How to avoid sedentary behaviour, a health risk with MS

This post is not an attempt to make you feel guilty because of possible sedentary behaviour, a health risk with MS. It is not a case of scaremongering – but first and foremost meant as encouragement! My aim is to give you a few bright ideas (hence the light bulb picture) to work with your mindset when it comes to being more physical active and reducing sedentary behaviour.

As I am updating this post in November 2021, we are experiencing a rise in Covid-19. On top of that Winter is upon us, which also adds to the risks of a more sedentary lifestyle. Cosying up indoors often include more sedentary activities like reading, eating and TV. That is why it is even more relevant to consider how to increase our daily physical activity level and avoid a sedentary lifestyle to take over too much.

First, we need to define what physical activity and sedentary behaviour are. We will dive into more depth about the infamous health risk that sedentary behaviour entails (both with and without MS). There are several MS symptoms which can become worse when living a sedentary life.

Warning: This post is a bit long, but please persevere to the end! If for no other reason, then to see the cute dog pictures at the end of the post!

Health promotion is not just about exercising?

“Well, are you not a physiotherapist?”, you might think. Yes, true – but let’s look at it a bit more holistically. Physical activity can be divided into physical exercise and everyday movement (from day-to-day activities). Physical exercise is an important part of health promotion – but we must also focus our attention on what we do when we are not exercising. The little choices in everyday life are important.

First, let us take a look at the recommendations of the Danish Health Authority regarding physical activity for adults (18 to 64 years) in general.

• Be physically active for at least 30 minutes per day (moderate to high intensity) in addition to your everyday movements.
• If you split the 30 minutes up, each part must last at least 10 minutes in order to count.
• At least twice a week, include high-intensity physical activity (at least 20 minutes) to maintain or increase your fitness and muscle strength. Include activities that increase bone strength and flexibility.
• Any additional activities give you additional benefits.

This is in line with the recommendations of the WHO for the same age group:

• A: At least 150-300 minutes of aerobic exercise with moderate intensity per week. Or B: 75-150 minutes with high intensity.
• Must be performed with a duration of at least 10 minutes at a time.
• Include strength training for all major muscle groups at least 2 days a week.
• If you increase A or B, you achieve further health benefits.

What are the recommendations regardingphysical activity when you have MS

Some people with MS (PWMS) will experience difficulties being physically active (with moderate or high intensity) for a period of 10 min (as described above). Please keep in mind, these recommendations are written for the general population. It is a general rule for anyone, who wants to increase their physical activity, to take small and gradual steps at a time. But for PWMS, it is even more important that you listen to your body and exercise safely.

In relation to MS, the The Danish Health authority talks about physical activity , which can improve muscle strength, balance and fitness.

• For PWMS include effective strength training 2-3 times a week with a duration of 45-60 minutes. Pick weight loads with which you can perform 8-15 repetitions, before exhaustion (done in 2-4 sets).
• Cardio exercise is recommended to be performed at a level of more than 50% of the maximum pulse.

For further details on recommendations for PWMS search up “Physical Exercise and MS – Recommendations” by Ulrik Dalgas from The International MS Journal 2019.

The small choices in everyday life

Now that we are familiar with the recommendations for physical activity – let us discuss what we do when we are not exercising? For a number of years now, research has suggested that we should also focus on sedentary behaviour. We can not only focus on exercise in order to promote health and fight lifestyle diseases. Sedentary behaviour has been portrayed as the smoking of our time.

We have realized, that you can easily be active 30 minutes a day (moderate to high intensity) and still live a very inactive life. Likewise, one can move a lot during the day with an intensity that is too low.

People on both ends of the scale may still be at risk of lifestyle diseases. It is very straightforward to accumulate quite a few sedentary hours in the course of a day. Have you tried counting your sedentary hours?

Although only activities of a minimum duration of 10 minutes count in the overall number of minutes, the small choices in everyday life are also helpful. Both The Danish Health Authority and the WHO stress that additional activity provides additional health benefits.

But what is sedentary behaviour actually? Why is it a health risk?

Let us take a step back and define sedentary behavior:

• The part of our waking hours that we spend either in a sitting or lying position and where the majority of our muscles are at rest.

Sedentary behaviour poses a health risk to all of us in relation to lifestyle diseases such as high blood pressure, cardiovascular disease, and more. The reason being that this behaviour weakens the bones, muscles and lowers circulation. The body will thereby decrease its ability to maintain a healthy metabolism.

Why is sedentary behaviour a risk with MS?

One could object that PWMS should be even more aware of the health risks associated with sedentary behaviour! MS can often lead to a more sedentary lifestyle than you aspire to. There are many good reasons for this:

1. As a PWMS you might often suffer from fatigue and/or a feeling of being unwell due to your MS symptoms. This brings on some barriers when it comes to living more active.
2. Your physical mobility and physical abilities due to your MS may also bring on some barriers. The tasks that you previously found natural may have become more demanding with time.
3. The prevalence of depression among PWSMS is high. According to the MS Trust, about half of all people with MS will experience depression at some point in their lives. This is 3 times higher than in the average population.
4. The fear of falling can also limit your physical activity. You may even choose to play safer than necessary due to this fear.

