Transcription:
Taking Control of MS with Comprehensive Rehabilitation and Wellness Programs

Melanie Cole, MS (Host): I've known a lot of people with MS in my life. If you look through the years, the treatment options and things that can help ease some of the symptoms have really come such a long way. It’s amazing to see and I'm so happy for my friends that they can get that kind of treatment now. We’re talking today about multiple sclerosis and therapy options with Ian Flannery. He’s the therapy manager at Multiple Sclerosis Institute with the Shepherd Center. Ian, tell us about the Shepherd Center’s MS wellness program. What’s it designed to do?

Ian Flannery, PT, DPT (Guest): Hi. So the MS wellness program is designed to be a community based program that provides care for people with MS between bouts of physical therapy and occupational therapy and speech therapy. To help keep people active, to help manage some symptoms, and to keep people exercising and get them involved with a community of people to help keep them moving towards their goals.

Host: So, Ian, as I said in my intro because what you just said is really—It’s not new per say, but back in the day 20 years ago, 30 years ago, MS patients didn’t have these opportunities to get fitness training and wellness programs. So how can it help specifically with MS? What are you seeing today that they're able to do that they maybe weren’t able to do 20/30 years ago?

Ian: Well, with MS it helps to take a look of the history of why people thought exercise wasn’t good for folks with MS back in the day. I think that stems from heat intolerance and fatigue. The amount of fatigue that people with MS experience when they're doing exercise is very different than the amount of fatigue that other folks do. So I think there was a misunderstanding that when you're overfatiguing people, you're causing the disease to progress or you're causing damage to folks. What we know now is that yeah, you can overfatigue people and they can have some of those symptoms, but typically they bounce right back from that. That we can really be pushing people and getting people involved. So the benefits of exercise for people with MS are one, they're the same as the benefits of exercise to anybody. But two, doing it in a place where people understand the symptoms of MS and how to manage those and how to adapt the exercise can really keep people confident in how they’re exercising and that they’re benefiting their body and their function.

So the benefits of exercise can be as simple as you're feeling better because you're more active and exercising, but exercise also has been shown to have changes in the brain too. So it actually can help some of the symptoms of MS along with the disease modifying therapies and the other medications that they're working on with the medical team.

Host: That’s so true. I mean the benefits for all of us for exercise are similar, but for MS exercise programs definitely have to be tailored. Tell us about how you tailor those exercise programs? Including, you mentioned overheating, smaller class sizes might help with that. Tell us a little bit about how you’re tailoring that.

Ian: Yeah. The smaller class sizes is big because it allows for a little bit more one on one attention. So nobody’s really getting left behind and the way they're doing their exercises. As far as the fatigue and the heat go, we keep our gym pretty cool. We keep it a little bit cooler than other gyms. We also have fans and ice water on hand that we can provide folks. That actually does tend to keep the heat intolerance at bay a little bit while you're doing exercise. We also build in rest breaks. So we know the signs that come on when you're doing exercise that we need to take a break and rest for a minute. Usually if we stay ahead of those fatigue signs then you can kind of prevent them from coming on. So a lot of it is adapting just the way you're approaching the exercises.

On top of that, since people do have a decreased tolerance for exercise, they’ll be fatigued a little bit easier. If we focus on exercises that hit multiple muscle groups of have a more functional implication or that can help something a little bit more functional, we tend to focus more on those kinds of exercises as opposed to exercising a single muscle group like somebody does bicep curl at the gym. We’ll do something that has a little bit more of a functional aspect to it that works all of the muscle groups at the same time.

Host: Ian, one of the things that I, as an exercise physiologist, know about exercise, it certainly helps us to feel better. It helps us to get stronger. For MS patients, a big part of what they go through is maybe depression. Feelings of isolation. How can exercise help MS patients to feel more empowered? How can it help psychosocial things that they might be going through?

