As trainers, one of our most important roles is that of understanding our clients. It is imperative that we take the time to get to know them, their goals, what motivates them and what their physical limitations may be. Every client has physical limitations, but when working with someone who has Multiple Sclerosis (MS), understanding the disease and its effects on the body is crucial.

MS is classified as an autoimmune disease that attacks the body's central nervous system. It causes the breakdown of the myelin sheath, a protective covering of the nerve cells in the spinal cord and brain, resulting in a lesion (sclerosis). These lesions cause messages sent from the brain to different parts of the body to become disrupted, confused or even blocked. The result may be the inability for muscular, cognitive and/or bodily functions to be controlled by the individual. How the body is affected is usually determined by where the lesion is located in the brain or spinal cord.

The symptoms of MS vary from one individual to another and they range from unnoticeable to debilitating. One person with MS may appear to be normally healthy while another is confined to a wheel chair and struggles with even the simplest of daily living activities. MS is unpredictable as a relapse may occur at any time causing new lesions and symptoms, and one never knows whether their MS will allow them a good day or bad day. This is what makes the disease difficult for trainers to work with as each individual has their own set of symptoms that affect them differently from others with MS and one never knows what a new day will bring.

Even though each person with MS has their own unique issues, there are symptoms that are more prevalent than others. The most common symptoms are fatigue, heat sensitivity and spasticity (a constant contraction of the muscle causing stiffness and/or involuntary spasms). Other common symptoms include numbness or tingling, gait issues, dizziness, pain, emotional issues such as depression, bladder and bowel control issues, cognitive issues and vision problems. There are many other symptoms that are not as prevalent but that can be equally debilitating.

We still have no understanding of what causes the disease and there is no cure. Various medications are available that will help to slow down the progression of the disease and reduce the occurrence of relapses. Aside from this, neurologists are encouraging people with MS to begin an exercise regimen as hundreds of studies have shown that exercise and being physically fit can be the greatest defense for dealing with many of the symptoms people with MS are struggling with each day.

Both the National MS society and MS Foundation estimate that more than 400,000 people in the US have MS and about 200 new cases are diagnosed each week. This is a population of people who need help now but there are not enough people who really understand how exercise and fitness can help them. As trainers, this is a population that we need to be ready to help. Once it becomes known that you can make a difference in one person's life, you will find yourself being contacted regularly by others with MS who will eagerly be seeking your expertise as this is a close-knit community.

Working with MS clients

When working with MS clients, experience is the best teacher. As fitness professionals, we are constantly learning and discovering new techniques and methods that produce encouraging results, but we always keep the clients condition, limitations and safety at the forefront. Expect as much from clients as possible while proceeding conservatively, as we never know what the post-exercise short- or long-term results may be; even though they may feel find during the exercise. However, experience should only come after you gain as much understanding of the disease as possible.

Before you take on any clients with MS, it is important that you become certified. Your certification will give you credibility as well as provide you with an understanding of the disease, how it affects people and precautions that should be observed.

Once you are certified, begin by working with one or two clients so that you will be able to develop a comfort level and not become overwhelmed by too many questions or unexpected situations that arise.

Build a network of trainers that work with MS clients and share information, findings and techniques that are working well. Your network is a great place to ask questions as each one of you will encounter different scenarios. Share information freely as you are working for the benefit of your clients.

Understand that each client is different and that intensity, frequency and duration of exercise will vary from client to client. Even though your client may become easily fatigued, they will still need to work on improving their cardiovascular fitness. This may take some time as short bouts of exercise will be required. But with consistency, there will be improvement over time. Be aware that your clients may need to conserve energy so that they can get through the rest of their day as recovery time for them may be slower than that of your healthier clients. Keep your client cool and hydrated, as heat can exacerbate their condition.

With more disabled clients, you will need to be creative with aerobic workouts as well as resistance training. For some of these people, a simple stretching routine may be enough at first followed by simple body movements that will awaken their muscles and improve range of motion. We started this way with clients bound to wheelchairs who are now taking steps with their walkers. Patience will yield progress! If a client does not seem to be progressing, remember that as long as they are maintaining, they are not declining.

Working with this demographic is incredibly rewarding, both for the client and for the trainers. We are constantly learning everyday and our clients get excited as they see progress and find relief from their symptoms. The surface of working with MS has only been scratched and we are excited about others joining in the endeavor to give hope to so many who believe there is no more hope. There is hope. And you can become a part of it.

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