Fitness Program¶

Structured Exercise for MS: John's Daily Routine

This fitness program was developed in collaboration with both my Neuro and my Ortho physical therapists, Nicole and Ben. In my case, there are currently shoulder, hip, and SI issues (Amongst the other list of "regular" ongoing items). The program ebbs and flows with energy levels, injury, and fatigue. And that's the biggest thing that I've learned is being patient and adaptive as issues arise. You pick yourself up, dust yourself off, and start it all over again when you need to.

I'm fortunate right now to have the time to focus on the program completely, and I'm very excited to be getting roped back in at the UW Fitness Center on Science Drive. I have a consultation on Friday and will be working with the trainers to establish a 3-4 times a week program. I was previously a member and so much enjoy the facilities, the sense of community, and the skill level of the trainers. The curated plan will include gym sessions, pool walking, and daily home exercises focused on upper body strength, core stability, and functional movement.

I think one of the great advantages of working with the team at this fitness center is they understand the propensity of MS patients to want to overdo it and try to "work out" their MS away. It always feels so great when you're crushing it at the fitness center, the endorphins are kicking, you feel capable and proud of the work you can do.

Pace is the trick.

I look forward to providing updates to this journey in journal entries.

Program Overview¶

Component	Frequency	Location
Gym Training	3x/week (M/W/F)	UW Health Sports Medicine
Pool Walking	1x/week (Thu or Sat)	Pool
Daily Home Exercises	5x/week	Home
Cardio	5x.week	Home (SciFit StepOne)

Daily Schedule¶

Wake Up Routine (Daily)¶

Morning stretching and mobility work to start the day.

Child's Pose Stretch¶

Reps: 8-10 | Sets: 1 | Weekly: 7

Setup: Begin on all fours.

Movement: Sit your hips back while reaching your arms overhead and lowering your chest to the ground. Hold this position.

Tip: Make sure to relax into the pose and try to sit your bottom back to your heels as much as possible.

Prone Press Up¶

Reps: 8-10 | Sets: 1 | Weekly: 7

Setup: Begin lying on your stomach, with your hands by your shoulders resting flat on the ground.

Movement: Push against the floor with your hands, bending your back upward.

Tip: Make sure to keep your hips in contact with the floor and maintain a gentle chin tuck throughout the exercise.

Shoulder & SI Joint Exercises (M-F)¶

These exercises target shoulder stability and sacroiliac joint function.

Hooklying Sacroiliac Joint Isometric¶

Reps: 8-10 | Hold: 3-5 sec | Weekly: 7

Setup: Begin lying on your back with your knees bent and feet on the floor. Lift one leg to a 90-degree angle and place both hands just above your knee.

Movement: Press your knee up toward your chest, resisting the movement with your hands. At the same time, dig your opposite heel into the ground. Hold, then relax and repeat.

Tip: Make sure to keep your low back on the ground and do not hold your breath. There should be little to no movement during the exercise.

Hooklying Isometric Hip Abduction Adduction with Belt and Ball¶

Reps: 8-10 | Weekly: 7

Setup: Begin lying on your back with your knees bent, a ball between your knees, and a belt looped around your knees.

Movement: Gently press your knees out into the belt, hold briefly, then squeeze your knees into the ball, and hold briefly. Continue alternating these movements.

Tip: Make sure to continue breathing evenly. There should be little to no movement during the exercise. A pillow works as an alternative to the playground ball.

Seated Shoulder Diagonal Pulls with Resistance¶

Reps: 10-12 | Sets: 2-3

Setup: Begin sitting upright, holding a resistance band in both hands.

Movement: Move your arms diagonally in opposite directions, pulling against the resistance and squeezing your shoulder blades together. Return to the starting position and repeat on the opposite diagonal.

Tip: Make sure to maintain good posture and do not shrug your shoulders during the exercise.

Seated Anti-Rotation Press With Anchored Resistance¶

Reps: 8-10 | Sets: 1 | Weekly: 1 | Weight: 10#

Setup: Begin sitting upright, holding a resistance band that is anchored at your side with both hands at chest level. Make sure that there is tension in the band at the starting position.

Movement: Handle should be at height of shoulder. Press your arms straight forward. Hold briefly, then bring your arms back towards your chest. Repeat.

Tip: Make sure to keep your core muscles engaged. Do not let your trunk rotate as you press the band forward. Keep breathing throughout the exercise. Sit back in your chair or angle your chair towards the machine if SI joint gets irritable.

Seated Hip Abduction with Resistance¶

Reps: 8-10 | Sets: 2-3 | Weekly: 4-5

Setup: Begin by sitting upright in a chair with a resistance loop secured around your legs.

Movement: Move your legs outward, creating more tension in the band, then return to the starting position and repeat.

