S5E28 Webinar Highlights: Movement and Breathing with Gillian Robinson

04:24 “It’s only in recent years that it’s been demonstrated that the respiratory system can be affected quite early on in MS. I think most of us are aware that it can be affected in the more advanced stages of MS. [These early effects are] logical really, as we know that muscle strength can be affected by MS in the disease process itself, as wherever your lesions are, they can cause muscle weakness in the rest of our body. So, it makes sense that it will cause muscle weakness in our respiratory system. Not only is this primary weakness a result of the MS itself, but if you’re not using [your] muscles and reducing levels of activity, you can develop secondary weakness or deconditioning.”

17:17 “Nasal Breathing is really important. We know that chronic mouth breathing can cause problems with your respiratory system and your lung function and certainly impair the effectiveness of your breathing. You can get dental problems by breathing through your mouth, and you’re losing 40% more moisture than you do by breathing through your nose.”

41:00 “An interesting bit of research out there shows that through visualisation activities alone, you can improve muscle strength. So, if you struggle with activity and getting your body moving, visualise activities that you might enjoy. The more detail that you can add to your mental imagery, the better and the more likelihood of success. Just try to bring your awareness of your breath. We’ve talked about how important breathing technique and exercising your respiratory muscles is.If your breathing is optimised, it most definitely has a knock-on effect on your wider wellbeing.”

42:39 “Notice your breathing responses during activity, so notice what your breathing patterns do. [Does your breath] start to get more shallow as you get more effortful? Do you start to breathe through your mouth? Be more mindful of how your breathing responds to activity.”

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Overcoming MS  00:01

Welcome to Living well with MS. This podcast comes to you from Overcoming MS. The world’s leading multiple sclerosis healthy lifestyle charity, which helps people live a full and healthy life through the Overcoming MS program. We interview a range of experts and people with multiple sclerosis. Please remember, all opinions expressed are their own. Don’t forget to subscribe to Living Well with MS on your favorite podcast platform so you never miss an episode. And now, let’s meet our guest. Today’s episode features highlights from the movement and breathing better wilst living well with OMS webinar presented by Gillian Robinson, and recorded live in front of our global audience as part of the finding hope with OMS series. To join us live for the next webinar or to watch the original presentation, head to our website overcomingms.org.

Gillian Robinson  00:57

Thanks, first of all, to Overcoming MS for inviting me here to talk to you this evening about breathing and movement. Just first a little bit of background about me. I’ve been qualified for almost 20 years ago, which is a little bit shocking. So I qualified with almost 20 years ago, started out my career in South London within the NHS. And then I moved up to Edinburgh in 2012. Where since then, I’ve been working as the lead physio at the MS Therapy Centre there. I definitely didn’t have enough to do I started a social enterprise with some other colleagues at Queen Margaret uni. And we have a few ideas about some different products to develop. And our first product that we’ve got under development at the moment is a some shoes for people with foot drop. So we’ll move on to the main part of the talk little overview of what we’re going to talk about this evening. It’s going to start and cover breathing. And of course we all breathe, we all need to breathe. And I certainly believe that if we can get the foundations of good breathing technique right, that can be a doorway to all sorts of health benefits, including better movement and better activity levels. So we’re going to cover why and how we should breathe. We’ll talk a little bit about how MS can affect your breathing and your respiratory system. And a few tips and tricks on how to help you breathe better and things that you can you’ll be able to put into action from this evening. I love keeping in mind then the idea of improving your breathing, we’re going to move on to the importance of keeping active and keeping moving. We’ll look at how your body responds to activity and what actually happens in response to any activity. And then we’ll look at the kinds of activity you might want to explore some that you may already be doing. But hopefully there’ll be a few ideas on how to get active. So let’s talk about why we breathe. The purpose of breathing really, of course is to take air into the lungs. And whenever the air is in the lungs, we remove oxygen from it and send it to our tissues. And also for us to take carbon dioxide out of the blood vessels and disperse it into the air again. The main mechanics of breathing should be driven by our diaphragm. This is the big stretchy muscle stretchy dome with a muscle that sits underneath our ribcage and separates our chest cavity from our abdominal cavity. The diaphragm is assisted by the little tiny muscles that sit in between our ribs. These are called the intercostals. And whenever the diaphragm contracts, it moves down and flattens downward. The intercostals cause the ribcage to let them move outwards. And the combined effect of this of course is to increase the volume of the chest cavity causing the air to move down into the lungs. When the air is there, it does its magic exchanges the carbon dioxide and the oxygen and then the diaphragm and the intercostals relax again. This is quite a passive movement then on the air moves out. So that’s pretty much pretty much the basics or why and why we should breathe.

