30 msfocusmagazine.org Exercise. Examine your reaction to that word, and you may find no small amount of resistance, even dread. At best, many of us think of exercise as a duty, an obligation to self-care about as appealing as drinking vegetable juice or taking medicine. Living with a diagnosis of primary or secondary progressive multiple sclerosis makes the question of exercise even more complex, of course. MS symptoms, such as fatigue, weakness, and spasticity, can interfere with training in more traditional ways, and we can become frustrated when our bodies do not function how they used to. Sometimes a strengthening or cardiovascular routine can put us face-to-face with precisely the thing we have difficulty doing. Given these experiences, it’s no surprise that a consistent regimen can be hard to maintain. And so it would seem that a slight shift in our mindset is necessary before we continue this discussion, a change in how we think about this activity that truly is as essential for our health as both food and sleep are. Perhaps we can consider exercise as an arena in which to learn how to more effectively connect with our bodies. For instance, we can notice the effect of cardiovascular training on our breath, and the feeling of endorphins that often follow that type of workout. We can pay attention to the experience of working into a deep stretch, and the sensation of relief and relaxation as we come out of that stretch. In short, we can learn to enjoy the process of exercise and use it as an opportunity to develop a friendlier relationship with our bodies. In the context of a MS diagnosis, the development of an effective program helps us to maintain the strength and function we have, and even possibly recover lost strength and function over time. Where recovery is not possible, we learn to compensate for the changes that have taken place. As one of my patients puts it, “adapt and adjust!” Exercise: Debunking the Myth Before we discuss the elements of an effective exercise regimen, it’s important to make sure we are not laboring under a false assumption: that exercise has a negative effect on MS. Manyyears ago, the medical establishment cautioned those with MS to avoid exercise based on the fact that MS symptoms were sometimes exacerbated following a workout. In 1996, a studypublished bythe Universityof Utah debunked this myth and demonstrated the benefits of exercise for people with MS. Among the findings were that consistent exercise over time resulted in better cardio- vascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities. Since that time, countless studies have demonstrated the positive effects of exercise for people who have MS, as well as highlighting the negatives of a less active lifestyle.According to a 2016 statement from the National Center on PhysicalActivityand Disability: “In addition Symptom Management Adapt and Adjust Exercise Can Help You Regain Strength and Function by Anneke Bender, PT, MSCS, CYT 200