Universal Fitness Innovation & Transformation
She is 37 years old and lives with her husband and 2 daughters. Paula was diagnosed with MS when she was 25 years old, after experiencing two attacks, during which she was incredibly tired, had trouble walking, and noticed that she couldn’t feel the difference between her wool sweater and cotton t-shirt with her fingertips. Since then she finds that her MS symptoms will come and go, but they haven’t gotten any worse. Paula is not sure what will happen in the future as each day is different. This makes it difficult for her to plan and schedule activities and she finds that she needs to be flexible in case she wakes up with a flare up.
He is 52 years old and has been noticing that he is having increasing difficulty with functional activities, such as being able to stand up after being seated in a chair. David was diagnosed with MS years ago and he has noticed a gradual decline in his abilities ever since. David is reconsidering living on his own as the reduced sensation in his fingers and occasional spasms in his arms are making things like cooking and cleaning more difficult to do. He enjoys spending time with others, however, David has been feeling down more often- even on sunny days- and combined with the frequent wake ups during the night, he has been too tired to call his friends.
Both Paula and David have been diagnosed with Multiple Sclerosis, however, they are experiencing MS differently.
Multiple sclerosis (MS) is a progressive condition that involves a loss of nerve myelination. This means that nerve impulses are not conducted properly and there signals between the brain and the body can be disrupted. It can be difficult to diagnose MS (and other autoimmune diseases) as there are a number of possible signs and symptoms (see list below).
Possible signs and symptoms:
MS is typically diagnosed when someone is between the ages of 20-40 years and females are two to three times more likely to be effected than males. The cause of MS is currently unknown and there is no cure. There are many options for people that focus on treating the disease as well as managing the symptoms. For a more detailed description of how MS can be diagnosed and treated please see Moore, Durstine, & Painter’s (2016) ACSM Exercise Management for Persons with Chronic Diseases and Disabilities
MS can be experienced very differently from one person to the next and across different periods of time for each individual (ACSM). However, there are four typical patterns of relapses and remissions that are experienced by people with MS (ACSM, p.,267).
Asking about which pattern of relapses and remissions best describes your participant will help you to better understand how they experience MS.
Exercise is important for everyone! For people with MS, the benefits of regular exercise include:
Since disability and impairment can be experienced so differently from person to person, this section highlights why the consultation phase is so important. Many fitness professionals are nervous about their first meeting. We hope this section will make you feel a little more comfortable and better prepared to manage this first step.
Use the consultation as an opportunity to get to know your new participant. In addition to gathering medical information and details about their fitness/ physical activity experience, you can focus on goal setting and learn about what they want. In addition to talking about exercise, ask the participant about how they will get to the fitness center, and what kind of support (if any) they need to be ready to exercise (for example, accessing the locker room).
You want to support the participant to be as independent as possible. Depending on the individual, this may change over time as they become more familiar with the setting and feel more confident and capable. Some participants may choose to include task-specific training as part of their goal setting (e.g., working on movements that will help them with getting out of bed or stopping quickly and changing directions in a busy environment).
When someone with MS comes in for their consultation you may notice the following:
What are you going to do?
Many people with MS are pretty sedentary because regular exercise (even light physical activity) can be challenging to do on a regular basis. This doesn’t mean that people with MS shouldn’t exercise! In fact, there are lots of benefits, including better movement, overall functioning, and quality of life. Pay attention when someone with MS starts a new exercise program (or completes a fitness assessment!), because you might notice the following:
Every person is like every other person, like some other person, and like no other person.
It’s really important that people who are new to exercise learn how to monitor and describe how they are feeling or their response to exercise. One helpful way to do this is to introduce the Rate of Perceived Exertion (RPE) scale. The smiley face RPE Scale or the OMNI scale (see below for examples of both) may be more suitable for participants with various disabilities than the age-predicted maximal heart rate (220 – age) (Stanish & Aucoin, 2007).
In the beginning, it is also recommended that participants measure their heart rate (using wearable technology such as a heart rate monitor may make this easier!). This information will help the trainer and participant to work together to learn about how the participant perceives their exertion during exercise and may help to inform programming strategies. For example, a trainer may encourage the participant to work towards a specific level of RPE, which can be complemented with information from the HR monitor to measure exercise intensity. Monitoring HR may also be useful in the event that participants are exercising at a level beyond the recommended intensity, which may happen if the participant is very engaged in the activity or trying to make a positive impression on the trainer.
Smiley Face Relative Perceived Exertion Scale
Although you will not be administering medication, it’s important that you have a brief conversation with the participant to make sure they are aware of any side effects of their medications that may impact their ability to take part in exercise and/or specific safety considerations.
Individuals with MS will most likely be taking regular medications. Similar to the variability you will find across individuals, you will find that different people are taking different medications to manage their symptoms at different stages. It is recommended that you talk about this during the consultation to see if there are any side effects that you should be aware of. You may also want to check in with them each time they come in to see if there are any changes or any new information that you should know. It is also important to ensure the individual has the go ahead from their health care provider prior to beginning a new exercise program. You can read about specific medications in (ACSM, 2016)
The tips and strategies found within the inclusive TIMES section will help you to create an environment that will support your participant’s participation in physical activity as independently as possible. It is important that you involve the participant whenever possible, along the way to ensure the program that you design will meet their needs physically, as well as emotionally and socially. Introducing a few simple strategies such as offering visual images of the participant’s program will help them to be more independent in completing their fitness programme. Ultimately, they will gain confidence and belief in their abilities (increasing self-efficacy) and experience self-determination (sense of control over their own destiny). This is key to establishing healthy habits that will be adopted for the long term.
http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf [accessed 12th July 2016]
Copyright © 2020 by UNESCO Chair , Institute of Technology Tralee
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UFIT c/o, UNESCO Chair, Institute of Technology Tralee, Tralee, Co Kerry. Ireland
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