Ian: Right. So I think you hit the nail on the head with talking about the benefits of exercise for everybody because they're all the same for the folks with MS. They get the same endorphins that we do when we exercise. They get the same boost in energy overall when they do consistent exercise. You see the functional changes in your life when you're going consistent exercise that’s tailored towards your needs. One of the things that—One of the benefits of the psychosocial aspect is that, especially in our wellness program, a lot of times people with MS tend to feel a little bit isolated when they go to other exercise programs or the gym. They don’t really have that comradery. Here where we have probably 98% of the people that come into our wellness program have multiple sclerosis, they have a sense of comradery. People understand what they're going through. If you're having a really bad day, as you have with MS, then you have a lot of people that understand that and know what you're going through. There’s people that you can lean to for support.

Host: What kinds of classes are available? Are they typical fitness classes? Yoga, step classes? Because balance and gait can be an issue for people with MS. What kinds of classes are offered?

Ian: So we have a wide variety of classes. We tend to have a few different levels of each of these to make sure that people who have a little bit more disability can come in and feel like they can get benefit out of it. Also the people who have pretty minimal disability. So we have core classes who focus on kind of just your core muscle groups, like you would any Pilates or core exercise class. We also offer an upper extremity class to focus on arm function. A lower extremity class to isolate leg strength and functional movements with the legs. We have a high intensity interval training that is kind of an agility and coordination class that focuses on folks that need a little bit more aggressive higher level exercise. We do also offer a yoga class and we just started a Pilates class as well for folks that would benefit from those. On top of that, we also have lectures twice a week that talk about different topics such fatigue management, diet and nutrition, pain, and other hot topics in MS.

Host: Who can participate in these classes? I mean what a great program. I imagine it’s quite popular because it really sounds like it’s so comprehensive and you're really tailoring it to the specific needs of MS patients. Who can be a participant of these?

Ian: Pretty much anybody in the community that has MS can participate. The classes sizes, we are still a relatively small rehab facility. At least, the MS department is. The Shepherd Center is a lot bigger overall. Our classes are pretty small right now, but as long as you have MS and you have the commitment to come in and do exercise and to join some of the classes, we’ll try to fit you in. We also offer one on one exercise sessions for folks that may not be able to get into the classes because they're full. But we offer that to also tailor a little bit more one on one exercise towards folks too.

Host: That’s so cool. It must be very rewarding what you do, Ian. Tell us a little bit as we wrap up about managing expectations. Because MS patients can think they’ve got this degenerative disease and that nothing is going to help make it better or see improvements. How do you help them manage their fitness expectations, and, indeed, their whole wellness expectations? Give us your best advice.

Ian: One of the things that I always go to when I'm trying to manage expectations with folks, and I encourage all of our staff to talk about this as well, is that folks with MS tend to be more sedentary and be less active than other folks. That’s the same with anybody with chronic illnesses or chronic disease. Typically less active. A lot of symptoms that come on, they may not be MS symptoms. Exercise can have an impact on the disease process, but what we’re doing here is primarily what we can do is really address the symptoms of being sedentary and the fatigue and the endurance of the muscles and the cardiovascular system. We can target all of those and we can expect for those to have big changes and for those systems to adapt as we exercise.

So managing expectations, but also letting people know that not everything they're feeling is because of MS and these are all things that we can address and improve for sure. Some of the MS symptoms, it gets a little bit more complicated and nuanced. That’s a little bit more of an individual conversation. But overall, if people are inactive, when we become more active and exercise more, you're going to see improvements in a lot of different systems in a lot of ways.

Host: What else would you like to add about the multiple sclerosis institute at Shepherd Center?

Ian: I think the last thing I would like to add is that the wellness program is a big part of what we do here, but we also do have physical therapy, occupational therapy, and speech therapy. The communication between the wellness program and the exercise physiologist that run the wellness program and the therapy staff can be really beneficial. So having a care team that communicates with each other and the people in the wellness program notice something’s coming up and we notice that we’re kind of hitting some walls or there’s some things that are backtracking, they can immediately talk, and we can transition them into a therapy tract. So that’s one thing that I think really important. Even in places where you don’t have that all in one spot, in one location, just encouraging that communication between anybody who has eyes on the patient can be really beneficial for folks.

Host: That’s great information. What a great program. Thank you, Ian, for coming on and explaining so very well the options for MS patients and how they can really get fit and involve themselves in these wellness programs and how these kinds of programs can really help their total body health, including their mental health and psychosocial issues. Thank you, again, for being with us. You're listening to Shepherd Center Radio. For more information, please go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.