S6E10 Webinar Highlights: Accessible Movement for the Overcoming MS Community with Véronique Gauthier-Simmons

Overcoming MS  00:00

Welcome to Living well with MS. This show 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. Receive monthly tips and ideas about living well with MS by signing up for our newsletter at overcomingms.org/newsletter. And now, let’s meet our guest. Today’s episode features highlights from the Accessible Movement for the Overcoming MS Community webinar presented by Overcoming MS facilitator, Veronique Gauthier-Simmons recorded live in front of our global audience as part of the Finding Hope with Overcoming MS webinar series. To join us live for the next webinar or to watch the original presentation, head to our website overcomingms.org.

Véronique Gauthier-Simmons  01:03

So thank you very much for joining me for this webinar about accessible movement. I would like to recap why exercise is important in general, and for us living with MS. So let’s start with the benefits of exercise in general. And as we go through them really think for yourself which ones resonate with you. So we know that exercise stimulates the formation of neurons, and also strengthens the connection between neurons. And it reduces brain shrinkage. Everybody when we are getting wiser and wiser, the brain shrinks a little bit and even more for people with MS. Reducing brain shrinkage for me, for instance, that’s a key motivator. In general exercise improves cognition, decision making, problem solving. It improves coordination. It supports immunity, strengthens the joints, improves the respiratory system, reduces cholesterol and blood pressure and prevents cardiovascular disease, type two diabetes and some cancers. I’ve got a history in my family of cardiovascular disease and cancer. And that’s also an aspect that I want to keep in mind when I’m exercising, when I need motivation. And as people with MS we are also benefiting from exercise in relation to some of our symptoms. So research has shown that exercise helps to improve sexual function, bowel and bladder function. It lowers the risk of depression. And we know that people with MS have a higher tendency to suffer from depression. So that’s another really important benefit. In general, the quality of life is better when we exercise, research has shown that exercise is associated with less disability and fewer relapses, so a reduced relapse rate, it improves the mood, increases the energy level, improves walking speed and increases muscle strength. So these are the general benefits. Obviously, as I said, we are all different. We all have limitations. And the benefits will vary as well depending on where we are at and what type of exercise we do. Something that I’d like to share with you, I don’t know if you’ve read the Joy of Movement by Kelly McGonigal. I got the book a couple of years ago, and I’m reading it for the third time. It’s a beautiful book, it’s written in a lovely style, she gives loads of easy tips. Because I read it already two and a half times I highlighted so many passages on my Kindle. I could share probably the whole book but I decided only to share two today. And this one really resonates with me because that’s something that I often tell my yoga students, I always say it’s not just about the movements that you do it’s about your intention, what you want to focus on. Kelly McGonigal says it much better than me, “your brain perceives the location of your limbs and the fluidity of your steps and realizes I am graceful. When you move with power, your brain encodes the explosive contraction of muscles, senses the speed of the action and understands I am powerful, when you move in a way that requires strength, your brain senses the resistance in your muscles and the force on your tendons and concludes, I am strong.” And this is something that you can easily try out, just sitting on your chair with the feet flat on the floor, lengthen the crown of the head, close your eyes. And just relax. Just relax every muscle in your body that you can relax, let it go. And you are sending the message to your brain. “I am relaxed.” Place your hands on your, on your thighs on your quads and push your feet into the ground and feel the strength in your legs. If you can’t feel the strength in your legs, or that is challenging for you, bring your hands in front of your heart and push your hands together, feel the strength in your arms. And now you’re sending the message to your brain that you are strong, you are getting stronger. I think it’s important to think about the movements that you do. But also, what is your mindset, what you want to achieve? Do you want to get more flexible, more relaxed, do you want to get stronger? So keep in mind that the mind is important. What is your goal? And I think it’s important to spend a little bit of time, think what do I want to achieve? Personally, if I’m told, you should do that it’s good for you, and I say okay, right, it’s good for me. But it’s not enough, it’s not enough to keep me motivated. But if I have a more precise goal, and I see that this will help me to reach my goal, I’ll stay motivated, and I will do it. So in, you probably have heard of this framework for goal setting called SMART. A goal should be specific, you could say I want to walk for 100 meters in that amount of time. So that’s makes it more measurable as well, which is the second aspect. A goal should be achievable. I wish I could fly, but I don’t think I will ever be able to do that. So it has to be achievable. And sometimes it’s useful to ask, you know, your doctor, or MS nurse or friends, partners just do they think it is achievable. Because sometimes we don’t, we’re not always aware of what we can or cannot do, or should or shouldn’t do. Relevant, if you want to exercise to improve living with MS, then make sure that what you’re doing is relevant and will help you to achieve what you want to do. And time bound. I find it useful. I love ticking, I love to have a program and say, what can next week go do this, this this and then to tick tick, tick