Tip: Make sure to keep your back straight during the exercise.

Lower Extremities (Daily)¶

Exercises for leg strength and functional movement.

Sit to Stand with Counter Support¶

Reps: 8-12 | Sets: 2 | Daily: 1 | Weekly: 4-7

Setup: Begin sitting upright in an armchair with a counter in front of you within arms reach.

Movement: Lean your torso forward, then press up through your hands and feet to stand up. Slowly sit back down using the armrests for support and repeat. Hold for 10-20 sec. Perform your reaches.

Tip: Make sure to use the counter to help you balance as you stand up and try to keep your weight evenly distributed between both legs. Do not lock your knees when you are standing.

Noon: Cardio (Daily)¶

Equipment: SciFit StepOne Recumbent Stepper

Program: Hill Profile

Daily cardio session on the recumbent stepper for cardiovascular health and endurance. The SciFit StepOne is a total body recumbent stepper designed for wheelchair accessibility.

Upper Body (Monday/Wednesday)¶

Upper body strengthening exercises performed at home currently.

Bicep Curl to Shoulder Press with Dumbbells¶

Reps: 6-8 | Sets: 1 | Weekly: 4-5 | Weight: 3#

Setup: Begin standing upright with a dumbbell in each hand and palms facing forward.

Movement: Perform a biceps curl by bending your elbows until the weights reach your shoulders. Press the dumbbells overhead, rotating your palms so they face forward again. Reverse the motion, lowering to shoulder height, then to your sides again.

Tip: Do not arch your lower back excessively as you press the dumbbells overhead.

Shoulder Flexion Serratus Activation with Resistance¶

Reps: 8-10 | Sets: 1 | Weekly: 4-5 | Resistance: Level 2 band

Setup: Begin standing upright with a resistance band looped around your wrists, palms facing inward, and your elbows bent to 90 degrees.

Movement: Gently press your hands out to shoulder width apart, then lift your hands overhead. Lower them back down and repeat.

Tip: Make sure to keep your elbows bent and your back straight. Focus on keeping tension in the band during the exercise.

Alternating Punch with Resistance¶

Reps: 8-10 | Sets: 1 | Weekly: 1

Setup: Begin in a staggered stance position, holding both ends of a resistance band anchored behind you at chest height, with your elbows bent by your sides and palms facing inward.

Movement: Slowly punch one arm forward until your elbow is straight, rotating your arm so your palms down, then return to the starting position and repeat with your other arm. Your trunk should rotate as you punch your arms forward.

Tip: Make sure to keep your back straight during the exercise. Avoid sharp pain in front of shoulder.

Seated Shoulder Row with Anchored Resistance¶

Reps: 6-8 | Sets: 2-3

Setup: Begin by sitting upright in a chair holding resistance tubing in each hand, anchored in front of your body. Your feet and knees should be shoulder width apart.

Movement: With your fists facing each other, draw your arms back until they are parallel with your trunk, and hold, before slowly returning to the start position.

Tip: Make sure to maintain a gentle chin tuck during the exercise and do not let your trunk rotate.

Seated Abdominal Press into Swiss Ball¶

Reps: 8-10 | Sets: 2 | Weekly: 5-7

Working lower abdominals, shoulder extensors (triceps and lat), and hip flexors

Setup: Begin sitting upright holding a swiss ball on your thighs.

Movement: Engage your stomach muscles and press your hands into the ball. Hold, then relax and repeat.

Tip: Make sure to maintain an upright posture and keep your shoulders and neck relaxed.

Plank Taps on Wall¶

Reps: 10 | Sets: 3 | Daily: 1 | Weekly: 7

Setup: Begin standing upright next to a counter. Place your hands on the counter, then step backward into a plank position.

Movement: Lift one hand off the counter.

Tip: Make sure to keep your chin tucked and your spine aligned. Do not let your low back arch excessively.

Core (Tuesday/Thursday)¶

Core strengthening and mobility exercises.

Supine Figure 4 Piriformis Stretch with Leg Extension¶

Setup: Begin lying on your back with both legs bent and your feet on the ground.

Movement: Lift one leg and place your ankle on your opposite knee. Grasp the ankle and knee of your top leg, then straighten your lower leg. Hold this position.

Tip: Make sure to keep your low back flat on the floor during the stretch.

Supine Gluteus Stretch¶

Setup: Begin lying on your back with one leg bent.

Movement: Gently pull your bent knee toward the floor on the other side of your body, until you feel a stretch in your buttock and hold.

Tip: Try to keep your shoulders flat against the floor and your back relaxed during the stretch.

Supine Lower Trunk Rotation¶

Reps: 6-8 | Sets: 2-3

Setup: Begin lying on your back with your knees bent and feet resting on the floor.