Gillian Robinson  04:22

So how does MS affect breathing? It’s only really in fairly recent years that it’s been demonstrated that the respiratory system can be affected really quite early on and MS. I think most of us are aware that it can be affected in the more advanced stages of MS. But certainly, I mean it’s logical really that we know that muscle strength and muscle can be affected by MS. The disease process itself wherever your lesions are, they can cause muscle weakness in the muscles and the rest of our body so it makes sense. If that will cause muscle muscle weakness and our respiratory system. Not only the primary this primary weakness as a result of the MS itself. But if you’re not using muscles may reduce levels of activity, you can develop secondary weakness or deconditioning, as we tend to refer to. I always talk to my clients whenever they can see me, it’s very difficult to ascertain how much of your weakness is due to the MS itself, or how much of it is due to just not using it as much as you previously did. And going to the deconditioning. So we’ve, we’ve mentioned that the diaphragm and intercostals those are the primary muscles of breathing, they’re the ones that are most important and should be most important in your breathing activation. But if these become weak, some of the other associated muscles can be overloaded. Now the associated muscles of breathing include the abdominals. These are particularly important in the more effortful and exertional breathing of increased activity levels, and particularly important as well and generally being an effective core. So if you have a chest infection, or if you breathe in a foreign body, or if you something that someone you might be familiar with as aspiration pneumonia, this is where food might, if your swallow is not effective enough, then the food may move down into your lungs rather than down into your esophagus and into your tummy. So if your abdominals aren’t strong enough, and your diaphragm is not helping your abdominals, you’ve may not be able to cough effectively. And this will increase the risk of developing chest infections. Your facial muscles are also really important to assess with breathing, it’s important to be able to keep your mouth closed. This maintains the air the pressure within your airways to allow the air to move effectively down into your lungs and enter those little alveoli at the end of your your airways. Your neck muscles as well. Now these should not be active at rest, but they can be can be an involved and breathing again that the more sort of effortful and the breathing.

Gillian Robinson  07:14

It’s also worth noting that your MS lesions can of course affect your respiratory center within your brain. So if you have a lesion on your respiratory center, this can affect your respiratory drive. You can speak to your consultant or your MS nurse, we should be able to tell you whether you have any lesions in this area. And, of course, medications can always be a culprit for causing causing problems with all sorts of symptoms or presenting symptoms. So if you have any concerns that maybe your breathing might be affected by your MS. That’s worth talking to your GP, your MS nurse or your consultant about your medication. So how do we work out whether you have an effective breathing or not or if you have problems with your breathing. Although it’s certainly possible for you to have respiratory problems early on and your condition, you may not display any obvious symptoms. But there are some other little signs and symptoms that you’re not reading effectively. It’s also worth noting that throughout the general wider, supposedly healthy population, there’s a huge amount of breathing and adequacy evident there and breathing pattern problems. So this is not just exclusive to people with MS. A common sign is increased fatigue, if you’re not breathing in enough oxygen, your energy levels may be depleted. I talked about your neck, the neck muscles and if they’re overactive. And if you see them tightening up around your neck, that can be a sign that you’re not using your other muscles and respiration effectively. You might find that you need to take more regular breaths, particularly when you’re talking. So taking little short breaths and only maybe speaking a few words at a time before you need to take breath can be a clear sign. reduced volume of your voice that’s another can be another indicator.

