S8E28: Webinar Highlights Expert Insights Physical Activity with Heather O’Neil and Lyndsey Housden

Heather O’Neil (00:00)

We want resistance training, we want aerobic training, and we want stretching. Increased repetitions and intensity as the body adapts.

 

Overcoming MS (00:08)

Today’s episode features audio from the Expert Insights Physical Activity webinar, part of the Living Well with MS webinar series. Overcoming MS facilitator Heather O’Neill and trainee facilitator Lindsay Housden explain physical activity and exercise tips for people living with MS.

 

Heather O’Neil (00:27)

Welcome back to Living Well with MS Webinar Series, we’re gonna be discussing the topic of physical activity in MS.

So my name is Heather O’Neill. I’m an overcoming MS facilitator and clinical social worker joining you from Denver, Colorado in the United States. we’re gonna be joined by a community member and trainee program facilitator, Lindsay Housden,

 

Overcoming MS (00:47)

Just a quick note to say that all opinions are those of the guest and do not constitute medical advice.

 

Heather O’Neil (00:56)

And before we go any further, I just wanna highlight a definition. So physical activity and exercise, we’re gonna kind of be using those interchangeable today, but they’re actually two different definitions. So physical activity is anything that gets your heart rate above resting, right? So walking up and down the stairs, gardening, doing the dishes, things like that. Exercise on the other hand is really a planned, structured, repetitive movement with a fitness goal in mind we’re gonna start with this quote by Kelly McGonigal. It’s just talks, physical activity influences many brain chemicals, including those that give you energy, alleviate worry and help you bond with others.

It reduces inflammation in the brain. The mind altering effects of exercise are even embedded in your musculature.

There’s a lot of great science and research around how it impacts our body and how it impacts our brain. And so I’m really hoping that that’s what you take away today is excitement and really kind of a love of like, okay, I wanna move forward and I wanna do this part of the program.

So we start with just kind of how the body works, right? And homeostasis is this constant tweaking to keep us safe and alive. And we tend to think of the body as different organ systems, right? Cardiovascular over there, digestive over there, skeletal over there, as if they were kind of separate things. But in reality, these systems all work together and they work together to create homeostasis.

A good example of this is eating. So eating isn’t just the digestive system, It involves the muscular system to contract and move the food through the esophagus and stomach. It involves the respiratory system, which stores energy from the food. The circulatory system transports nutrients to different organs. And then the digestive system breaks down the food so the body can absorb it. So, so many different systems are involved.

And these systems communicate via the autonomic nervous system, These are the things that are going on that we don’t have to think about like breathing, We don’t have to think about breathing. It’s just happening, To keep us safe and alive. And they also communicate through the endocrine system and the skeletal muscle is an endocrine organ. And this matters because it means that muscles can communicate with the rest of the body.

And it’s really why when you exercise, you can improve functioning in all the other organ systems. So as we talked today about specifically physical activity and exercise, which is helpful for everybody, it’s particularly helpful for people with MS so that our systems and organs are running more smoothly and working together.

So with exercise and physical activity, our muscles contract and this produces myokines. And myokines are molecules that are exchanged between the muscles to the brain and other organs and systems. And right now researchers know about 650 of these different myokines, We’re learning new things all along and these different myokines do different things. A few of them that are particular to people with MS, is they do things like regulate heat and body temperature and weight loss. They help reduce inflammation. They help with survival and growth of neurons. They help with neuroplasticity, So these are things that are particularly important. And they also have an anti-inflammatory impact on our body.

So besides physical activity, there’s other factors that influence myokine production. A few of those, body weight management, being a regular body weight, stress reduction, nutrition, daily movement, and other lifestyle factors.

So we’re influencing myokine production by all of these things we’re doing. an unhealthy lifestyle leads to loss of muscle mass and impaired myokine production. So if you don’t use it, you lose it. This idea of keeping track of that as well.

A presentation done by Professor Robert Motl, who’s a researcher, a well-known researcher around exercise, physical activity, and MS And he really talks about this idea of all the systems working together better with exercise, right? And in this presentation, he talked about physical activity activates the central nervous system, the peripheral nervous system, the endocrine system, the skeletal muscle system and the cardiovascular system. And he goes on to say, it does so in a very integrative and systematic manner and by repeatedly exposing yourself to bouts of exercise. All of these systems adapt in an integrative manner. They learn how to work better, they grow stronger and they grow better.

 

We also have great information about how physical activity and exercise also influence the brain. So Dr. Wendy Suzuki is a professor of neuroscience and psychology.

