Education and Counseling
Research has shown that many people with disabilities, and persons with MS in particular, believe that they do not possess the knowledge and skills needed to exercise safely. Because of these beliefs, it is not surprising to find that preliminary evidence shows that persons with MS are less active than the average, non-disabled American. However, before one can counsel the person with MS regarding exercise and physical activity, it is important to understand the perceived barriers that may be present.
In non-disabled populations, the four major barriers to participation in an exercise program have been reported as: financial cost, lack of energy, transportation, and not knowing where to exercise. Other barriers that have been cited include: not having someone to exercise with, childcare responsibilities, and lack of confidence. These factors, some more than others (e.g., lack of energy, lack of confidence), are more than likely the real issues for the person with MS. Such barriers need to be overcome before we can facilitate successful participation in a program of regular exercise.
At the foundation, counseling should focus on the basic principles of training (e.g., frequency, intensity, duration and mode). Special emphasis on how to modify each principle specific to the clients lifestyle and physical impairments is very important. Advice related to dealing with spasticity, tremor, incoordination, balance deficits, and general fatigue, when appropriate, will set a tone of "understanding" that will help to promote a level of confidence for these individuals. These issues have been outlined in the section "Special Considerations".
While evidence related to the efficacy of surface cooling for improving exercise performance is equivocal, previous research has shown that persons with MS perceive exercise to be less stressful when surface cooling is present. As such, strategies to promote surface cooling may improve exercise tolerance and adherence. These include: 1) selecting water exercise instead of land, 2) using a bicycle ergometer with a fan-style flywheel, 3) wearing a pre-soaked neck scarf, 4) ingesting ice-chips prior to exercise, and 5) skin surface misting with cool water. Pre-hydration and drinking during exercise should also be discussed.
Providing information to the client regarding cost, accessibility, and scheduling of local exercise opportunities sponsored by community recreational facilities, senior citizen centers, universities, and hospital outreach programs can reduce or eliminate several other barriers. However, if the client feels sufficiently confident in his/her general knowledge base, he/she may prefer to exercise at home. This will require the clinician to provide basic information regarding appropriate choices of home equipment, particularly as it relates to safety, cost, and the ease of use.
Finally, an important key to successful counseling and education with the MS person, as well as any disabled population, is the building of sufficient confidence to practice self-advocacy. A candid and comprehensive discussion of basic exercise responses, training principles, modifications related to symptomology, safety issues, and programming can provide a solid foundation for this to occur.