tick and have a deadline. But usually having a time bound that is not too far ahead helps. So instead of saying for instance, I want to run a 5k before the end of the year, which is still very far away, then maybe break it down and I want to run 1k in two months. Yeah, and focus on this one first, and then you can move on being clear on your goals, the goals that are important for you that are achievable. Then we can look at exercising, try and find exercises or movement that are accessible. So the difference between exercise and movement just because I use both terms at the moment, but exercise is something that is more structured with a specific aim. And movement is more general like physical activity. And this actually can be applied to both. I like to adopt the same approach for exercise as for goal setting, and I’d like to give the example of running, if you cannot run, why not break it down and look at all these benefits, and think about what can I do to have the same benefits. But instead of having all in one, I’ll just do separately, yeah, we have a tendency, I think, to want to do something that is really powerful and bring all the benefits at once. And we save time and save energy. But I think it’s also nice to do things slowly. And that allows us to do something for a few minutes here in the morning, and then maybe later during the day, so that we can balance our energy level a little bit better, instead of running to improve your lung capacity. You could do some breathing exercise just sitting on the chair, whenever you want during the day, you can do some breathing exercise, and know that you are improving your lung capacity, the way the oxygen is delivered to all the cells in your body. And that is accessible to anyone, you can really, as long as you live, you can do breathing exercises, so it cannot be more accessible than breathe. So running also strengthens the joints, the bones, the muscles, and you can practice a lot of exercises to strengthen your bones, joints and muscles sitting on the chair, or using your body weight instead of machines in the gym. So you just need to find the right movements for you. But you can really strengthen the joints, the bones and the muscles. And in a softer way, instead of running to relax. You can also just do relaxing exercises. And you can sit outside if the weather is good, you can listen to soft music or music that you enjoy. You can do some yoga, you can do some tai chi, qigong, visualization, there are loads of options. Another benefit of running is that it helps to connect with nature when we run outside. And we know that it’s really helpful when you can just be outdoors. And you could combine for instance, you can do some strengthening for your muscles and the joints sitting outside in your garden. So there are loads of ways we can replace one activity and just take out the benefits and focus on doing one at a time. The other way to make exercise more accessible is to adapt. There are so many different examples. So instead of cycling, with a bicycle outside, if your balance is not great, you can use a gym bike, so a static bike. Yeah, that’s an adaptation. Or instead of doing some marching, you can match on the chair. So using a chair, is, I think the best way to adapt exercise if you’ve got balance issues, because then you are safe. And that safety is the first thing you need to look at. You could also do exercises on a mat on the floor and focus on sitting exercises. And you can do loads of exercises, sitting or lying down, instead of sitting on the chair, stand beside the chair, or beside the wall. And as I said before, you can use your body weight, you can use little bottles of water filled with water or sand instead of weight. And you can just use whatever you’ve got around you. The idea is to be just creative and focus on what you want to achieve. You want to get stronger. And if your intention is to get stronger, do the movement with this in mind. So I’m going to go through a little sequence. There are basically 20 different things that you can do on the chair or beside a chair. You don’t have to do them all. You can just pick again think what do I want to do I pick one or two exercises. And then tomorrow I do these other two or I’ll repeat them and do them longer. But first, we’re going to do some breathing because that is, for me the most accessible, and I want to show you, I hope I have already convinced you that with breathing, you can improve your fitness, your cardio fitness, and you can work your abs, as well. So we’re going to do the few rounds of a breathing technique that is called bellows, bellows breathing. So place one hand on your belly, and we’re going to inhale and exhale quite strongly through the nose. If for any reason that feels really hard for you, use your mouth instead. So ideally, through the nose, if you can’t, then use your mouth. And as we inhale, we want to extend the belly quiet strongly. And as we exhale, pull the belly in, inhale out, exhale in, out, and in, out, and in, out and in. And if that’s okay with you, go a little bit quicker, out, in, if you repeat that regularly, you will notice your core. But it also helps you to breathe better because you are using the diaphragm to breathe in and out. And if you find that’s too easy, then add the arms. And the key is to bring the arms up, and when you exhale and pull your belly in, draw the arms down. If you find this movement quite challenging, maybe your shoulders are tender, try and bring the arms forward. And if you want to get even stronger, then you can use some weight, some bottles, some little weight, the focus is on the belly. So keep repeating these. And you will feel you’ll get warmer, you’ll get more energy, and you’ll breathe better, and your core will get stronger. Yeah, another one that is a little bit less challenging and focuses more on really squeezing the belly in is called Breath of Fire. And this time we only focus on exhaling through the nose. So the inhale is normal, but the exhale is forceful through the nose and we squeeze the belly