This quote is just simply moving your body has immediate, long lasting and protective benefits for your brain. And that can last for the rest of your life. Her research really kind of looks at two specific areas in the brain that are influenced and benefit from physical activity. One is the prefrontal cortex, which is critical for decision-making, focus, attention and personality. And I like to think about when we think about symptoms of MS, we think about cog fog or that inability to focus. And so that prefrontal cortex with physical activity improves. The hippocampus also improves, which is critical for our ability to form and retain your long-term memories for facts and events. And I think about this with cognition, As MS is a neurodegenerative disease, and so cognition sometimes is problematic. And so by doing physical activity and by doing exercise, we know we’re improving these two areas. Dr. Motl I came across a paper that he published looking also at how exercise impacted the thalamus, which is a major relay area associated with cognition and the basal ganglia, which is associated with movement and control of movement in a smooth and coordinated way. And his research really showed that as aerobic fitness gets higher, the volume and integrity of these structures in the brain get better.

 

And with physical activity, our brains can strengthen and they can find new neural pathways. Strong neural pathways equal stronger muscles and improved mobility. neuroplasticity can happen for anyone with MS regardless of the level of disability or the year of diagnosis. Neuroplasticity can happen for anyone with MS, regardless of level, disability, or your diagnosis. So hopefully if you take anything today, that’s a really good one to kind of stick in your brain and walk away with.

So give your brain a chance to find new neural pathways by repeating the exercise, even with no movement. So we know this with sports psychology, We work with athletes around visualizing the next event, Visualizing their race or visualizing the game, because as they go over and over their head and visualizing that they are creating new neural pathways, we too can do that without being an athlete, So let’s say you have some weakness in one of your arms and you can only do a few bicep curls, And then it just, you know, feels like, okay, I can’t do any more than that. But you can work with visualization of actually visualizing that movement because we know that creates new neural pathways and will enforce kind of getting stronger.

The other thing I wanna talk about before we get on to kind of what we should be doing is this idea of a disease modifying intervention. So Professor Dallgus is another researcher who does a lot with exercise and MS and he is out of Europe. And he really is asking this question more and more, is this a disease modifying intervention? And he talks about exercise is a safe and well-recognized symptomatic treatment option that has beneficial effects on a variety of symptoms in persons with MS. we’ve got a big body of research that shares that exercise can help with symptoms of MS. which is great to know because, you know, 20 plus years ago, people were told not to exercise, not to do physical activity if they had MS. And we know that that is absolutely not true now. We know that exercise and physical activity needs to be a part of the protocol with this disease. He also shares, however, recent evidence suggests that exercise may also have a disease modifying effect in persons with MS and may even have a preventative effect by lowering the disease risk. So we’re getting more and more information, getting closer to being able to really identify this as a disease modifying intervention physical activity. In a paper I read recently with him too, he also talks about really this idea of can we start encouraging neurologists to prescribe exercise and physical activity to people with MS. That is how much research we are getting on how helpful this can be for our disease progression.

So we know this is all good for us, so how do we do it? So we know we need to be doing some resistance training. So resistance training really increases mytokine production. when we think about resistance training, I think we often think about weightlifting. But there are other resistance training ideas too, right?

 

Rock climbing, boxing, rowing. the best exercise you can is the exercise that you enjoy doing. So if you are trying to do something that you’re not enjoying, it’s unlikely that you’re going to be consistent with it. And consistency is really the name of the game in exercise and physical activity. So we know we need to be doing some resistance training.

We know we need to be doing some aerobic training, getting our heart rate up, people with MS tend to have significant lower VO2 max. So VO2 max is an indication of how well you use oxygen. It really tells us about our aerobic fitness.

People with MS in general have lower VO2 max, and it also gets lower with age.

A recent journal article I read from Dr. Motl explained that it isn’t so much something inherent with the disease of MS that makes people have a lower aerobic fitness. It’s really that people with MS tend to do less exercise and physical activity. He even cited a study that showed that only 20 % of adults in the US engage in recommended amounts of exercise and physical activity for health. So that means 80% are not doing the recommended daily amount. And so that’s why we’re here today really talking about how do we get more physical activity and exercise into your life. Other things, people with MS tend to have a lower six minute walk test results. We tend to have impaired heart rate reserve.

