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Fighting back with exercise.

Two years ago, Norman Howells of Peoria, Illinois, slowly walked 200 feet to the pool for his first aquatics exercise class. Ten years of MS and a sedentary life had left his 66-year-old muscles so weakened that he had injured his back. A physical therapist had prescribed water exercises, but the first session was far from encouraging. Climbing out of the pool after the class was even more difficult than getting in, for he was aching with fatigue.

Although he had to persevere through months of post-exercise fatigue before his body adjusted to the three 30minute sessions a week, today he has enough energy to work around the house. He still needs a cane for balance and his leg brace "to keep my foot from dropping and tripping me," but he is only tired for twenty minutes after his exorcises. "I've built up endurance, my muscles are stronger, and the psychological benefits are wonderful," Mr. Howells said rocently.


Norman Howells is one of legions of people with MS who challenge the old tradition in which doctors advised rest, rest, rest, for people with MS. There is no longer any doubt that exercise improves how people with MS feel, combats the pain and stiffness of spasticity, and reverses some of the loss of fitness that comes not from MS but from disuse.

"Some kind of exercise is good for everybody who has MS," said Dr. George H. Kraft, who directs the MS Clinical Center at the University of Washington in Seattle. He is a physiatrist, an MD who specializes in physical rehabilitation. Stretching exercises, which move the joints and stretch the muscles and tendons, are good for everyone who has MS, regardless of its severity, according to Dr. Kraft.

Passive, "range of motion" stretching exercises, taught by a qualified therapist, are essential for people who cannot move one or more of their arms or legs, for they play an important role in preventing contractures, or frozen joints. "But I am very cautious about recommending active exercise for people with severe MS," Dr. Kraft said.

In Dr. Kraft's experience, isometric exercise -- where muscles work against resistance to build strength -- and aerobic exercise -- which raises the heart rate -- benefit most people who are mildly affected and some people who are moderately affected.

What about fatigue?

Dr. Jack Petajan at the University of Utah is in the middle of a research study on exercise and fatigue, funded by the National MS Society. The early observations suggest that people with mild to moderate MS -- and no other medical problems -- can do thirty minutes of aerobic exercise daily without increasing their fatigue.

The majority of people in the Utah study say that exercise has really improved the quality of their lives, Dr. Petajan reports. "They feel more aware and energetic. And they are able to accomplish daily living tasks more effectively," he said.

Getting started

Cinda Hugos, a physical therapist at the MS Center at the Oregon Health Sciences University in Portland, always starts a person on a stretching program. And she has found they almost always feel some benefit right away. Success makes them willing to continue. "Then we explore the next step together," she said. "The most important thing is finding an activity the person enjoys, so they'll stick with it!"

The psychological benefits of regular exercise seem to be enormous -- if the "sticking with it" part can be mastered. Ms. Hugos notices her clients who exercise regularly "seem more in tune with what their bodies can do...and more in control of their lives."

What helps people stick to their routines?

Barbara Jo Sexton, of Ogden, Utah, who has been moderately affected by MS for about five years, uses a local health spa five days a week. Stretching, bending, and weight lifting are her exercise choices. "I have a very supportive husband, so that makes it easy for me to take the time," she said.

* Get your family members to "buy in" to your program.

Through painstaking trial and error, Mary Jac, of Chicago, has discovered that five or six a.m. is the best time to use her in-home exercise equipment. "This gives me time to rest before beginning my day," she said. She has acquired a stationary bicycle, rowing machine, and a stair climber.

* Experiment to find the best time of day for you.

Carolyn Barone of Rochester, New York, goes to a yoga program specially adapted for the needs of people with MS, provided through her local NMSS chapter. At first, she was skeptical about the ancient Indian practice, which involves deep breathing, stretching, and mental centering. But now she calls yoga '"the best frazzle-reducer I've ever found. "In addition to keeping her body more limber, and friendships forged with other class members, yoga gives her "a profound sense of peace."

* Choose an activity that gives you something you value.

Ted Pavlakis of Denver, Colorado, is enthusiastic about tai chi, a Chinese exercise system that involves slow deliberate movements and mental concentration. He too goes to a program adapted for disabled exercisers. "It makes me feel good to do something positive for my body," Mr. Pavlakis said. "Tai chi has taught me how to pace myself."

* Check out alternatives. Adapted sports and exercise programs are available in many communities.

Handle with care

Health professionals stress the importance of first consulting a doctor or physical therapist who is familiar with one's individual condition. A program that is right for one person may make another feel terrible. And experts agree that how a person feels is an excellent guide to both type and duration of any exercise.

"I wouldn't want anyone to feel driven to exercise or to feel guilty if it makes the person feel worse," Dr. Kraft cautions. "The practical approach is to try an activity and see if it feels comfortable."

"It takes time to get back into condition," Cinda Hugos advises. "Don't overdo. Add a little bit at a time -- and creep up on fitness."

Since overheating can make MS symptoms worse, some precautions are in order. Fans, open windows, or an airconditioned room are recommended. If overheating is severe, there are commercially available garments that hold cold packs.

Exercise in cool water (80-84 degrees F) is particularly beneficial. Protected from the force of gravity, disused muscles can be safely put into action. Many people with MS experience a precious freedom of movement in a swimming pool -- and overhearing is rarely a problem. Aquatic exercise programs specifically designed for people with MS are now offered by most National MS Society chapters.



"Maximizing Your Health" and "Moving with Multiple Sclerosis" are excellent manuals available from your local chapter of the National MS Society or call 1-800-LEARN MS and use the automatic order system.


* Your local NMSS chapter

* Your local YMCA, YVVCA, community center, or health spa

* National Handicapped Sports (451 Hungerford Drive, Suite 100, Rockville, MD 20850; 301-217-0960)

* Taoist Tai Chi Society of the United States (49 West 11th Avenue, Denver, CO 80204; 303-623-5163)

* International Association of Yoga Therapists (c/o Amy Kline Gage, 109 Hillside Avenue, Mill Valley, CA 94941)

* North American Riding for the Handicapped Association (P.O. Box 33150, Denver| CO 80233 1-800-369-7433)

More Tips for Success

* Keep a record, in a style that works for you --a notebook. a week-at-a-glance calendar, a chart on your refrigerator door.

* Plan to reward yourself for meeting a goal. (Make goals short-term at first.)

* Exercise with a telephone buddy or join a group,

* Never compare your performance to that of others.

* Don't be discouraged by backsliding. Almost everyone does. BUT: Question what really happened. Acknowledge and accept it. Define what triggered your lapse. If it's part of a pattern, rethink your program.

Safety Tips

* Check with your physical therapist ordoctor before you begin.

* Don't start a new program dudng an exacerbation unless it is advised by your doctor.

* Drink plenty of water before you begin an exercise session.

* Always warm up with stretches and slow, rhythmic movements. Use a similar routine to cool down as you end.

* Listen to your body. Pain, overheating, fatigue or weakness are signals to adjust your program.

* Don't overdo. Rest whenever you feel the need.
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Article Details
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Title Annotation:includes resource list
Author:Carlson, Cathy
Publication:Inside MS
Date:Jun 22, 1993
Previous Article:Someone to listen: new training program to make a good idea great.
Next Article:National MS Society goes on-line.

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