really squeezing, and you can do 20 of these and then relax, do another 20 and then relax. And to make it even stronger, bring the arms up and keep the arms up. These are two breathing exercises that can make a difference if you do them regularly. Next, we’re going to focus on the shoulders. And that’s one part of the body where I notice a lot of people with or without MS tend to lose range of motion in the shoulders, just with age, because we don’t use the movement of the arm. So if you’ve got MS, it might be a different reason why the range of motion is limited. But it can also be just because we are not using the arms. We are not really very often during the day lifting the arm when we’re in school does young kids but we don’t very often do this movement. And I find that really nice to do some, some movements for the shoulders regularly. One simple exercise is to inhale, bring the arms overhead. Exhale, bring the arms down, palms facing down. Inhale and exhale. Okay, if you want to improve your flexibility and range of motion, just think that you are more flexible. Younger. If you want to strengthen, use some little weights and lift. I am strong and you will notice that the same movement feels quite different. And even if you don’t have weight, squeeze, make fists and squeeze your fingers just by creating tension in your body, like this, you increase the resistance, and you increase the strengthening aspect. Next movement, still for the range of motion in the shoulders, bring your fingertips on your shoulders. If you’re quite tight in the shoulders, just circle the elbows. And then see if you can make the circles bigger. And you maybe the elbows come in touch and you lift the elbows. Be careful not to move the head.  So you want the head to stay in line with the spine and to sit tall, and than change direction.  Let’s move now to the spine. If you’re doing yoga, you might have heard before that you are as young as your spine is flexible. So one simple way to keep your spine young and healthy is hands on the knees and just circle the upper body. So you need to sit a little bit in front of your chair. Let’s move to the legs. So sitting, not touching the back of your seat, a little bit forward, simply hold the side of your chair and lift one foot, lift and lower one side and then the other side. And it is harder, and it might look. So that’s where you could adapt with the Thera band or any soft band will do. And you place the band under your foot. And if the movement that is the hardest is to lift the leg, then use your arms to lift and then push and then bend and lower. So you lift, basically your upper arm is lifting the leg and then you extend and lower and you can do that changing side after a few repetitions or you can alternate left to right, left to right as you prefer. Still working on the legs. Another option if your legs are stronger is to inhale and lift the arms and one knee up, extend down, inhale lift leg up and then down, inhale right and down. And so this exercise is not for everyone if you find it difficult to lift the leg, do the first, do the previous one instead using a band to support your leg and lift the possibility as well to make it more accessible. But you’re still moving your legs and moving your joints. Still on the chair, bring your legs apart. So the knees are over the ankles. And for this one, we’re going to place the hands behind the head. Inhale and as you exhale, do the elbow towards the inner back, exhale to the other side and back. There are really loads of options to do on the chair. But I like to mix a little bit different movements and to have an overall general practice. And then bring your knees together so it’s nice as well just to rest forward for a moment in between. So drawing your chest towards your knees and let your arms hang loose. The hands are coming to the floor here. One way to make it more accessible is to use your folded towel or you can use a cushion, a pillow and to place it under your chest, so it’s a little bit easier. That feels really nice in the lower back. So so far we’ve focused more on range of motion, flexibility really seeing the upper body. Let’s look at strengthening the legs because I know that something that a lot of us want to do, we’ll start with the easier version of this. So sitting, make sure that there’s a bit of space between your back and the back of the chair. So you’re sitting in the middle of a chair, place your feet hip width apart, so the knees are directly above the ankles. And we do what we did earlier. So hands on the knees, lean slightly forward, and push your feet into the ground, push the feet into the ground, you might want to lift your toes, if you don’t feel the strengthening, lift your toes. If you can’t really feel alot of strengthening, visualize your muscles getting stronger, contracting. And then if you want, bring your arms up, so you’re also strengthening your back muscles, and then release. It’s difficult but it’s not too challenging for your balance. Next one is a little more challenging, because we have been to lift off the chair, so it’s better to have the feet closer to the chair. So the knees are a little bit forward, not directly above the ankles, you can keep your hands on the knees first, lean forward, and push to lift and you want to hold it not to completely straighten your legs. So you feel the strengthening in the leg and the same, bring your arms overhead and that is quite challenging. And then lower down. Good. And you can start with holding the pose just briefly, and you can build up and repeat more often or stay longer in the pose. So holding the chair or beside a wall. Just march lift the knee and then the other knee. Sorry to adjust the camera. So lifting, lowering, lifting, lowering. This is also a nice exercise to do. And if you want to strengthen your legs, but your balance is not great. Place your hands on the chair in front of you and slowly bend your legs. Smile it makes it easier. And lift again and repeat the little squats. Another exercise is to stand beside your chair. So my