So heart rate reserve is really the difference between your maximum heart rate when you’re working out at maximum level and your resting heart rate. And people with MS tend to have widespread pattern of gray matter atrophy. what research really shows is that by doing physical activity, by doing aerobic training specifically, it really modifies the gray matter areas, especially involved in sensory motor control, visual processing, and cognitive functions, Which are all very significant for people living with MS. It also has neuroprotective role with reduced atrophy progression rate. So we need to be doing some resistance training. We need to be doing some aerobic training, getting our heart rate up. We also need to be doing some stretching.

 So stretching helps to release endorphins, dopamine and serotonin, which help to motivate us, fight off depression and decrease anxiety. Dr. Helen Langvins has done some work around yoga rats and so, basically they took a group of rats and they injected them with an inflammatory chemical, So they had inflammation in their rat bodies, right? Half of the group, was given stretches. So half the group was giving these yoga stretches where the rats held on and they pulled up their tail like they were doing downward dog. And half of the group was not given that. And what they found was the rats that were stretched had a high concentration of resolvins in the tissues after stretching, which turns off inflammation. The other thing they found that was really cool was that resolvins enter the blood and make clear inflammation anywhere in the body. So if you might be stretching your arms, but you’re having an anti-inflammatory effect in the whole body. So we need to be doing some resistance training. We need to be doing some aerobic training and we need to be doing some stretching.

The Holism study, which has been going on since 2011 with about 2,500 participants, and the results really show that exercise was associated with less disability, better quality of life, and lower risk of depression. it also showed that exercise has protective effects, helps to manage symptoms, preserves brain volume, and has disease-modifying benefits, the biggest jump is from people doing very little to doing moderate activity. So we don’t have to be Olympic athletes. As we increase physical activity and exercise, we are getting benefits with energy, with social functioning, with overall quality of life, with physical health and with mental health.

So physical activity helps increase muscle strength. It improves walking speed, which we mentioned a few slides ago, which is lower with people with MS.

It increases energy levels. And I love this one because I think one of the biggest barriers of people not doing physical activity with MS is often fatigue. And what we know is that exercise actually improves fatigue. It’s not a one-on-one. It’s not like I exercise or I work, I do physical activity today and tomorrow my fatigue is better. But what you will notice as you increase and do more physical activity and exercise, the evidence really shows that fatigue decreases. It improves mood. It reduces relapse rate, improves sexual function, improves bowel and bladder function, lowers the risk of depression, offers better quality of life, and is associated with less disability. So we’ve got a lot of things specific to people with MS where exercise and physical activity are really significantly helpful.

So how often is two to three days per week to start and you’re building up to two to five days per week and you’re gradually increasing to 30 minutes.

The amount of time for physical activity and exercise that is recommended is actually not different from people without MS. It’s 150 minutes of moderate exercise a week. Same for people with MS as people without MS. The how hard question, this idea of moderate intensity.

Moderate intensity can just be done with a breath test. so moderate intensity is basically you can talk, but you probably can’t have a full conversation and you can’t sing. And so if you can have a full conversation and it’s not really a problem, you’re probably going too slow. And if you can only utter a few words, you’re probably going too fast. So it’s somewhere in the middle of there, that moderate intensity.

 

We want resistance training, we want aerobic training, and we want stretching. Increased repetitions and intensity as the body adapts.

So our bodies will adapt to exercise, and that’s when we have to either increase intensity or we have to increase repetitions, Or we have to go longer. So, you know, as your body adapts, then you change things around. This other thing is start slow and build over time.

If you’re not doing any physical activity, you might want to start with five minutes in total and slowly build up to 30 minutes, maybe start with two sessions a week and focus on moving more, just getting more physical activity in your day-to-day life. If you already have a routine, you want to build up to 30 minutes per session, maybe build up from two to five sessions per week  and including strengthening as well as aerobic exercise. And I would also include some stretching in there. You wanna prioritize safety. Use assisted devices if balance is an issue. You can use the pool.

If heat is an issue. So there are ways to adapt things for your safety. Don’t overdo it. This is always a hard one, right? What is overdoing it? That’s a really personal one and I can’t tell you what overdoing it is for you.

When we can tune into our body, we start to listen to like and know a little bit more about what’s too much and what’s not enough. And the more you get comfortable with that, the easier you’ll be able to know and like, okay, absolutely overdid it. I need to kind of scale back a little bit. And then the final thing on there, talks about focus on regularity and progression. So consistency, right?

This is not like, I do this once and then I don’t work out or I don’t do any exercise for a month. It’s doing something consistently over time is how you’re going to see the benefits of this.

So Dr. Gretchen Hawley she talks about this idea of six out of 10. looking at strength, endurance, stretching, balance, aerobic exercise.