It is reasons like these, that make me focus on sedentary behaviour just as much as physical exercise when we talk health promotion and MS.

How long do PWMS sit down?

The “National estimates of self-reported sitting time in adults with Multiple Sclerosis” (JE Sasaki 2018) conclude that PWMS sit down twice as much as the general population. An average value of 8 hours per day is mentioned. This is based on self-assessment by the individual rather than the use of wearable technology. Self assessments do not always correspond with reality for various reasons. In my experience using wearable technology gives a more accurate answer than using a self assessment.

What is the effect of sedentary behaviour on your MS mobility?

Sometimes things can turn into a vicious circle. Your level of mobility can cause you to reduce an active lifestyle. But a passive lifestyle can also reduce your mobility. In other words – your mobility is not only an expression of your MS if you live a very inactive life. A passive lifestyle can also affect your mobility.

The phrase “Use it or lose it” is a little unfair when it comes to MS – but I still dare to write it. Sometimes you may experience a form of secondary weakness that is not directly brought on by your MS – but instead by an inactive lifestyle.

Which MS symptoms can be aggravated by sedentary behavior?

In addition to affecting your gait function, sedentary behaviour may also affect other MS symptoms. This applies to e.g. spasticity, flexibility, constipation, and some forms of pain.

What can I do to avoid sedentary behaviour with MS?

It is actually possible to do physical activities of moderate to high intensity in a seated position. (Activities where the muscles definitely are not at rest, even if you are sitting down) If you are unsure how to do this, I am sure that your local physiotherapist can guide you individually.

However, we must not forget the importance of standing up and bearing weight down through the legs. This may help to alleviate some of your symptoms. It may reduce your spasticity, which is one of the MS symptoms that can be aggravated by sedentary behaviour. As the illustration shows, there are several benefits of standing up:

Help to avoid the health risk by building up everyday movements.

As a physiotherapy student, I remember expressions like “the best position is the next” in terms of ergonomics and work environment. Let us try to transfer that way of thinking to our everyday lives. I am aware that some will object to this kind of sayings – but do try to reconcile with the thinking behind it. It is about avoiding sitting in the same passive position for extended periods of time. Perhaps you could take a few steps before you change your posture – or make use of the standing posture for a change. Ideas like this would keep you ahead of the game.

Avoid only making exercise your priority – try to think of opportunities for everyday movements. Think about the small choices you make in everyday life. It can be anything from walking the long way around the car before you reach the front door – to folding the laundry with brisk movements.

Some people like routine. Once they get something into a routine, it will stick with them. They will keep taking the long way around the car. Others might find it pointless not to take the direct path to the front door. It is all about finding a solution that works for YOU.

Despite people’s different personalities, many have one thing in common. They have a certain way of thinking when it comes to being more physically active. For some, their thinking and their mindset regarding physical activity will be positive. For others, their way of thinking gets in the way of being more physical activity. This can be described as barriers. Fortunately, by adding a bit of problem-solving you can also influence this! Sweet music for a physiotherapist!

Release the barriers – exercise your mindset

As we already know, there are many good reasons why it can more hard to be physically active when you have MS. These reasons are valid. Fortunately, there are also some reasons that you can work on in your mind. Doing this may promote activity rather than passivity.

The barriers can be divided into 3 areas: external/environmental factors, internal/ personal factors or factors related to your MS. (source: Miho Asano 2013: Exercise barriers and preferences among women and men with multiple sclerosis)

The top position within the external factors (according to Miho Asano 2013) is lack of time. Let’s take a closer look at this particular barrier and a few other barriers.

Another frequent external factor is the weather. Something most people like to comment on.

Perhaps you are just not that much into exercise.

Some PWMS also finds that the exercise is not helping. Maybe they have had bad experiences with physical activity and exercising in the past. Remember maintaining your level of mobility is also important for PWMS. With that in mind, allow yourself to approach the matter with an open mind and curiosity anyway. You might be surprised.

The dog pictures are coming soon!

I hope you have gained some background knowledge about sedentary behaviour and the associated health risks (with and without MS). Most of all, I hope I have challenged your mindset. Given you inspiration to have a childlike curiosity and be open to change when it comes to reducing sedentary behaviour within your own personal context.

For some this post will a case of old wine in new bottles. However, in my experience, it sometimes pays off with a little old wine in new bottles. Sometimes it pays off to hear something that you have heard before. Maybe explained in a different way or by a different person. In any case, it is worth a try.

• How about you – Do you dare to count how many hours you sit down?
• What do you think of old wine in new bottles?
• How can you change your mindset in order to avoid sedentary behaviour?
• Last but not least – check out the dog pictures below – were they worth the wait?

Regardless of this being either old wine in new bottles for you – or a completely new angle, feel free to share the post with your friends using the share buttons below. Please help spread the word! Together we can try and fight sedentary behaviour a health risk with MS!

If you would like to read more, check this post about goals and motivation. Nudging can also be relevant when it comes to reducing sedentary behaviour, read more here.

Please also check out my disclaimer.