The Priorities of Neurologists for Exercise Promotion in Comprehensive MS

[ActiveMSers]

The Priorities of Neurologists for Exercise Promotion in Comprehensive Multiple Sclerosis Care

Emma V. Richardson, Matthew Fifolt, et al
https://doi.org/10.1016/j.msard.2019.101482

Highlights

•Exercise is an essential strategy for improving symptoms of MS.

•Neurologists are under resourced to provide this information.

•We addressed gaps in knowledge and practice in the paper.

•Time, training and insurance constraints were barriers to exercise promotion.

•Exercise guidelines, resources and a team approach facilitate exercise promotion.

Abstract

Background
Fewer than 20% of persons with multiple sclerosis (MS) engage in sufficient amounts of exercise for experiencing health and wellness benefits. Neurologists have a powerful and influential relationship among patients, highlighting the potential for the patient-provider interaction to be a gateway for promoting exercise behavior. Neurologists, however, are under-supported and under-resourced for promoting exercise in comprehensive MS care. The purpose of this study was to determine the priorities of neurologists for exercise promotion among patients in comprehensive MS care and, where possible, provide suggestions for how each priority may be addressed in practice.

Methods
Priority areas were identified through deductive content analysis of 20 semi-structured interviews with practicing neurologists.

Results
Seven priority areas were identified regarding promotion of exercise among patients in comprehensive MS care. These included (Olek et al., 2015) How do I fit exercise promotion into a patient's appointment? (Moreau et al., 1996) What resources should I give my patients about exercise? (Dendrou et al., 2015) What are the benefits of exercise for people with MS? (Motl et al., 2017) What training can I do to be better informed about exercise? (Pilutti et al., 2014) What are the prescriptions/guidelines for exercise among persons with MS? (Motl and Pilutti, 2012) What kind of services can I rely on to support me in promoting and supporting exercise behavior? (Klaren et al., 2013) How do I negotiate reimbursement and insurance restrictions when I promote exercise?

Conclusions
This research sets an agenda regarding approaches for exercise promotion among patients with MS through interactions with neurologists in comprehensive care settings.

[Suebee]

These guidelines are desperately needed. Water exercises need to be in cool temperature pools. HITT
Works well, especially for msers with low endurance. TRX is great for strengthinging and those with poor balance. Just telling me to exercise more isn't a good directive.

[Drillerdou]

I often wonder, with a limited amount of time what a person should focus on? Aerobic vs strength. I usually work 12 hours a day plus 45 min commute each way driving a dump truck. It's very difficult to make myself do anything when I get home. My neuro doesn't give much if any input about exercises.

[Suebee]

Drillerdou, working full time like you do with MS, that is awesome. I have been working full time on / off. I found the biggest challenge was to figure out/know/ respect my physical limits in the day. Not easy, for me it was moving target and ambition and sense of responsibility, maybe pride, often. Drove me to a level of fatigue that i cant describe in words. My health and after work family time suffered. I am always fearful of taking on a new workout routine that cummalticely will make it difficult to do my job and other responsibilities
. 1) I recommend trying out yoga sun salutations for flexibility. It's quick, not complicated, and you can find video of it in a lot of places. The key is to find a video that you dont mind the narrator and stick with it a few days before you decide not to do it. This shouldn't negatively impact your physical strength the next work day at all.
2) Do strenght training but start slow.
Find a trx studio and see if you like it. Suspension training is used by the marines. The strongest I got after getting MS was after I did TRX. Or cheaper alternative is resistance bands. Again I recommend starting slow with 1 rep because I found I could do multiple reps but then next day I would feel significant fatigue
https://www.silversneakers.com/blog/...sistance-band/

3) aerobic exercise is trickey to in corporate into work life because you need to be consistent and figure out from trial and error how much you can do before it impacts your stamina the next day. There are so many great testimonies on this forum about cycling and running. I think a lot of MSers like HIIT stategies. You can do that with any activity and for any duration. Dave has a great post on how to do HIIT with a stationary bike for a few minute commitment.
Best of luck and keep us posted on your exercise adventures.

[cl3me]

MS Society Canada has the following guidelines posted:

http://www.csep.ca/CMFiles/Guideline..._adults_en.pdf

In spring/summer/fall I easily meet the guidelines for aerobic activity between cycling, kayaking, horseback riding. Just barely in winter with swimming 1x a week.

I don't do specific strength exercises, I am hoping that I get sufficient strength work with my activities.

The speaker from any talk I've heard says the most important is just get active and start where you are at, with these goals in mind as a target.

[Suebee]

Clm3e. Great find! The guide gives freedom to choose activity but outlines what is important and frequency. I plan to use these guidelines to help me get max out of my work outs. Thanks for sharing!

[heather510]

Drillerdou, it can be hard to find the time to do all the exercising you want to do when working. I am lucky in that my commute is short and involves some walking. I make sure to take all the breaks that are coming to me and use them to get my 10000 steps. I also got a spin bike for my basement that makes it easier to get the cardio I need. I do one weekly strength training session with a trainer on the weekend, and throughout the week I throw in some pushups/crunches which only take a couple of minutes to do. Basically I had to decide that exercising was my main hobby now.

As far as cardio vs. strength, I feel like both are really important. I feel like I do cardio for my brain and strength training for my body. This is somewhat of a false dichotomy because they are both good for both—I have seen research on the benefits of strength training for the gray matter, and I can tell you that after 5 months of spinning, my thighs are definitely bigger and harder! (I am a tiny person so bigger is better for me.)

[Drillerdou]

Thanks for the replies, I'm going to go workout right now lol. The irony is that I changed careers after twenty years because I thought this would be easier on me (it is), and I'd have more free time to focus on exercise (I don't). I have always believed that some sort of exercise is great for a healthy person, but now I believe it's more important for a mser.
Those guidelines are a great starting point!
Ps I have played with yoga,I have greatly underestimated how challenging it is. I see how bad my balance has become!