Gillian Robinson  09:13

If you’re not able to take enough air down past your vocal cords and generating the volume on the way it can be difficult with just cough strength to cultivate the importance of the abdominals. If you’re having difficulty coughing up a sign something called Personal breathing which we often see in people with respiratory problems where you keep your breathe through a little tightened cough necessary counting little tactic to maintain the pressure within your airways and keep them splintered are one symptom that is all too common is tingling and your hands feet and sometimes in your face. You might notice that you size left or yawn more frequently meant. Can chest infections as being an issue, and increasingly dental problems, I’ll refer to that a little bit later on cognition and memory problems. Also can be assigned headache, persistent or recurrent headache headaches. Dry mouth is something else that I’ll talk about in a minute or to. And also, ineffective breathing can also be associated with increased frequency of urination at night, they started these symptoms you may associate with your MS already. But it’s worth considering this, if any of these have got worse, or if any of these are a significant problem, they could be improved by improving your breathing. To help you try and identify whether you have led any of these issues, or any problems with your breathing patterns, I want you to pay attention to your breathing. Okay. So I think if you could all just close your eyes, you’re sitting comfortably in your chair, I want you to just listen to the questions I have for you.

Gillian Robinson  11:00

So I want you to bring your attention to your breathing, which I think a lot of you should be used to doing because the OMS program promotes meditation on mindfulness. So take your attention to your breathing, and pay attention to whether you’re breathing deeply or shallow. Do you feel that you’re failing? Breathing quickly? Or slowly? Can you feel whether your chest is moving? Or if your belly’s moving? Or if both are moving? And how much they aren’t as one part of your chest as your chest or belly moving more than the other? Also, are you breathing with your mouth open or closed? And pay attention to your posture? What way are you sitting are you sitting with your shoulders rolled forward is your chin tuck forward. And finally, I want you to just take a deep breath. And notice if you open your mouth to do this. So we’ll go back over these questions that I’ve just asked you and talk a little bit about why they’re relevant. A lot of it is very common to see shallow breathing. And particularly if you’re sitting if you’re just sitting breathing quietly, you may not need to take particularly deep breaths. But if you’re sitting a lot and not doing a lot of activity, you may always be shallow breathing, You need to breathe deeply down into your lungs to get the air down into your airways to get them right into the alveoli so that you can exchange your oxygen into the bloodstream. Also, if you’re breathing quickly, quickly is often associated with shallow breath. If you’re breathing quickly, you’re not able to take a deep breath. And breathing fast and shallow is often associated with a stress response and this kind of fight or flight response. So can be closely associated with stress. Conversely, if you think about managing, if you’re feeling stress, that to take deep, slower breaths can be an effective way to manage your stress. I guess just thinking about what is fast breathing, what they call normal breathing rate normal limits of breathing rate. That is that the be between 12 and 16 breaths per minute. But if you read some of the other literature about more recent years, that number has increased over the last sort of 20-30 years. It used to be considered as about 10 to 14 breaths. So really fast breathing is anything about 14 breaths per minute. You think about your chest movement and belly movement. If you’re only moving your chest, you’re not using your diaphragm movement and your belly will indicate that your diaphragm is working on but you’re taking deeper breaths. And also, whether your mind is open or closed. If your mouth is open, you’re not activating your diaphragm, you need to close your mouth to get your diaphragm to work and contract properly. So feeling your belly moving as a good a good indication for your diaphragm working more effectively.