left hand is on the top of the chair. I’m going to separate my feet so my feet are hip widths apart. Lift the right arm and bring the right arm overhead as I lean a little bit to the, towards the chair and that feels good. After strengthening to stretch a little bit. Try to include some stretching as well as strengthening. And now the other side, and now one of my favorite the downward facing dog with a chair. So standing in front of the chair, place your hands flat on the chair and walk back and you can keep your legs as bent as you need. So bend your legs as much as you need and release your head between your arms. If this is not an option for you, you can sit in front of another chair. Yeah, and place your hands on the chair opposite you and do the same. And this is another example where you can change the impact of the exercise with your intention. So if you lean forward and just think “oh I’m stretching, stretching, stretching and releasing.” That feels like stretching and releasing. But if you place your hands flat on the chair and push, push your hands into the chair, push and feel the strengthening and if you want to strengthen your legs as well as the upper body place the hands flat on the chair, the feet flat on the floor, push your hands down, push your feet into the ground. And feel the strengthening in your body. Which really is quite intense. And you hold for a few seconds and then you release. Should we quickly do the last few ones? So when you are in this pose, a downward facing dog, you can also step, one foot forward. And the front leg coming into a high lunge, if that feels fine, if you’re safe, bring your hands on your knee. If you’re really strong, bring your arms up. And you will feel your legs, your quads getting really strong. And you can hold just for three breaths. And then you change and change sides and repeat another time. Or what you could do is with your hands on the on the chair, focus and lift one leg and lower down, that will target your glutes and the back of the legs. And if you want to challenge yourself even want to challenge your balance, place your left hand in the middle of the chair, lift the right leg and the right arm. This is really challenging. Or lift the left leg and the right arm. There’s so many options. So many ways you can play around to move and get your exercise goals. Another option, but please make sure that you’re really safe, that your chair doesn’t move, is to do a high plank. So your hands are flat on the chair. And you are on the tip of the toes with the body in a straight line. I can feel my core. And that is a plank, to release you can come into some cat and cows with the hands on the chair, we’re rounding the back curving the spine. And the last movement that I want to share. Just because I think it feels so good. So when you are sitting, inhale and as you exhale, twist, twist to the side, so holding the back of the chair with the right arm when you twist to the right, left hands around, then back to center. And twist to the other side, back to center. So this was just a few ideas, things that you can do to make sure that you get your exercise. And most of them we can do quite easily. We can do a couple of them throughout the day. Like it doesn’t have to be within 30 minutes setting. You can decide oh, I’m going to do the downward facing dog whenever I get off my chair, or I’m going to do a little bit of squatting before dinner. The key I think is not to decide what to do. The key is to stay motivated. I read a couple of really lovely books about dopamine recently and one of them said that researchers found that on average, it takes about four sessions a week, for about six weeks before you feel, you know the exercise high, what you know the runner’s high or to feel the release of dopamine and you feel good. It’s not going to happen straight away. Most of the time, I know you need to, to do it for a while before you feel that you need to keep doing it. So one of your objectives could be, I will keep going for six weeks to get to find out what it feels like to have some dopamine release. The author I mentioned earlier Kelly McGonigal suggests something really nice is to add music to your practice. So choose your favorite music and listen to it while you exercise. So you will associate exercising with pleasure. I do that when I go running, I’ve got my playlist, and then I just combines together to make me feel good. Yeah. Another useful thing to do is to ask friends, or to join a club. Because you want to feel good, and it’s a social opportunity and doesn’t have to be live, it could be on Zoom, but just to see the same people again and  to build friendship is a nice benefit as well. And something else you can try is to journal or to keep track. If you got a watch that connects to your whatever Garmin app, then you can follow some data, I got really big into my VO2max and I wanted to see, because it tells me, oh you are biologically only that, that old, ooh I’m only 30 now, great, oh I’m going 25, oh I’m going to 21 okay, I know that’s probably ego, motivating, but it doesn’t matter you can just if you see that you improve some some data, then it keeps motivating you. So I think the for this the end justifies the means. So one, the second quote from the Joy of Movement. “And I think that’s really the key thing to remember, anything that keeps you moving and increase your heart rate is enough to trigger nature’s reward for not giving up. There is no objective measure of performance, you must achieve no pace or distance you need to reach that determines whether you experienced an exercise induced euphoria. You just have to do something that is moderately difficult for you and stick with it for at least 20 minutes. That because the runner’s high isn’t a running high, it’s a persistent high.” So keep doing it. Start and keep doing it. It will come when you feel oh, I’m just feeling better and I want to continue and be playful, be creative with making movement more accessible.

Overcoming MS  38:04

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