Professional Advice On Being A Personal Trainer For MS Patients

As a personal trainer for someone with MS, you need to take a delicate approach when crafting a bespoke workout programme. 

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What A Personal Trainer Needs To Know About MS And Exercise Programmes

As a personal trainer for MS patients, you need to be aware of how the condition affects both the daily life of a client, and their ability to exercise.

This information will help when crafting exercise programmes for people with MS, as you can use it to understand their capabilities and what specific workouts are going to benefit them the most.

Learning About The Diagnosis Process When Training Clients With MS

MS, or multiple sclerosis, is classified as a lifelong autoimmune disease that can affect key areas of the body, such as the brain and spinal cord.

Those who suffer from MS will have an immune system which mistakenly attacks parts of their own body believing them to be foreign substances.

Specifically, MS will target the protective layer (known as the myelin sheath) that surrounds the nerves in the brain and spinal cord. Typically, these areas are responsible for sending signals from the brain to the rest of your body.

According to the NHS, symptoms of MS can include:

• Fatigue 
• Mobility issues - e.g. Difficulty walking
• Issues with balance and coordination
• Muscle stiffness and spasms
• Issues with vision - e.g. Distorted or blurred vision
• Numbness or tingling in different areas of the body
• Issues with bladder control 
• Continual issues with thinking, learning, and planning

These symptoms are said to occur when the myelin sheath protecting the nerves becomes inflamed. Consequently, patches of information distributed from your brain can become disrupted, causing them to become jumbled, or not get through at all.

As a personal trainer for someone with MS, you should be aware that certain patients won’t show all these symptoms, but can still be diagnosed as having multiple sclerosis.

To gain a better understanding of what symptoms your clients suffer from, ask them to fill out a PAR-Q form prior to the commencement of training. This is a simple questionnaire that will help to determine whether it's safe to train a client.

PTs for MS should also be aware that the condition will change overtime. In many cases, symptoms will become worse and occur at a higher frequency.

Consequently, the bespoke exercise programme for MS patients can be affected, as what was once a suitable workout could be rendered physically impossible.

Will All MS Personal Trainer Clients Have Similar Symptoms?

A personal trainer for MS patients will quickly learn that MS is a challenging condition to anticipate and study. 

Even medical professionals struggle to find direct causes for the condition, with the NHS suggesting these possible reasons behind MS:

From this, you can see that there is no clear cut description of what an MS patient looks like. 

For example, some clients may require wheelchair assistance, whilst others will be able to move independently.

This may be a result of their specific condition, with the NHS believing that all patients fall into one of two diagnostic categories:

#1 - Relapsing Remitting MS

8 out of 10 people who are diagnosed with MS will fall into this category. This describes a patient who will suffer from worsening symptoms known as relapses. 

These symptoms will become severe over passing days, with the potential to last a few months before slowly improving across a similar period of time. This is often referred to as ‘remission’.

There is no known cause of potential relapse triggers, but medical professionals believe they could be associated with stressful events.

Following years of severe relapses some clients may shift from this diagnostic category to what’s referred to as “primary progressive” multiple sclerosis.

#2 - Primary Progressive MS

In every 10 patients that are diagnosed with MS, 1-2 can be diagnosed with this specific variation of the condition. 

As stated above, there is potential for symptoms to worsen to the point of someone developing Primary Progressive MS. 

In these instances there are no periods of remission, but rather the relapses will merely stabilise over intervals of time.

As a personal trainer for multiple sclerosis patients, you will need to keep both of these variations in mind, as this can influence a client’s performance and long term goals.

How Can An MS Personal Trainer’s Programme Be Affected By The Condition?

Before you craft an exercise programme for MS patients, you should be aware of some of the variables that could influence a client’s ability to perform an assigned workout. 

Some of the more obvious factors that could cause complications to a programme are mobility and balance issues. 

If a client suffers from either of these symptoms, they will not be able to perform at the same capacity as able-bodied individuals.