Gillian Robinson  14:05

Your posture is still important. If your shoulders are rounded, if you’re slumped in your chair, if your chin is poking out in front, it’s so difficult to take a deep breath and get air into your lungs. So it’s something we really need to think about. And again, what if we think about whenever you took a deep breath and did you open your mouth, a lot of people whenever they think of big taking a deep breath and to get more, more air, they will open the breath open their mouth, but actually if you close your mouth and take a deep breath and with your mouth closed and breathe through your nose, you’ll feel the difference and the way your chest moves. If you breathe and deeply through your nose, you’ll feel your belly start to move. If you did take a deep breath in with your mouth closed, well done, but I’d like you to try it with your mouth open and feel the difference in the way that your chest moves. So now that you’ve got in touch with the way you breathe, I also would like you all to be able to test yourself. This, this score the body oxygen level test score as a handy little self test that you can do as often as you wish. And then certainly a great way of monitoring how effective your breath is it can be reflective of your fitness, and certainly can monitor your response to doing some of the exercises that we’re going to talk about. I will talk you through first of all how to do it, and then I’d like you all to give it a go. So what you need to do keep your mouth closed, you breathe in through your nose and out through your nose. So take a normal breath. And that doesn’t need to be as not deep as just a normal, relaxed breath and through your nose, and out through your nose. As you get to the end of your out breath, close your nose with your fingers. And then count how many seconds that is until you feel the distinct urge to take the breath. And again, this is not a test of how long you could hold your breath. It is a test of how long it takes before your body wants you to take a breath. And let’s have a go. If everybody has a little bit of it, breathe in through your nose. Take a breath out through your nose. And when you get to the bottom of that breath, if you would just close your nose with your fingers and count how many seconds it takes. And so the the normal limits of the bolt score are suggested to be between 20 and 25 seconds. That might feel like a long time, elite athletes will display a board score of around 40 seconds, that is a long time. But if you can hold your breath, or if you can resist the temptation or if you don’t feel the urge to breathe in for 20 seconds, then that’s reasonably good. We’re gonna move on to some tips and tricks are a few exercises for you to work on. So the most important thing really is to think about your posture, we mentioned that so make it as you work on these exercises initially sitting support and a chair or even if you’re sitting on one of those kind of recliner chairs. Have a check in on your shoulders, make sure the roll back that you’re sitting nice and straight and that your chin is tucked back.

Gillian Robinson  17:15

The next thing that’s really important is to close your mouth. Nasal Breathing is really important. We know that chronic mouth breathing can cause problems with your respiratory system and your lung function and certainly impair the effectiveness of your breathing, you can get dental problems by breathing through your mouth, you’re losing 40% more moisture through breathing through your mouth than you do through breathing through your nose. So the acidity of the saliva in your mind as increased by mouth breathing, obviously, then you can become dehydrated if you’re breathing through your nose more habitually. And also, there’s some evidence in the literature that urinary frequency is more common and people breathing through their mouth. Sleep Problems. Of course, if you’re breathing through, you might be more likely to snore, people with sleep apnea, which some of you may already experience. So breathing through your mouth can cause all sorts of problems. So not only is my breathing, not great nose breathing, nasal breathing, has all sorts of benefits. Not only just breathing through your nose and activate your diaphragm, but it also warms and filters on humidifies the air that comes into your into your nose and diamond airways. Also the nitric oxide oxide is found in your nose and produced within your nasal cavities. It’s much higher concentration therefore in your nose. Certainly if you’re breathing through your mouth, you don’t generate nitric oxide within this is a really important gas. It’s a natural sterilizer. So as you breathe in environmental air, if there are bacteria or viruses within the within the air, the nitric oxide kills those off before enters into the lungs. This nitric oxide also stimulates the activity of the little cilia, the little hairs that line your airways. And these are really important for leaving the mucus out of your airways and the little particles that might move in through your nose or through your mind. As well as the nitric oxide. As it moves down into the airways when it gets right down into your lungs. It helps to facilitate the movement of oxygen across into the blood. So that’s quite a lot of good reasons to breathe through your nose I would say and one of the best ways to increase the level of nitric oxide you have is by humming so how many favorite tunes a few times a day and that will boost your nitric oxide levels and help all the benefits. So moving on to practice some breathing exercises, something that’s really useful to practice is as breathing lately. So if you can use this within your meditative practices that you’re already doing, if you bring your attention to your breath, and feel the air moving in through your nose, the cold air moving in, and warmer air coming out.

