Question: I’ve been recommended to do physical activity, but I lack motivation and desire, which is critical. Are there any specialized centers or private trainers I can rely on?

Answer: Depending on your physical condition, you can train in a standard gym, an adapted gym, or group settings. It’s advisable to consult with your physiotherapist about the recommended type of exercise, its intensity, and frequency, and then exercise under supervision. Adapted gyms are available, for example, at Beit Spivak in Ramat Gan, Ilan in the Krayot, and Wingate. Suitable groups are also available through various health funds (some within and some outside their coverage plans) and private institutions. There are also fitness trainers who have studied rehabilitative movement and are more focused on these needs. Once again, consult your physiotherapist to build a program tailored to your functional level and location.

Question: What are the essential exercises, in your opinion, that someone with multiple sclerosis should adopt?

Answer: Studies show that aerobic activity improves MS symptoms. Recommended exercises include:

• Walking
• Cycling or using stationary bikes
• Swimming
• Climbing and descending stairs
• Repeated sit-to-stand exercises

Exercises should be adapted to the functional level, challenges, and goals. For instance:

• Stretching may benefit spastic individuals but is unnecessary for others.
• Sensory training, like recognition games, may help those with sensory impairments.
• Balance exercises should challenge without risking falls.

Consult a personal physiotherapist to build a program. Health funds offer a package of 12 sessions specifically for monitoring and adapting programs, even for chronic conditions.

Question: What can be done to prevent deterioration in the upper and lower limbs, balance, and walking ability?

Answer: Deterioration depends on disease progression, response to treatment, and other factors. To maintain:

• Walking ability: Practice walking.
• Balance: Engage in balance exercises that challenge without risking falls.

Studies indicate that aerobic activity enhances function in MS patients. Examples include walking, cycling, swimming, stair climbing, and repeated sit-to-stand exercises tailored to your functional level.

Question: I’ve been doing physiotherapy for a year but haven’t improved my balance. I often feel it depends on my overall condition, and I’m losing confidence in walking. What should I do?

Answer: Balance and confidence in walking are closely tied to your overall condition. Fatigue, lack of focus, weakness, spasticity, and sensory loss all contribute to balance issues and walking difficulties. MS may be progressive, and physiotherapy and regular physical activity may maintain ability even if they don’t improve it.

Consider:

• Consulting your physiotherapist about alternative training approaches.
• Increasing aerobic intensity or adding more home exercises.
• Switching physiotherapists or seeking a second opinion for fresh ideas.

Question: What can be done about tremors in the hands and body, which make writing, applying makeup, and other hand activities difficult?

Answer: Tremors can stem from:

1. Clonus – related to muscle tone.
2. Ataxia – due to brain areas responsible for movement control being affected.
3. Weakness or sensory deficits – resulting in loss of motor control.

Diagnosis is crucial to identify the cause and determine appropriate treatment, which could be medical or physical. Consult your doctor and physiotherapist for evaluation and recommendations.

Additionally, occupational therapy can help practice tasks like writing or applying makeup using supportive devices. For instance:

• Resting your elbow on a table for support, limiting the degrees of movement freedom.
• Using thicker pens for better grip and control.

Question: How can stability and balance be improved?

Answer: Tailored exercises are essential to challenge balance while ensuring safety. Suggested activities:

• Practice balance in various positions or on different surfaces.
• Include aerobic exercises like walking, cycling, swimming, stair climbing, and sit-to-stand repetitions.

Consult a physiotherapist for a personalized plan. Health funds offer a package of 12 sessions for monitoring and adjusting programs as needed.

Question: How can I improve my motivation to continue living my life?

Answer: If this question arises, it’s essential to seek mental health support through therapy (individual or group) and, if necessary, medication. Finding meaning and beauty in life is a challenge for everyone, especially those with chronic illness. The challenge intensifies with progressive deterioration.

Professional emotional support and social connections from family and community are crucial. Research shows that:

• Engaging in activities improves mood and motivation.
• Community and social participation enhance quality of life.

Incorporate these elements into your daily routine to maintain a positive outlook.