You will therefore need to take these factors into consideration to ensure that the workouts won’t physically harm the client, or cause them great discomfort.

For example, if you wanted to incorporate a cardio workout but wished to avoid the treadmill due to balance issues, you could instead work on a rowing machine. This way, clients can remain seated to reduce the risk of falling.

Research conducted in 2017 helped to shed some light on other conditions that could also influence a patient's ability to exercise:

“MS patients are especially susceptible to exercise-related fatigue, heat intolerance, and falling. Furthermore, some problems such as spasticity, neurological or cognitive deficits, and urinary incontinence may influence the exercise program”

This is why knowing what symptoms your client is suffering from is absolutely vital. Through the completion of the PAR-Q form you will be able to accurately assess what aspects of your workout programme need amending.

Why It’s Important To Offer Personal Training For Clients With MS

Whilst you must be cautious when creating exercise programmes for people with MS, this doesn’t mean that it’s completely unsafe for them to exercise.

In fact, people with MS have been encouraged to engage with at least 30-minutes of moderate exercise a day. According to the MS Trust, this can help to improve: 

• Mobility
• General Strength 
• Bowel and Bladder Control

The MS Trust also highlighted the importance of regular exercise for reducing symptoms and further risks of developing comorbidities, such as depression and anxiety-related disorders.

Therefore, it can be stated that a well planned exercise programme for MS patients can effectively help to improve their physical and emotional wellbeing. 

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If you’re looking to be a personal trainer for someone with MS, and want to expand your knowledge beforehand, we’d recommend these articles: 

• How To Train Disabled Clients
• 7 Tips For Training Clients With High Blood Pressure
• Expert Guidance on Cardiac Rehabilitation for Personal Trainers

5 Key Tips on Being a Personal Trainer For MS Patients

When operating as an MS personal trainer, or as any kind of PT, you must always have your clients’ wellbeing at the forefront of your mind during every session. 

These top tips have been specifically chosen to explain how you can best go about this, from the planning process to the delivery of your sessions. 

#1 - A Personal Trainer For Someone With MS Must Have A Great Understanding of the Condition

As a personal trainer for MS patients, it’s essential you develop an extensive knowledge of the condition. This understanding will include learning about: 

• Symptoms of MS
• Differences between the two MS diagnosis 
• Physical limitations caused by MS
• How exercise programmes for people with ms can be beneficial 

All of this information is vital in ensuring the safety and wellbeing of the patients you train. 

Multiple sclerosis personal trainers who fail to take time to actively conduct research run the risk of putting their clients in harm's way, or find themselves lacking the skills to properly provide for those clients. 

Developing this knowledge won’t occur overnight either - it will take time and dedication on your part to learn, understand, and implement effectively.

This means that you will have to actively research multiple sclerosis cases, observing how the lesions on the spinal cord can impact an individual’s range of mobility, and capacity for exercise.

A large chunk of this research should be spent learning how the condition can alter and change over time. 

Whilst no two clients' bodies will respond to MS relapses in identical ways, this research can help to prepare you for various outcomes.

You may even choose to compare notes with other MS PTs, in order to see if you can learn anything from their clients, who may suffer from worsening relapses or improved periods of remission than you have experienced. 

Following this research, you will be able to effectively plan a bespoke training programme that adapts to the patients changing physical capabilities.

#2 - Perform Routine Assessments When Training Clients With MS

As we’ve already discussed, the key thing for an MS PT is to be constantly aware of their client’s current physical capabilities. 

This will inform their bespoke training programme, and guarantee their safety when performing workout routines that could potentially harm them if not done correctly. 

In order to determine a client’s current physical capabilities you should conduct an assessment before the commencement of every training session. 

It’s essential that this occurs every session, as MS can drastically change from day to day.

This assessment is a process that can flag the severity of a patient’s condition, and their inability to perform specific exercises. 