Gillian Robinson  20:19

As you focus in on that breath, try and make it as light and as quiet as possible. So slowing down the breath as it moves in and out to rate slow breathing, this type of breathing doesn’t have to be deep. This is shallow breathing. And that’s all about just moving the air really slowly and smoothly and through the nose. And it knows this is a little bit of a tactic as well, to allow you to build up its carbon dioxide and your blood. And that also a cunning little plan to encourage the building up carbon dioxide in your blood, it encourages your blood cells to release oxygen into your tissues. So by doing this, it helps to increase the amount of oxygen you get to your your tissues. Now on top of the lights slow Breathing, then you might want to, it’s important to incorporate some deep breathing. We talked earlier about the deep breathing really, you need to use your diaphragm for that. So you must close your mouth. If you put your hands on either side of your tummy, just underneath your ribs and above your hips, then you can use this as an eighth prompt for encouraging you to breathe deeply and get your diaphragm working. So again, concentrate on your breathing. Breathe slowly and steadily. And as you breathe in, focus your breath to move your hands outward underneath your ribcage. So as you breathe deeply, your hands should move outwards. And be dynastic as you can and repeat this cycle cycle several times to make sure you’re using your diaphragm. And as well as this deep breathing, you might also want to try holding your breath at the top and holding yourself your breath at the bottom something called Box breathing is really useful for this, holding your breath. So breathing in maybe for four seconds, holding your breath for four seconds, breathing out for four seconds and holding it out for four seconds. This is a really useful tactic to ensure that you’re giving the the air time to move into the the anterior airways and to give your give your body time to exchange the oxygen enter your blood and take your carbon dioxide out. Now, some of the evidence in the literature suggests that the muscles of the expiration so the breathing out that the muscles of expiration that that weaken first and MS. So it’s important to incorporate some breathing activities that force the breath a little bit harder. So on top of your deep breathing exercises, again, maybe spending a few minutes of breathing deeply. And then as you breathe out and get to the end of your breath, then you force it further. You pull your belly and unforced that breath out. And again, practice this for a few minutes. So all of those exercises can be really useful to use as part of your meditation practices. Or you can do it when you’re watching TV. You can do it when you’re driving you can do at any time of day. But certainly focus on trying to do them in isolation first before you try and incorporate them into activities.

Gillian Robinson  23:36

Now the next one might seem like a bit of an odd request taping your mouth. I’m not talking about putting duct tape on or sello tip, I’m completely covering your mouth. There are some mouth tapes available online on one particular one in particular that I have find particularly useful. There’s something called myo tape. And actually, what it is, is essentially a sport tip that has been cut with the hole so that you can place it over your mouth. By basically these bits of tape are just a prompt for your mouth stay closed. So if you find that you are attempting to breathe through your mouth, as a habit, then using these can be a really useful way to promote the nasal breathing. It’s still important. Try it during the day, try it just while you’re setting, try to use it whenever you’re doing some activities around the house. The highest, the highest. Certainly whenever we start to increase our activity levels, that’s when we tend to want to breathe through our mouth. So using the tip to stop us from doing that and prompt us to do that is really useful. It’s also really useful to use it at night. Many of us breath through the mouth at night How many of you go to bed with a glass of water beside your bed knowing that you’re going to wake up with a dry mouth. This is when I started started using this stuff. And it certainly has been I have noticed a big difference in how well I sleep, actually when I wake up in the morning and what’s more. So my tip is a really useful thing to do. Respiratory training devices, these, this is something that are talked about much more in the more traditional pulmonary rehab and respiratory settings within the NHS. And these are mainly used for increasing respiratory muscle strength, increasing lung volume, and also for facilitating the removal of secretions if you have difficulty coughing, these are really useful and they can they certainly have a place. But one of my concerns with them is that they a lot of them use mouthpieces. So if you’re at their facility, they’re basically promoting breathing through your mouth. So I think using them in conjunction for a very specific reasons in conjunction with the nasal breathing techniques and exercises can certainly be very useful. Another thing I just wanted to bring up is a different kind of breathing method, which has got a lot of attention in the last few years. This guy called Wim Hof, who promotes breathing techniques, along with cold water immersion, is getting an awful lot of attention has, achieved great physical feats. And certainly research is indicating that some of his methods certainly have impressive effects on the immune system. They his technique is about forced. It’s like controlled hyperventilation techniques. So rather than than slow, late controlled breathing, like we’ve just talked about. This is forced, repetitive, fast breathing. That causes a stress response. But it’s done in a controlled type of way. And there’s some interesting research coming out of this, but it’s just a different approach. Some of you may have heard of it. And some of you may even be using it.