So let’s just take an example of if you took a yoga class. So if you took a yoga class, you’re going to get some stretching, some balance, some coordination. You’re going to be implementing daily movement. And if you actually go to a class, you’re going to get five of these already just in a yoga class, right? I’ll throw out another example, right? Let’s talk about if you’re a walker, like you do, that’s the physical activity you like to do, you like to go on a walk. So if you do walking and let’s say you’re like, okay, I wanna add some things in here. I’m gonna do some speed work. So I’m gonna walk my normal pace and then maybe for 30 seconds or a minute, I’m gonna increase my walking speed for a little bit and then I’m gonna come back to that regular speed and I’m gonna do that throughout my 30 minutes of my walk, right?

 

So you’re gonna get some strengthening from the walking. You’re gonna get some endurance. You’re gonna get some aerobic exercise, because you’re gonna get that heart rate up. You’re gonna get some speed work. And you’re going to get some implementing daily movement.

So you might be doing a lot of physical activity, but are you doing all of these things? And can you incorporate some of these? And so this is a nice way to kind of add some things in if you’re one of those people who are already doing a lot.

And so just this idea of making time for movement in your life is not a luxury and it’s not self-indulgent, it’s a necessity. I’m gonna invite Lindsay to share her story with you.

 

Overcoming MS (20:07)

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Lyndsey Housden (20:19)

Yeah, thanks, Heather. I’m Lindsay Houston, So I’ll just share a bit about my journey with MS. I was diagnosed first of all, when I was living in the Netherlands when I was 30 and it was around about 2010. if you’ve had a chance to speak to other people with MS, you might notice some similarities in the timing of your diagnosis that there may be a significant life event that happens around about that time. So increased stress levels.

The Netherlands is not particularly known for its sunny environment, so probably some low vitamin D levels, and it’s got a very high dairy content in the diet. So anyway, not to blame the Netherlands, but yeah, that was my experience in 2010. I was diagnosed whilst living by myself in a country without my family around. So of course, some isolation there as well, and all of those things.

Yeah, it was great and wonderful to find the OMS programme and one of the big kind of light and encouraging aspects to it was the community that is also there and the people that I’ve been able to meet since then. So in the context of the physical health and exercise pillar of the OMS programme, I would say that at the time of experiencing the diagnosis that was probably becoming quite disconnected from my body. I wasn’t exercising very much. in that way that when you are stressed, you stop to take care of yourself as well as you would do normally. And I think one thing that I found with yoga became quite a big part of my life, I would say, and still is something that I absolutely love doing.

You know how it is when you go through the diagnosis process, you’re suddenly in a hospital, you’re being scanned and it’s all kind of data and technical conversations. And then when I shared my diagnosis with a yoga teacher that I was seeing at the time, he just actually said, we’re going to get through this. He was 72, he was teaching five classes of yoga a day.

And well, talk about consistency, he definitely lived what he taught. So having somebody there to support me in that journey and especially to begin to reconnect with myself again. I yoga is wonderful in that it helps you to develop, to train and develop your breathing so that you are able to regulate actually what it’s doing is regulating your nervous system, so it’s helping you to come into a more the relaxed part of your nervous system or the parasympathetic part of your nervous system. So, so you’re doing those stretching where you’re also releasing, of course, the anti-inflammatory molecules. You’re also developing strength and you’re also developing a kind of proprioception and an inner awareness of what you need and what you need to take care of yourself. And I think it was that development and understanding that really helped me to make some good decisions regarding my health. since then, I’ve become a yoga teacher myself, and also like to share my practice and also work towards chair yoga and assisted yoga practices as well.

When I was initially diagnosed, the advice in a way was, maybe it’s best not to meet other people with MS. You might become worried. Well, I’ve got a chronic disease that is completely, you can’t make any predictions about it. What’s more to be worried about? Let’s just meet people and exchange. So that’s what I really loved about the MS community is the first time that you could really let your guard drop and you could really share your experiences and hear how people build in exercise during the week, how they deal with fatigue, how they deal with disclosure of their condition to their workplace, how they deal with adapting their life as the disease changes or takes different progression. So yeah, it’s been a wonderful journey to become part of this community and to learn more about certainly the more the research and the evidence around the programme which keeps becoming deeper and deeper.

