Why exercise?
Benefits of an Exercise Program
1. prevents problems such as weakness or poor endurance due to inactivity.
2. helps to improve your general health and Atness of your heart and lungs.
3. helps to maintain your best health and may improve the body's defence against illness.
4. stimulates motivation.
5. helps release emotional stress.
6. prevents weight gain, may suppress your appetite and may lead to weight loss.

Fatigue in Multiple Sclerosis
Fatigue in Mutiple Sclerosis could be due to one or more of the following:
1. Normal Muscle Fatigue
We all feel tired after working hard. People with M.S. may feel this way more quickly than most. This can make It difficult to cope from day to day. Exercise can be like working hard and may make you feel tired. It is important to find a balance between exercise, rest and day to day tasks.
2. Substitution Fatigue
Extra work is often done by strong muscles in order to substitute for weaker muscles. This extra work leads to muscle strain and fatigue. I An example is the extra arm work used to walk with crutches or to push a wheelchair Being aware of this type of fatigue can help to reduce stress and frustration.
3. Depression Fatigue
A loss of ener~y and interest is often found with depression. These feelings add to your problem of fatigue. It then becomes harder to work or exercise.
4. Cardiovascular Fatigue
Your ability to cope with exercise and your endurance during the day is related to the efficiency of your heart and lungs. Exercises such as swimming, biking and walking can help to improve endurance and reduce your fatigue.
5. Nerve Fiber Fatigue
Nerves affected by M.S. plaques are less able to conduct impulses under certain conditions. Elevated body temperature and repeated muscle use are examples of these conditions.
M.S. symptoms typically worsen temporarily when body temperature rises slightly with infection, a hot room or a hot day. Exercise itself can also raise body temperature. So, extreme exercise should be avoided. Exercising in a cool environment or cool pool helps to keep your body temperture from rising and helps you to cope better.
Also, muscles controlled by affected nerves tire more quickly with repeated use. You may have difficulty doing the same exercise routine several times in a row. Change frequently from one exercise to another. Your Physiotherapist will help you to choose the best schedule of exercises for you. It is important that you start slowly and build gradually.
Nerve fiber fatigue is a real weakness. It cannot be overcome with effort. You may find that you are able to do certain things when you are rested that you cannot do when you are tired.
Remember, nerve fiber fatigue must be considered in relation to exercise and to temperature. When you work to the point of being tired, your symptoms with M.S. may temporarily worsen. If this occurs you should rest.

Learning to Cope with Fatigue
Generally, your fatigue is not harmful - if not prolonged. However, one cannot deny the problem - you must learn to cope with it.
To understand the nature of your fatigue, you must learn to recognize the symptoms that signal the onset of fatigue.
For example, you may:
- feel very tired
- feel sleepy
- feel weaker
- feel heavier
- feel numbness in your arms or legs
- lose your balance
- have blurring of vision
Remember, everyone experiences fatigue in a different way. It is important to rest as soon as you feel fatigue. Usually 15 to 30 minutes is an adequate rest period.
Proper use of any equipment recommended by the health care team can decrease your fatigue level significantly. A walker, cane or footdrop splint can prevent overuse of your stronger muscles.

Common Sense Techniques to Help Combat Fatigue
1. Balancing rest and work is important. If you feel fatigued, plan to sit or lie down for a rest between activities at work and at home.
2. Organize your day to complete the most importantjobs. Priorize!
3. Modify your exercises if they are leaving you too tired to go out later in the day.
4. Plan to do your most strenuous activities in the morning. Why?... Because body temperature normally increases between 2 and 4 p.m. Increased body temperature can result in fatigue.
5. Stay generally lit and healthy. Get adequate sleep, eat well and stop smoking.
6. Maintain a normal weight. Extra weight makes your muscles work too hard.
7. Educate your family about fatigue. You need their support

Rules to Remember When Exercising
1.Do only the exercises circled by your Physiotherapist.
2. Avoid exercise that causes you pain.
3. If you feel fatigue, change exercises.
4. If you continue to feel fatigue or your symptoms worsen, rest for 15 to 30 minutes and then resume activity.
5. If your symptoms become worse for any reason and do not improve with rest, contact your doctor.
6. Many of these exercises may be progressed with weights. However, this should be monitored by your Physiotherapist.
Why? ...Weight training can make your legs or arms tighten up temporarily. Lifting too heavy a weight can lead to pain or fatigue.
7. Use breathing to your advantage. Breath out as you start your exercise. Breath in as you relax.
8. The benefits of exercise occur over time. You will need to do your exercise program three to five times a week in order to make progress.

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