Overcoming MS  27:05

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Gillian Robinson  27:23

So moving on, onto the next part of the talk really a bit movement and activity and trying to just keep the breathing stuff in the back of your mind. And we’ll try and bring bring it together a little bit towards the end of the talk. So the importance of staying active, it’s really important for all of us to stay on. But certainly if you’ve got a long term condition that could potentially degenerate condition like MS, that’s even more important. the benefits that we get from staying active and keeping moving are things like keeping your joint range of movement and keep them well lubricated. Maintain the length of your muscles and can minimize the risk of developing contractures and shortening of the muscles. Which of course other implications to how you can move maintaining or building muscle strength. boosting your circulation the muscles of course are responsible to a large extent for creating upon of moving fluids blood and lymphatic fluid around the body. Keeping your bile bladder and bile function up optimized, the more inactive you become the more sluggish your bile becomes. And certainly exercise also can help maintain your blood bladder function too. Pain management if you’re getting stiff and an active. This can just make any pain issues worse. Keeping active and keeping moving and certain types of exercise can be really beneficial for managing your fatigue, relieving stress and of course controlling our weight. If we keep it when we’re when we’re doing exercise and keeping moving or sleep improves, and of course we have social benefits if you’re doing activities with your family and friends that can give you a sense of achievement and give you the social benefits that can certainly contribute towards mental well being. More medium to high impact types of activity are hugely beneficial to maintaining bone health and keeping them strong and healthy. Evidence also quite clear that your memory and cognition benefits from staying as active as possible. And of course in relation to the earlier part of my talk. Getting active stimulates your respiratory system and encourages better breathing, better breathing patterns.

Gillian Robinson  29:43

So I also just we’ve got the most professional effects are the benefits of exercise, but I just want to draw your attention to some of the more physiological effects of activity because of how your body responds. And this might help to reinforce some of the benefits and the reasons to stay active. So obviously, when you get active, some of the initial effects are that your heart rate increases, trying to get blood around your body, your breathing rate increases to try and get more oxygen. But, of course, as we know that if your breathing patterns are not optimal, you may have sub optimal optimum oxygenation. As you get more active, your sweat glands get active, you sweat upwards to try and keep you cool. And as you demand more energy, these little guys call them mitochondria, which are within your cells, they get more active because these are the guys that produce all your energy. As you’ve been exercising for a little while or doing some activity, you then after about 15 to 20 minutes, we start to release the feel good hormones, or neurotransmitters called serotonin, and noradrenaline. A little bit after that we start to release endorphins, which again are feelgood factors, but also on our natural painkillers.

Gillian Robinson  31:03

Literature also shows us that your immune system can get really activated by moderate levels of activity. Depending on the intensity and duration of the activity that you’re doing, your immune system can be boosted by up to 400%, which is pretty phenomenal. But after you’ve once you stop your activity, after about three hours, these levels of immune cells return back to normal levels, like the longer term effects, so if you’re doing repetitive and regular level regular activities, the more longer term effects, of course, will be increasing your stamina, your fitness and your strength, your muscle fibers will increase in size. If you’re overloading them, you’re doing strengthening type of activities, your heart, of course, will get stronger because it’s having to pump harder as a muscle the same way as all the rest of our muscles on your levels of high-density level of protein increase and your levels of load versus your good cholesterol versus bad cholesterol. So all of these aspects are the sort of longer-term aspects of activity and exercise. Of course, lower the risk of other developing other healthcare content or other health conditions, like diabetes and cardiovascular disease. Repetitive, and regular activities also will stimulate the development of new neural pathways. And referring back to mitochondria, again, these little guys within yourselves, if you keep demanding more energy from them, then they’ll start to produce more mitochondria. So if you have more mitochondria produced and live within your cells, you’re going to generate much more energy. And I think really, this is a big benefit for fatigue management.