 

Heather O’Neil (24:58)

The question is, what are the benefits of chair yoga? So the benefits of chair yoga are really very similar, the same as the benefits of yoga, right? stretching actually helps with inflammation in the body and stretching anywhere. So if you’re doing chair yoga, you might be just stretching kind of the upper body or stretching, maybe you’re not stretching the whole body like you would in a regular yoga class, but you are still getting the anti-inflammatory impact in the entire body. And so the other benefit of chair yoga is if you have any balance issues, then it’s really much safer, It also might be helpful, yeah, for any kind of assistance that you need, right? But the benefits are really the same as stretching and yoga, It’s gonna help with mood, because it’s gonna add serotonin and dopamine, and it’s gonna help with inflammation in the body.

 

Lyndsey Housden (25:50)

Yeah, so the next question I have is what aids do you recommend for balance training? They give some examples like standing cushions, wobble boards, anything else. Well, the first aid I would suggest is a wall. If you are able to stand and you are, you know, you’re practicing just simply lifting up off the heels and back down again, perhaps training your ankles, strengthening your feet, any work like that. Just having the wall nearby is a free and very accessible tool, The second thing, something I like to use is this kind of wobble cushion. And this is something that I have by my desk and I can just stand up. I’ve got a higher desk here, which I can use for just checking my balance if I need to. And you can just practice standing on one foot, checking your balance. And the great thing with this one is that it’s got this lovely slightly painful side, which also helps to stimulate the soles of the feet and wake up the nerves on your feet.

 

Heather O’Neil (26:47)

So the next question that I have down there is, mentally can’t sit still. I live with primary progressive MS. I try to push myself every single day. And I feel like I rest enough. How much is too much?

One of the things I would say I love, you know, hearing that you feel like you rest enough. means that you’re tuning into your body. Cause that’s probably the first in like how, how much is too much. One of the ways you might know that is if you’re not resting, if you’re doing kind of seven days a week and you’re not resting. So you really need to tune in to, what works for you. and good for you for pushing and doing things. This idea of I can’t sit still, right? This might be where that mindfulness and meditation comes in of like pulling some of that into some of the work that you’re doing with physical activity that might mean like bringing some yoga in. So you’re maybe helping your mind to kind of slow down a little bit that parasympathetic nervous system fill in, but how much is too much? You know, I think it’s really individual. I would say, you if you feel like you do a workout and then maybe for the next two days, you’re really wiped and you can’t actually do much, or I’m having a lot of physical symptoms show up, that might be your body’s way of saying it’s too much. I think this is a hard one always because when you do physical activity and exercise, especially if you’re new to this, there’s gonna be some soreness, your body is going to feel that. So I think it’s not realistic to say you’re not gonna feel any of that. You actually should feel some of that. That’s how you’re gonna know that your body is getting stronger, but you need to be in that sweet spot.

So I’ve got this next question. I want to get my teenage girls interested in something fun so I can work out, but also share the experience with them. Something like Zumba, any advice how I can convince them? So my daughters are now young adults, but I too have had two teenage girls in my house.

So I would say a couple of things to this. One is just, I love that you wanna get them involved and that share something with them. And I think starting there, right? Maybe just saying to them, hey, like, you know, I’m really trying to get more physical activity, exercise into my life. And I would really, love to share this experience with you. So letting them know why. The other thing that I often think about with teenagers and when I do some of my work, as a clinical social worker is this illusion of choice, I call it. So it’s this idea where you might say, like, I really want to do more physical activity, and I’m really excited to share that experience with you. Would you guys want to do a Zumba class or walking or a yoga class with me? So it’s this idea that they have choice, but you really choose one. So it’s this gentle parent manipulation in a loving way, right? I think the other thing I would say to this is like this idea of just doing something for yourself as well. hopefully they’ll be like, yes, we’d love to do this with you, mom. But you know, that’s not always the relationship. Sometimes it’s a little bit more fiery. And so they might be not interested. And I would say just do it and kind of, you know, know that they also will see you doing this and see you taking care of yourself. And that’s a huge benefit in this relationship piece with teenagers.

 

Lyndsey Housden (30:04)

Yeah, great. So the next question, are there any specific exercises to help manage fatigue and spasticity? This is something I can definitely connect with in terms of the symptoms. you know, the thing with fatigue is, again, it’s recognizing, do I actually need to rest? And do I need to rest guilt free?

That’s something that Dr. Gretchen also says, it’s important to recognise in that moment what is it that you need. At the same time, much of the research shows that as you’re consistent and you start to build up an exercise programme, that will give you energy, that will help you to develop stamina.

