S3E18 Rethinking exercise for people with MS with Dr Gretchen Hawley

Geoff Allix  00:01

Welcome to Living Well with MS, the podcast from Overcoming MS for people with Multiple Sclerosis interested in making healthy lifestyle choices. I’m your host Geoff Allix. Thank you for joining us for this new episode, I hope it makes you feel more informed and inspired about living a full life with MS. Don’t forget to check out our show notes for more information and useful links, you can find these on our website at overcomingms.org/podcast If you enjoy the show, please spread the word about us on your social media channels, that is the kind of viral effect we can all smile about. Finally, don’t forget to subscribe to the show on your favorite podcast platform so you never miss an episode. Now, without further ado, on with the show. In this episode of The Living Well with MS podcast, I’m joined by Gretchen Hawley. Gretchen Hawley is a doctor of physical therapy and a Multiple Sclerosis certified specialist. After graduating from Simmons University in Boston, she developed a Multiple Sclerosis program alongside two of the city’s top MS neurologist. Dr. Hawley utilises the concept of neuroplasticity to improve strength, balance and walking in those with MS by using specific functional exercises. She has been a keynote speaker at several national MS Society events and other MS focused conferences and presents frequently to MS groups. Dr. Hawley brings a keen understanding of the challenges faced by people living with MS and has developed a virtual physical therapy program to help people improve their MS symptoms while in the comfort of their own home and guided by an MS specialist. Dr. Hawley resides in Buffalo with her dog, Finn. So Dr. Hawley, welcome to the podcast, or can I call you Gretchen? So to start off with, we hear a lot about new physical training methods, such as high intensity interval training or HIIT. So i wanted to ask, do you think that that sort of training high intensity interval training is effective for people with MS?

 

Dr Gretchen Hawley  02:02

Yes, I do. There has been a lot of research that has come out recently proving that high intensity interval training is beneficial for people with MS and because of that I’ve been talking about it more and sharing it and different strategies and ideas. It’s funny because a lot of my clients, when they hear high intensity interval training, they’ll say, “Oh my gosh, that sounds intense,” or “Oh, that’s intimidating, I don’t think I can do it.” And what’s interesting to know about high intensity interval training is that it’s different for everyone. So high intensity, a lot of people think means running, or the stairmaster or an elliptical like these intense things or jumping jacks or lunges, but it doesn’t have to be. High intensity just means high intensity for you, so even if you’re someone who does a lot of sitting throughout the day, or maybe you’re in a wheelchair, high intensity might mean a seated marching exercise, or seated jumping jack arm, so it’s just your arms going up and down, that might be high intensity. So you do that high intensity, and then there’s a little bit of a break or a lower intensity workout and that lower intensity might just be; bicep curls with no weights, so you can make high intensity interval training work for you, regardless of what your mobility status is, just making sure that the high intensity feels like high intensity movement for you and the lower intensity feels like lower intensity.

 

Geoff Allix  03:37

So you’re getting your heart rate up, getting out of breath, that sort of feeling?

 

Dr Gretchen Hawley  03:42

Absolutely, and one thing that I actually like to do to get my heart rate up is just moving my arms as quickly as I can and maybe it’s in that runner’s position, like I’m just pumping my arms back and forth pretty quickly, or forward punches or side to side punches. But you’d be surprised at how quickly that can actually increase your heart rate, especially if you’re talking at the same time, that tends to make it even harder.

 

Geoff Allix  04:08

And then how long for the high intensity bit would you do before a break?

 

Dr Gretchen Hawley  04:14

Yes. That’s a great question. So we don’t know yet from research exactly how long it needs to be to be effective. So there’s no guidelines right now saying your high intensity should be 30 seconds long, and then your low intensity should be for one minute. You know, there’s no guidelines like that. The important thing to know is that the high intensity should be for as long as you can go for before you feel like you need a break and then low intensity should be long enough where you feel like you can recover but not exactly to your baseline. So you feel like you’re definitely not working as hard as you were during the high intensity, but you’ve recovered enough where you’ve caught your breath and you can now work harder again. So some people, the longer they’re doing it, the shorter their intervals are, because they’re losing strength, they’re losing their energy and so it’s shortens the longer you do it.

 

Geoff Allix  05:12

Okay. And if you’re doing strength training as well, should you do cardio before or after strength training? Or if you’re doing HIIT stuff are you saying maybe mix it up between the two?