Gillian Robinson  33:00

So types of activity. We’re talking about activity in relation to cardiovascular response. The two sort of main types that we tend to refer to our aerobic activity and anaerobic activity. Recommendations are to kind of have a combination on a variety of different types of activity. But really, the main thing is that you do some sort of activity, the so your anaerobic activity is really a short, sharp and high intensity increase in your heart rate. That’s only for less than two minutes. So the high intensity interval training type of stuff that has become really popular in recent years. That’s what this anaerobic type of activity is. Like, we do a high intensity interval training class online, with our clients at the center, which has been really popular, because the more sustained levels of activity for some people is definitely more challenging. Like getting your heart rate up, breathing rate up, there’s all sorts of benefits to this may helps you it can help with your energy, but certainly it seems to help with energy helps the speed of activation, and certainly seems to be pretty good for strengthening aerobic activity as this longer duration activity. Getting your heart rate up to a moderate level. I guess we told me, you may wonder what moderate level of activity is, it’s a numeric rating scale or your perceived level of exertion. You don’t need to worry about your heart rate but you have an idea of high heart and zero is doing nothing at all. So you’re lying on the sofa watching TV, whatever. But you’re putting a very low level of effort and your 10 out of 10 is maximum effort. You cannot put any more than you’re about to collapse on the floor. It’s exhaustion. A moderate level of activity is considered as more really around a four or five out of 10 level. You’ll be starting to sweat you’ll be starting to breath heavier, but you should still be able to manage a conversation. So the aerobic type of activity should be this level of activity maintaining a conversation around middle of the table. So the types of aerobic and anaerobic activity are obviously defined by your level of heart rate. And traditionally, of course, we think of things like walking, running, swimming, maybe rowing. But anything that gets your heart rate is what matters here. Depending on your level of function, you may not be able to access some of the more traditional types of activities. But so we’ve got some examples on here, someone on a motorman, which is a motorized exercise bike where you can strap your feet and your hands on the machine itself can do all of the work for you, but will take your limbs round, but that might get your heart rate, if you’re not able to activate your muscles yourself. Also something an example here of someone rolling over in bed, that in itself can be activity that will get someone’s heart rate up. Doing it repetitively, of course will get your heartbeat more. The quicker you do the higher reason. I also have someone here with their feet on a wobble board, they can be unsettling. I certainly one of my clients uses a wobble board to get his heartbeat up as a repetitive whenever we’re doing something like the high intensity interval type training. So really, the type of activity does not matter. The main thing is that you’re getting your heart rate up, it could be squeezing your fists, it could be shrugging your shoulders repeatedly or it could be twisting in your chair. The activity is not important. The key messages here, get your heart rate up.

Gillian Robinson  36:38

Moving on to some other just examples of activity. They’re not that are not defined by heart rate. However, you might find that doing some of these will get your heart rate up. It’s important to incorporate some resistance types of activity, particularly when you’re when you reached your the over 40. You can use Thera bands, you can use dumbbells, you can use your own bodyweight to provide resistance, gravity resistance. Or it might be that you need some assistance to actually activate your muscles. So this is important for obviously, for maintaining and increasing muscle strength. Stretching, particularly if you have spasticity was really, important to maintain your muscle length and keep your joints moving. Again, this can be done by yourself. Or it can you can have someone else to do stretching for you balance activities. No of course, so many people with MS have balance impairments and difficulty with staying standing. Tai Chi has been shown within the literature to be really helpful for improving balance. Now your physiotherapist can help you to identify some graded exercises to target your specific aspects of balance that are an issue. And there’s also some evidence and the literature about vestibular retraining. So your vestibular system being your inner ear which is so key, to maintaining your balance, and there’s some research out there, showing that if you integrate some vestibular retraining exercises into your balance programs, that can be much more effective.

