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Dave Bexfield, diagnosed with MS in 2006, enjoys playing tennis, so he adapts the sport to his needs by wearing a cooling vest to manage heat.
Photo courtesy of Chip Simons
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Keep moving with MS

Getting wet

Water dissipates heat about 25 times faster than air, so water activities can be ideal for people who have heat sensitivity. Water-based aerobics, walking and tai chi; water polo and volleyball; and swimming and snorkeling can feel very freeing if you have weakness, spasticity, pain, or balance or gait issues, Rohrig says.

However, she recommends caution if you’ve never exercised in the water before. “You’re moving well, without becoming overheated or fatigued. In this situation, it can be very easy to overdo things. Then when you get out of the water, and suddenly gravity’s back, your symptoms may temporarily feel more pronounced,” she says.

Start conservatively, she recommends, with water walking or a gentle swimming stroke. Watch for warning signs like shortness of breath or muscle soreness, and keep your rate of perceived exertion at an intensity of 1–2 for warm-up and cool-down, and 3–4 for your “exercise zone,” on a scale where 10 is the maximum effort. The pool temperature should be 80 to 84 degrees to minimize overheating. She encourages clients to confirm that the local pool is in this temperature range, as some pools are transitioning to warmer water for people with arthritic conditions.

If you find swimming monotonous, you can listen to music, even while you swim. “My partner got me a waterproof iPod that clicks onto my goggles,” says Green, who started swimming last year. “It makes a huge difference for me.”

Bexfield points out that tandem or group kayaking, rafting and canoeing can be good options for people with MS. Not only are you able to sit and rest your legs, but there’s someone to help if needed. Plus, if you get overheated, you can dip your hands, hat or neck scarf in the cool water.

Rohrig says these are excellent strategies, but notes that being on the open water can lead to a significant amount of sun exposure. “Potential ways to manage this include paddling shorter courses or courses that allow for ‘pulling over’ in the shade,” she says, “or using an umbrella or canopy-type system for some shade” on the watercraft. If water-sports enthusiasts find that wearing a life preserver creates additional heat, Rohrig recommends that they have cooling devices available and stay well hydrated.

Research shows that a preworkout shower or bath can also be a powerful coolant. Ideally, immerse your legs in about 70-degree water for 20 to 30 minutes before you’re going to be exposed to heat. “Precooling allows the lower limbs to effectively serve as heat ‘sinks’ in order to blunt internal temperature increases and decrease reliance on … sweating,” wrote researchers in a 2010 study published in the Journal of Applied Physiology. If you can’t stay in water that cold for that long, a 5- to 10-minute pre- and post-workout shower that’s as cold as you can comfortably tolerate can also prove to be somewhat effective, Rohrig says.

Green likes to cool off after exercise in a 10-foot-wide inflatable pool that she places on her shaded patio and fills with cold water. “I can sit in water up to my neck and read a book,” she says.

Keeping active in the summer

Dave Bexfield enjoys a range of outdoor activities and stays smart about adapting to the heat.

Other outdoor options

Tennis, particularly with a partner, can be a good choice for a cooler summer activity if you have adequate hand-eye coordination, Yamaguchi says. The U.S. Tennis Association has adaptive programs specifically for people with challenges like MS, and can match you with local players with similar skills.

Softball and baseball offer frequent opportunities to rest in the shade, but require some arm power and ability to sprint short distances. If you have adequate balance to swing a club, Yamaguchi recommends golfing. Using a cart helps with fatigue and, because you play in pairs or foursomes, there’s also a social aspect.

To evaluate whether a type of exercise is right for you, Yamaguchi recommends paying attention to your symptom patterns. “It can be helpful to keep a workout log listing what you did, how you felt immediately afterward, and how you felt later in the day or the next day,” she says. And be sure to check with your physician before starting any new exercise regimen. Once clearance is granted, a physical therapist with experience treating individuals with MS could help structure your program.

One thing to keep in mind: A 2013 study published in the Multiple Sclerosis Journal reported that people with MS who do 30 minutes of endurance exercise have significantly greater increases in heat-related symptoms compared with people who do the same amount of resistance exercise. Endurance exercise includes aerobic activities like walking, running, biking and swimming, while resistance exercise focuses on weight lifting and strength training.

Of course, as the temperatures spike, none of these options can seem very attractive. Green realized that if she waited until she felt like exercising on hot days, she might never leave her couch. So she came up with a solution that she calls her 10-minute rule. “I do an activity for 10 minutes and then listen to my body. I check in and see if the feeling of wanting to continue follows,” she says. “Often, after 10 minutes the feeling has kicked in. If it hasn’t, I stop and try again the next day.”

Vicky Uhland is a freelance writer and editor in Lafayette, Colo.
Summer 2014

Related Links

For more on water exercise, read “Should you try aquatic therapy?”

For other summer sports opportunities and tips, visit disabledsportsusa.org.

How do you adapt your favorite summer activities? Share with other at MSconnection.org.
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