Similarly it can also be used to highlight that a client has entered a period of remission, and will be able to take on more challenging workouts.

Research conducted in 2014 assessed MS patients physical capabilities through the Berg Balance Scale. This required participants to perform a series of unaided activities, which included:

• Standing unaided 
• Walking without assistance (if possible)
• Transitioning from standing to sitting in a chair 
• Turning 360 degrees 

Whilst this is typically used by healthcare professionals, as a MS PT you could implement a simplified version in order to assess a client’s physical capabilities. 

For example, this could be completed through asking your clients to walk slowly on a treadmill, using the machine for support if they really need it. 

Or ask them to perform basic stretches and actions, like an unweighted bicep curl, or a lunge with your support.

Unlike doctors, you won’t have to give these movements a numerical value, and can instead use it to view how clients perform physically demanding tasks.

If your client is wheelchair bound then you should place a greater emphasis on their cardiovascular endurance through the likes of a modified BEEP test. 

This shouldn’t be as intense as those conducted with able bodied clients, taking the MS condition into account, but should still allow you to gauge your client’s capabilities. 

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#3 - Create Specialised Exercise Programmes For People With MS

A personal trainer for someone with MS will need to know how to create workout programmes that are specifically designed to both suit your client’s existing capabilities, and that aim to improve their overall condition.

As previously discussed, well crafted training programmes can help to alleviate MS symptoms, whilst also improving a patient's physical and emotional wellbeing.

When crafting a bespoke workout programme, a PT for MS patients should place great emphasis on several key areas.

The Importance Of Balance In An MS Exercise Programme

Balance issues among MS patients is largely due to deficiencies in movement capabilities. Your clients will often suffer from a partial absence of sensation and proprioception, which essentially means they lack control of their own body.

When creating an exercise programme for MS patients the purpose of balance training is to realign the centre of gravity. This can include the likes:

• Squats 
• Lunges 
• Calf Raises 

This form of strength training will help to improve a client’s overall centre of gravity by improving their muscles within their lower body.

This training should be progressive in order to appropriately challenge the MS patients. Jumping straight into workouts that are too challenging will simply result in injury, or a client feeling disheartened.

Include Flexibility Training In Your MS Exercise Programmes

Typically, MS patients suffer from restricted movement due to muscle spasms that affect their range of motion, and cause intense amounts of pain and discomfort.

A personal trainer for someone with MS will typically be tasked with improving the flexibility of their client. 

This can be achieved through regular stretching sessions that focus on muscle fibre and increasing blood flow.

In some instances, patients will not be able to stretch themselves and will require the assistance of the PT, who will need to apply the external force to the particular area of the body.

This enables the trainer to have direct control over the stretches:

• Intensity 
• Direction
• Speed
• Duration

Pay particular attention to the lower half of the client’s body, as this is the area that is most commonly affected by MS, with the adductors and abductors becoming significantly weaker overtime.

Should a client suffer from a spasm during a flexibility workout, reduce the stretch until the feeling has subsided.

MS Exercise Programmes Should Take Thermosensitivity Into Account

MS patients are also sensitive to temperature and may overheat as a result. To combat this you should plan your training sessions to occur indoors, or during cooler parts of the day e.g. early morning.

Thermosensitivity among MS patients is also known to significantly increase and worsen general symptoms. 

If you’re a personal trainer for someone with MS, the threat of overheating can be avoided by encouraging your clients to wear loose fitting clothing made of a breathable material. 

You should also remind clients to stay hydrated during sessions, and always have a bottle of water on hand in case of emergencies.

#4 - An MS Exercise Programme Must Feature Goals Tailored To The Specific Client 

Part of creating an MS exercise programme is setting goals that are dependent on the client’s physical capabilities, as well as their own personal wishes. 

Whilst ‘staying healthy’ is a commonly occuring long-term goal among many MS patients, you should also work to understand personal aspirations that your clients have in regards to their training.