 

Dr Gretchen Hawley  05:26

That’s a good question because so I’ll answer the first part of your question. Cardio should be done before your MS specific exercises. So when it comes to strengthening there’s a few different ways to strengthen, there’s general strengthening and then there’s MS specific functional strengthening. So research has proven that doing cardio exercises before your MS specific exercises, it actually prime’s your brain for neuroplasticity, meaning your brain is actually more likely to find a neural pathway to strengthen your muscles. So yes, cardio should be done before those MS specific exercises. Similar to high intensity interval training, there’s been no research published yet as to how long you should be doing cardio for or how intense it needs to be, so unfortunately, at this time, we don’t have guidelines, we just know that doing cardio first is helpful. And if your high intensity interval training is getting your cardio in then that can absolutely be used before your MS specific exercises.

 

Geoff Allix  06:36

Okay. And you’re saying MS specific exercises. So how does MS specific exercise differ from regular training?

 

Dr Gretchen Hawley  06:47

MS specific exercises is functional, so there’s two different groups, whereas functional exercises will help you improve a function. Whereas strengthening exercises will help you get stronger and both are good, I don’t think one is better than the other, it just purely depends on what your goals are. So, you know, as an example, I can’t tell you how many times I’ve heard someone say, you know, I’ve been doing this strengthening program, and I’m getting so much stronger, but my walking is not any better. Or I can tell I’m getting stronger, but it’s still hard for me to get in and out of my car. So if you have functional goals like walking, climbing stairs, getting into and out of your car, into and out of bed, standing up from the ground, like a specific activity, then the best exercises for that is functional; meaning break down that movement into as many different small movements as you can and those small movements are now your exercises.

 

Geoff Allix  07:53

So can you give us an example of that if you were to take a step, for example. So if you’re saying, okay, I can break walking down into taking steps then. So how would you then would you break that down further?

 

Dr Gretchen Hawley  08:07

So walking is a big goal that a lot of people with MS have. And it’s a great goal and definitely one that you can improve on. But most people practice walking just as a whole. So if they want to improve their walking, they’ll just practice walking, or they’ll do squats or lunges. And again, those are good things to do, but walking actually requires seven different motions. So in order to just take a step forward, you first need to shift your body weight forward, so weight shifting forward, which for some people, that’s actually really hard to do. So you need to be able to shift your weight forward, then you need to be able to bend one of your knees, then swoop your toes up so that you don’t have foot drop, then bring your knee up towards the ceiling in the marching position, then straighten your knee and put your heel down on the ground again, so you don’t have foot drop and then keeping in mind that that whole time that that was happening, you were standing on one leg, meaning you also need single leg balance. So each of those seven things that I just mentioned should be exercises that you do and there’s different positions to do them. You can do them in a standing position, which is most functional, since walking is performed in a standing position. But if that’s too hard, you can modify them and do them in a seated position at first, or even a lying down position maybe on your back or on your side. So the trick with functional exercise is pick an activity that you want to improve and break it down into all the different movements that are required to perform that activity and those movements are now your exercises. Then just find a position where you can do them successfully.

 

Geoff Allix  09:56

And so you then do your cardio training. That feels to me like I do that before my strength training because it sounds like you need to get the form just right? Whereas strength training I kind of like at the end of it, yeah, the form is gonna go a bit because it’s hard.

 

Dr Gretchen Hawley  10:15

Yeah, so that’s true. If you if you’re thinking about all the components, so cardio, functional and strength, I would agree with you, I would say cardio would be first and not only that, but keeping in mind that cardio doesn’t need to be walking, or the elliptical or treadmill. Cardio can just be our movements, as we discussed for the high intensity interval training. So you don’t want to tire your legs out when you’re doing cardio, because then you’re going to be doing leg exercises for your functional exercises, and you’re strengthening. So yeah, I would start with cardio, followed by your functional MS specific exercises based on what your goals are and then you could end with some strengthening exercises.

 

Geoff Allix  10:58

So if I go back to the example of walking, I’ve got a smartwatch, and it prompts me to keep active and it says I need to do steps every hour. Now, is it more important to do those steps, which I can manage that. But if I’m not having a great day, and my walking isn’t great, Is it better to do them badly, or not to do them and only do them when you can do the form well. Should you always try and make sure that your form is best? Or do you think actually it’s better to, you know, do 250 steps regardless, if you’re doing that badly?