Gillian Robinson  38:16

Other types of activity, core strengthening, of course, the strength of your core and core stability. I’m sure you’ve probably all heard us therapists talk about this. Your diaphragm not only is really important in your breathing, but actually it’s a real it’s a key muscle and maintaining your spinal stability. And also when you activate your diaphragm, you activate your pelvic floor and you activate your abdominals. So using any of your breathing techniques, along with things like your Pilates and yoga, and doing general activities, and any other core strengthening types of activities is really important. Hydrotherapy. This is another great type of combination approach to exercise. Combined strengthening flexibility gets your heart rate up. And also really useful for people who have got a significant amount spasticity. The buoyancy of the water itself can help to release that. A few other things that are a little bit different vibration, but there’s some research out there as well indicating that it can benefit that can improve sensation. It can reduce spasms and spasticity. It can certainly improve in your walking endurance and walking performance. Something that I’m particularly keen on is this anti gravity treadmill. Again, this is something I’d love to know if any of you guys have had experience with this, my dream machine for the clinic where I work but basically it’s a treadmill that has a big inflatable bubble that you put around you and you can play it as much or as little as you want. That’s a great safe way to try and rehab and improve on your walking and possibly running if you’re able to run

Gillian Robinson  40:06

And lastly, ideas, rights of virtual reality starting to get a little bit of research, and a little bit of attention using things like the Oculus system. I mean, our developments in technology are really exciting for helping to reinforce our rehab. And can certainly help with things like balance or performance of specific activities. But aside from the virtual reality, if you don’t have the technology, visualization and mental imagery can be really useful. Again, incorporating lessons and things like your mindfulness and meditative practices that you recommend within Overcoming MS. There’s quite a lot of research out there with mental imagery for sports performance. Replaying performance within your mind to improve your performance and gain personal bests and optimize optimize performance. But there’s also some interesting bits, little bits of research out there showing that through visualization activities alone, you can improve muscle strength. So if you struggle with activity and you struggle, getting your body moving, visualize, activities that you might enjoy, the more detail that you can add into your mental imagery, the better and the more likelihood of success. Just trying to bring together again, your awareness of your breath of breathing. We’ve talked about how important breathing technique and exercising your respiratory muscles is, if your breathing is optimized, most definitely have a knock on effect on to your wider well being.

Gillian Robinson  41:53

So remember, practice your breathing techniques that we talked about earlier, practice them in isolation, get used to them get used to higher feelings. And then as you get used to these breathing exercises, there’s light slow, deep breathing. And remember your inspiratory hold holding at the top of your breath. Adding in some of these activities, adding up some of your breathing exercises than to the activities that you might like doing, even if he’s just starting to do. Thinking about when you’re preparing dinner, keeping your mouth closed breathing through your nose, incorporating it all. Notice your breathing responses during activity. So notice what your breathing patterns do. Do you start to get more shallow as you get more effortful? Do you start to breathe through your mouth, be more mindful of how your breathing responds to activity and gently challenge your boundaries. We don’t improve on this we push the boundaries. So when you’re doing your exercises, whenever you’re doing any of the activities that you might do, push your limits a little bit more, whether it’s just about pushing your breathing levels, whether it’s providing extra resistance. Whatever it is a bit of pushing your boundaries.

Gillian Robinson  43:17

Monitor your progress. This is a great way to help stay motivated using something like the board score which can help you monitor the changes in your breathing effectiveness and your fitness levels. But also doing something like keeping a diary of your other symptoms. And if you have more specific symptoms that you want to monitor you can speak to your health care professional about your specific outcome measures that you can monitor.

Overcoming MS  43:44

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 useful links and bonus information there. Have questions or ideas to share. Email us at [email protected]. We’d love to hear from you. Thanks again for tuning in and see you next time for tips on living a full and happy life with MS.