I know is pretty intense, so when I’m starting I might just do the warm up. 

It’s a 10 minute full body warmup that feels like a full workout when I’m just getting back into a workout routine.

And I’ll be sure not add much more activity into my day. 

My Starting Point

When I’m first starting back I likely won’t do back to back days either. 

I might start with 2-3 days a week. 

My goal in starting back is not to immediately get back to my old routine which I know is tempting, but that’s the fastest route to a set back. 

When I’m first starting back, I want to avoid energy crashes. 

I’m more satisfied with a shorter, less intense workout if I know that I was able to maintain energy the rest of the day and wake up feeling good the next day than to feel completely set back for days. 

Physical Therapy + Multiple Sclerosis

This is important to keep in mind if you’re going to physical therapy too. 

Many of my clients say that a full hour of physical therapy is too much.

So that’s important to discuss with your physical therapist. Cut it down to 30 minute sessions so you’re recovered to come back the next day. 

I guess the main message here is that exercise is important, it’s not something to ignore, but we can’t force it. 

Start slow and pay attention to the results. 

As you progress your body will become more resilient but that happens when you work WITH your body, not working against it.

What’s Your Experience with Exercise?

Share in the comments below what’s working for you and how you best navigate MS (or your chronic illness) and exercise. I want to hear from you!