 

It’s always tricky that that kind of moment of actually do I need to rest? Last night for example I really could have just slept but I did go to yoga it was a 45 minute class really lovely teacher and I came back sort of rested in a way that I could sleep you know so also in terms of for spasticity sometimes stretching is difficult and it might be that you want to find a foam roller you know something to help kind of massage and stimulate the muscles in different ways. So yeah, there’s not specific exercises that we can say right now because it’s cause it’s always different depending on what’s causing it. But I think movement in general and stretching especially is going to release those anti-inflammatory molecules is going to building up stamina and being consistent will certainly help to increase your energy levels in general. And then recognizing when perhaps you just need to take a rest.

 

Heather O’Neil (31:49)

This next question on there is, what assistive devices can support me when I try to exercise? Some of the simple ones that don’t cost any money, chairs, walls, Thera-bands can be helpful. Those are those like stretchy, you can put them on a doorknob and you can use those.

Hand cycle, right? Hand cycle uses arms. It’s like a three wheel bike and allows you to kind of safely buckle in and use your hands to pedal and steer.

 

So the next question on there is, what should I look out for when choosing a physical therapist? Do they need to work specifically with people living with MS, or will any be okay? How I would answer this one is, if you have access to a physical therapist that specializes in MS, I would absolutely try to do that.

So this next question that was sent in was, I read that exercise promotes neuroplasticity in MS. Is that true? Yes, yes, and yes. Hopefully you guys can go back to that idea of how physical activity and exercise impacts the brain. Because yes, we are creating new neural pathways. We are creating neuroplasticity. Absolutely.

Okay, next question on there. Is it true that we should avoid exercise with high impact, such as jumping and running? So I have not heard this. I actually am a runner. That is the exercise that I like to do. I don’t think there’s any necessarily exercise specific that we need to avoid with

 

and that’s, it’s just, it’s depending on you. If your body, if running and jumping does not work for your body, then let’s figure out how high impact, exercise does not work for your body or does not work for, sometimes right. There’s heat tolerance. That could be a barrier. but I don’t think it’s necessarily specific to MS. I don’t think it’s like, wow, we can’t, you know, you shouldn’t do high impact.

 

Lyndsey Housden (33:57)

I totally agree and in terms of running if there’s something that you’re starting to do and you’re yeah whenever I try to go for a run I quite often end up going for a walk and then running a bit but there’s this great app called Couch to 5k probably a lot of you’ve heard of it and it’s just you know you’ve got someone in your ear who’s sort of your coach and then is kind of talking you through the program and it’s a nice way to kind of build up your stamina with that yeah that you don’t feel exhausted after kind of overdoing it.

So, please can you give some ideas to increase heart rate for someone who has very limited mobility? Yeah, so the great thing about cardio is that you can get great cardio workout. I’m not sure where your limited mobility is if it’s in your lower or upper body part how can you find ways of increasing the heart rate? And you can do that really well with the upper body. Yeah, similarly with one or both legs.

So I would say in your case, if possible, finding a physiotherapist, And great question. Thanks for bringing that up.

 

Heather O’Neil (35:00)

Yeah, I think that question comes up a lot and that is actually one of the places I would encourage people if you have a lot of mobility issues seeing a physical therapist to help you like, okay, what can I do? Because it would really give you some ideas about what your body can and can’t do.

What do you do to assist with mental health when exercising and recognizing that you are no longer capable of what you once considered normal movement? Yeah, this is a good one. I’m a therapist, that’s what I do in my work. And so I often work with people on this idea of what’s the new normal. And there is a grief and loss process to it, There’s the sense of I need to grieve maybe what I once was able to do and I have to step into like what I can do now. And so what we do know actually about exercise is exercise and physical activity really, really help with mental health. So I think in general, as you’re doing more physical activity, you’re going to, we’re gonna have less depression, there’s gonna be less anxiety. But there is this new normal that you deal with a progressive disease, right? Of what I can do now and what’s my new normal. And so sometimes, if you’re having, if that’s a part of the struggle that’s really challenging for you, I would encourage you to maybe seek out some counseling, to talk about, to be able to grieve this old thing that I can no longer do and accept kind of who I am now and what I can do. Because that’s the other part of this is not, coming back to that neuroplasticity can happen at whatever disability level you are. So remembering that piece, right? Not just shutting it down like, I can’t do that anymore, so I shouldn’t do anything. So we’re getting ready, we’ve just finished up all the Q &As, great job. So thanks, it was great to see everyone.

 

Lyndsey Housden (36:49)

Bye. Thanks. Bye.

 

Overcoming MS(36:52)

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