31 msfocusmagazine.org to improving overall health, cardiovascular fitness, range of motion, and flexibility, exercise can help one increase energy, improve balance, manage spasticity, decrease muscle atrophy, and better perform activities of daily living.” Elements of a Comprehensive Exercise Regime Traditionally, there are four general categories of exercise: cardiovascular training, strengthening/resistance training, stretching, and balance. It is important to work with a professional (ideally a physical therapist) to develop a personalized routine that targets key areas of maintenanceandrecovery.Itmaybenecessary to think creatively about how to achieve particularactivities in differentways.You must learn to work with limitations without creating unnecessary anxiety or tension. Of course, safety is key, particularly when practicing sitting or standing balance, and a professional can also assist in assuring that exercises are being done correctly and at an appropriate level of difficulty. One of the most common and significant limitations that comes with a diagnosis of MS isfatigue,andmodificationsareoftennecessary to accommodate this symptom. Particularly with cardiovascular exercise, it is important to monitor level of exertion using the Borg Scale, pacing your routine in the 11-13 range (“fairly light” to “somewhat hard”). Utilize cooling equipment during your routine, and consider precooling before your start. Most exercise-induced increase in symptoms will resolve quickly, so plan a short period of down time following your routine; if you find thatyou have longerduration fatigue, consider performing shorter duration workouts throughout the day. The primary element in a successful exercise program is consistency. No matter how hard you work or how dedicated you are, changes onlyoccurin the bodywith consistent practice. You want to create a comprehensive plan that feels manageable and realistic, convenient and accessible. Options to consider for exercise are: hospital-based wellness programs with accessible equipment, aquatic exercise (water temperature from 80-85 degrees is ideal), senior or online exercise classes, or use of gaming systems like the Nintendo Wii or Xbox Kinect. Remember that exercise is a wonderful opportunity to develop a stronger connection and friendlier relationship with your body! The important piece is to consider your situation workable, and to notice and celebrate the small gains as they occur. The Borg Scale 6 – No exertion at all 7 – Extremely light 8 9 – Very light 10 11 – Fairly light ENDURANCE 12 TRAINING 13 – Somewhat hard ZONE 14 15 – Hard STRENGTH 16 TRAINING 17 – Very hard ZONE 18 19 – Extremely hard 20 – Maximal exertion E F F O R T t