 

Dr Gretchen Hawley  11:43

I am a firm believer that quality is the most important thing. So I would say wait until you have good quality, our brains remember what we do more of. So if more times than not you have poor quality, that means that your brain is creating a neural pathway for that bad quality, because it thinks that’s what you want it to do. And when I say this, some people feel discouraged, like, well, what the heck, I can’t do a good quality all day long and it doesn’t have to be all day, but at least 50% if not more of the times that you walk or do your exercises, it should be good quality. So I would personally say hold off, even if that does mean that you’re not walking as much. The reason I say that, especially with our example of walking right now is because if you’re doing a strengthening exercise, or an MS specific exercise for walking, but let’s just say it’s the marching exercise, so you’re sitting down and your knee comes up towards the ceiling. Poor quality usually results in your knee falling slightly out to the side and your foot coming in. So if you were to keep doing that over and over and over again, when you go to stand up and do that same movement, your knee will fall out to the side and your foot comes in towards your other foot, which often leads to tripping over yourself or tripping over the ground. So quality is really important in getting the movement that you want versus movement that is still not the best and could result in a safety issue.

 

Geoff Allix  13:22

We’ll get back to our episode in a moment. But I wanted to take this quick pause to tell you to please be on the lookout for our brand new engagement survey, hitting your email inboxes soon if it hasn’t already. By taking part in this exciting survey, you’ll be able to have your say and help shape the future of OMS, your input means a lot, so thanks for taking part if you can. Now back to my interview with Dr. Gretchen Hawley. Okay, and another thing is motivation. So I mean, I’ve gone from being quite an active person, I’ve done a lot of running and I used to run, probably, when I was training sort of for long distance runs or something, I was probably running six days a week or something and I did other outdoor activity. But now it’s hard to motivate myself because I’m not going to run a marathon and I’m not surfing or doing some, like activity, which I actually enjoy. So how do you get that motivation to keep consistently doing your exercises?

 

Dr Gretchen Hawley  14:25

The best way that I have found is to form a really deep ‘why’. And what I mean by that I’ll give you an example of one of my clients. So I asked her, you know, well, why do you want to exercise? She’s telling me; I’m not consistent, and I know I need to be and so I asked her, Well, why do you want to be consistent? Why do you want to exercise in the first place? And she said to get stronger, and I said, Okay, well, why do you want to get stronger? So taking it past that first level of well, because I want to do this. So I asked her why does she want to get stronger? And she said, I want to get stronger so that I can do more things. And I said, well, why? And she said, because if I can do more things that would mean that I can go for walks with my family instead of sitting at home alone. Okay, well, that’s good, but why is that important? And she said, because if I can go for walks with them, instead of being alone, I’ll feel less alone. And so for her, her Why is now I want to exercise consistently, so I feel less alone. So it’s much deeper than; because I want to get stronger. Or it’s even deeper than because I want to go for walks more with my family. So if you can just keep asking yourself, why over and over and over again, as many times as possible to get to the deeper meaning of why you actually are sticking to it, why you want to stick to it. Another example that I really loved was a client, same thing. I said, Why do you want to stay consistent? Why is this important to you? And she started with the same thing of, well, I want to, I want to have more energy. I say, Okay, well, why do you need more energy? So the will I need more energy because otherwise, I’m just sitting around all day. I said, Okay, why is that important? Well, I don’t want to sit around all day, because then I don’t get out, I don’t talk to people as much. So well, why is that important?  Well, if I can’t talk to people, I can’t socialise. So for her, we just kept going over and over and over, how many times can we say why. And so for this client, it went from ‘I want to exercise so I have more energy’ to ‘I want to exercise so that I remain a part of people’s lives, not just energy’. And so if you can associate it with that deeper meaning, it can be really powerful in that extra push that you need to exercise consistently. It can be anything, you know, we’re talking about exercise now, but maybe it’s a goal of drinking more water, or eating healthy for any goal that you have, you can use this same motivational why, for staying consistent.

 

Geoff Allix  17:02

That’s a really good point, because I use that technique with my son, to get him to study more. So that he does well at his exams so that he ends up in the career that he wants to do, but I haven’t applied it to myself. But you’re right, It’s exactly the same. Really, it’s a completely different thing but it’s the same technique, isn’t it? You’re saying okay, yeah, the ultimate goal is not to be able to walk, because actually what does that give me? And then yeah, there’s, there’s a step beyond that. Because actually, in my head, walking is yeah, that’d be quite nice, but actually, it’s not the deep, why do you want to be able to walk? And then that’s much more of an emotional thing and, and yeah, then you get real motivation don’t you?