During an initial PT consultation clients may share that they wish to:

• Walk unassisted for a longer period of time
• Reduce their symptoms and work towards rehabilitation 
• Feel more energised  
• Improve their overall balance to run for short periods of time

These goals should be taken into consideration along with the clients physical capabilities, in order to craft realistic, obtainable goals. 

If these are too outlandish, a client could become injured when trying to match your expectations, or find themselves becoming disheartened by the programme all together.

You should therefore implement SMART goals to assist your clients, which stands for:

An example of a SMART goal for MS patients could be: 

Goal: To perform 10 squats unaided in a time frame of 3 months

Specific: There is a specific goal as the client isn’t being vague with phrases such as ‘stretch my lower body’. There is a clear goal in mind for what they wish to achieve. 

Measurable: There is a total number of squats given to be completed by the client.

Achievable: Clients will be able to move at their own pace, taking regular breaks to allow spasms to ease and increased symptoms to subside. 

Realistic: The MS patient will have enough time to improve their overall flexibility, with room for rest days caused by relapses.  

Timely: An end date is set for 3 months, giving the client a timeframe for the end point of this specific goal.

This would be an example of a long-term goal. Prior to achieving this, the client may set themselves short-term targets to hit, such as being able to perform 3 squats unaided by the end of one month.

The purpose of SMART goals is to consistently build upon your existing achievements, and advance onto the next target.

For example, once your client has achieved 10 unassisted squats they may want to progress and set their new target to complete 15 within the next 2 months.

#5 - Be Prepared To Alter An MS Exercise Programme 

As we have stated throughout this article, MS is a fluctuating autoimmune disease. A patient who is suffering from this condition could experience the peak of their physical fitness, only to suffer from a damaging relapse days later.

For this reason you must be prepared to offer alterations to your exercise programme, in order to accommodate the client’s present condition. 

This will require you to familiarise yourself with possible alterations that can be made. For example, if a client wishes to stretch their lower body, many MS PTs will have to implement a sit to stand workout. 

This will be moderate intensity, and will require the client to:

• Sit tall in a chair, with feet a shoulder-width apart.
• Hinge at the waist and shift their weight forward.
• Push through their heels, squeezing the quads and glutes and bring themselves to a standing position.
• Use the chair for added support and balance if needs be
• Slowly sit back and down and repeat the process for multiple reps

Amendments to a sit to stand workout can be made to suit the needs of clients in remission, who will be able to perform at a higher level.

For this advanced option, wall squats will be a well suited alternative: 

• Clients will stand a foot away from a wall, with their back to the wall.
• They will then lean back so their shoulders, torso and hips are flat against the wall.
• The client will slowly slide down the wall, bending their knees and keeping their upper bodies flat against the wall.
• They will hold this pose for five seconds, then slowly push their legs to return to the starting position.

This process can also be altered to suit the needs of patients who have recently suffered from a relapse.

In this instance, you will need to make the workout less physically demanding, and a great way to do this is with a seated leg extension.

Here, you won’t ask your clients to stand, and they’ll instead perform seated leg extensions.

• A client will sit upright in a chair, with their feet shoulder width apart
• They will then lift their right knee and extend the right food forward, toe pointing upward
• By squeezing their quad they will be able hold the position for several seconds
• Using their hamstrings, clients can pull their heel back to the starting position and switch legs

A personal trainer for someone with MS must be on hand to offer support should a client suffer from a relapse. 

This could involve assisting clients with their stretches by moving their joints for them in the appropriate manner. 

These alterations could be required during the session itself, as a client may express their discomfort or feelings of symptoms worsening during a specific point of their workout.

Before You Go!

As a personal trainer for someone with MS, your approach will vary depending upon the severity of their condition, and can change from session to session, meaning it’s hugely important to be adaptable and flexible.

If you're looking to expand your client base, you can do this with our Level 4 Nutrition qualification. You can also download OriGym’s course prospectus for FREE!