Movement: Keeping your back flat, slowly rotate your knees down towards the floor until you feel a stretch in your trunk and hold.

Tip: Make sure that your back and shoulders stay in contact with the floor.

Hand Exercises (Most Days)¶

Exercises for hand strength and nerve mobility.

Ulnar Nerve Glide¶

Reps: 10 | Sets: 1 | Daily: 1 | Weekly: 7

Setup: Begin standing with your arm at your side.

Movement: Bend your wrist back with your fingers straight so your palm is facing the floor. Then raise your arm out to the side until you feel stretch. Once you feel a stretching bring your arm back down to the starting position.

Tip: Only raise your arm to 90°. You should feel a gentle stretch, do not push into the stretch. Do not hold the stretch. Do not increase your symptoms during that exercise. If your symptoms increase after the exercise, the symptoms should decrease in 20 minutes. If the symptoms do not decrease, you must shorten the range of motion of the fingers, wrist, and arm.

Wrist Tendon Gliding¶

Reps: 10 | Sets: 1 | Daily: 2 | Weekly: 7

Setup: Begin sitting with your elbow resting on a table and your fingers straight.

Movement: Bend at your bottom knuckles so your fingers are in a table top position, straighten them, then bend your bottom and middle knuckles, straighten your hand, make a claw fist, straighten your hand, then make a half fist, and straighten your hand again. Repeat these movements.

Tip: Make sure to keep your wrist straight during the exercise.

Putty Squeezes¶

Reps: 10 | Sets: 1 | Daily: 1 | Weekly: 7

Setup: Begin sitting with your hand in a comfortable position, holding putty in your palm.

Movement: Gently squeeze the putty using all of your fingers equally, and repeat.

Tip: Make sure to keep the rest of your arm relaxed during the movement.

Thumb Opposition with Putty¶

Reps: 10 | Sets: 1 | Daily: 1 | Weekly: 7

Setup: Begin sitting upright with a roll of putty on the table.

Movement: Using the tips of your thumb and index finger, gently pinch into the putty making an "O" shape. Return to starting position, and repeat with each finger.

Tip: Make sure to relax your hand between each finger press. Try not to let the base of your thumb collapse or over extend.

Quick Finger Spreading with Rubber Band¶

Reps: 10 | Sets: 1 | Daily: 1 | Weekly: 7

Setup: Begin sitting upright with a rubber band looped around your fingers.

Movement: Quickly open your fingers to stretch the rubber band, then relax and repeat.

Tip: Make sure to keep your movements controlled and your wrist straight during the exercise.

Joint Protection Principles¶

These principles help reduce stress on joints, prevent further damage, and increase independence in daily activities.

1. Respect for Pain During Activities¶

Stop activities before you reach the point of discomfort or pain
Limit activities which cause your pain to last more than one hour after you have stopped

2. Balance Activity and Rest¶

Rest before becoming tired
Plan rest periods during longer or more difficult activities
Plan to rest/stop activity every 30 to 40 minutes for 5 to 10 minutes to decrease strain on joints

3. Avoid Activities Which Cannot Be Stopped¶

When you begin to feel joint pain, stop
Prioritize activities—consider the length of time and difficulty before beginning
Plan difficult activities for "peak" energy times

4. Avoid Staying in One Position for Extended Periods¶

Plan rest periods
Change your position
Stretch and relax your joints
Set a timer during activities to remind yourself to change positions

5. Avoid Sustained, Tight Pinching or Gripping¶

Use built-up handles on daily items (silverware, hairbrush, etc.) and large barrel pens
Use foam tubes or Coban to build up handles
Position hands to avoid pinching—place a book or phone in the palm of the hand

6. Use Good Joint Alignment¶

Maintain proper posture: perform activities with your elbows at your side and your wrist in a straight neutral position
Move your body close to items to have your elbows close to you to decrease strain

7. Use Larger, Stronger Joints When Possible¶

Distribute weight over non-involved or stronger joints
The stronger elbow should carry the weight of a purse (not weak fingers)
Pick up dishes with two hands, using your palms
Push on pump bottles using the palm of your hand, not fingertip

8. Improve Your Mechanical Advantage¶

Do not force yourself to do activities which you do not have the strength to do
Use levers (door handles) and friction (gloves) to decrease the force required
Slide versus lift
Push versus pull

Exercise Disclaimer

This program provides exercises related to your condition that you can perform at home. As there is a risk of injury with any activity, use caution when performing exercises. If you experience any pain or discomfort, discontinue the exercises and contact your healthcare provider.

Program developed in collaboration with UW Health Physical Therapy

See also: Nutrition Guide | Meal Cost Tracker