 

Dr Gretchen Hawley  17:51

Yeah, the more why’s you can ask, the better. And ideally, as you just said, you want emotion behind your why, not just the first thing that pops into your head. So if anyone listening is going to do this, I actually suggest take a day or two or three days to figure this out. Don’t feel like you need to come up with your why in five minutes, you know, ask yourself and you can even write it out. It’s a really good practice to not just think about it, but write it out. So starting with, why do I want to stick to my exercises? And then answer and then ask why from that. And if you can, I always say shoot for at least five why’s, if not more, go to 10 why’s, if you can get really deep and if you’re done for the day, leave it come back tomorrow, you might have some more thoughts as to how you can keep answering those why’s.

 

Geoff Allix  18:42

Okay, that’s great advice. We mentioned sort of having so many days of exercise, and then like sort of six days a week or something. Do you recommend having days off in that practice? So would you exercise every day maybe doing different things? Or would you actually schedule in a day off, or two days off? Or whatever you’d have?

 

Dr Gretchen Hawley  19:06

I like that question because MS research indicates that six days a week of exercise for people with MS is best. But keeping in mind every day can be different intensity. It doesn’t mean six days a week of your most intense exercises that you can think of, but I personally do like taking at least one, if not two or three depending on the person rest days. And it’s really important for the people who are big go getters and they just push, if you tell them to exercise seven days a week they will because often with MS and not MS I’ve had client’s who come to me and say Dr. Gretchen you know I was getting so much better and I’m noticing less foot drop, I can pick my leg up more, but it just stopped like I’ve plateaued and my first question is always okay, well how many days a week are you exercising and I may have only told them to exercise maybe five days a week, but they’re doing seven and so I always say, give yourself at least one day, if not two days off and 99% of the time, as soon as they start doing that, they’ll start to improve more, your body needs rest, that’s when the muscles grow and so it’s important to do the work and functional exercises in general strengthening exercises, but our body does need that rest time to grow and to build the results that we want.

 

Geoff Allix  20:31

Okay, and finally, you’ve got an online wellness program for MS called The MSing Link which is spelt MSing link. And there’ll be a link to that in the show notes. Could you tell us a bit about that?

 

Dr Gretchen Hawley  20:47

Yeah, so the reason that I created it was because there are very few physical therapists who are also MS certified specialists, and the treatments for someone with MS and the exercises, the parameters, everything is so different than if you were to go to what I call a general physical therapist or physiotherapist. So it’s really important that when you have MS, you’re doing functional exercises and not only that, but you’re using the right strategies when you’re doing them. So I created this online platform, not only to help more people and get the message out there, but even the people within my own town that I was living in at the time that I created it, they even couldn’t get to PT with me several days, just because they had a high fatigue day or they weren’t feeling well. So just getting to the PT clinic was physically challenging for them. So this was an option where it’s all online, you can do it at home, it doesn’t require equipment, it’s all functional based, with the goal of improving neuroplasticity, so that you actually can get stronger and walk better and have more energy. And then I also added in more of the wellness components, so we have guest speakers from other MS experts every single month, we have research updates, we have MSing Link yoga, task specific exercises, where I demonstrate how to climb up stairs, and how to get out of the shower and get into a car. So it’s kind of an all encompassing course for someone who is looking to focus on exercises specifically for their MS. And I’ve also decided for all of the listeners to give a $15 off discount for your first month of The MSing Link. So if anyone is interested in that, then you can just go to the show notes to find the discount.

 

Geoff Allix  22:43

Oh, thank you very much for that. So if anyone’s listening just on their mobile device on iTunes, for example, you can go to our website or you can go to the providers, you know, whoever provide’s your podcasts, if you go online, then you can see the show notes beneath it. But yeah, you can find all the links in there and there’s extra information and links to Gretchen’s site and everything on there. So with that, thank you very much joining us Dr. Gretchen Hawley.

 

Dr Gretchen Hawley  23:12

Of course thank you for having me.

 

Geoff Allix  23:19

Thank you for listening to this episode of Living Well with MS. Please check out this episode’s show notes at overcomingms.org/podcast you’ll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at [email protected]. We’d love to hear from you. You can also subscribe to the show on your favorite podcast platform so you never miss an episode. Living Well with MS is kindly supported by a grant from the Happy Charitable Trust. If you’d like to support the Overcoming MS charity and help keep our podcast advertising free you can donate online at overcomingms.org/donate Thank you for your support. Living Well with MS was produced by Overcoming MS, the world’s leading multiple sclerosis healthy lifestyle charity. We are here to help inform, support and empower everyone affected by MS. To find out more and subscribe to our E-newsletter, please visit our website at overcomingms.org

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