Which strategy will help a client best understand joint positioning and how the muscles should feel when learning a new strength exercise?

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Special considerations and precautions for exercise prescription in MS patients

Special considerationsPrecautions
FatigueSchedule resistance training on non-endurance training days [13, 53, 54].
SpasticityConsider foot and/or hand straps for ergometers. Use machines instead of free weights [53–55].
Heat intolerance and reduced sweating responseEncourage adequate hydration, keep room temperature between 20 and 22 ° C. Using of cooling fans and precooling before aerobic exercise might have positive effects on performance. It is better to plan exercise in the morning when body temperature is at the lowest [53, 54, 93].
Cognitive deficitsProvide written instructions, diagrams, frequent instructions, and verbal cues [53–55, 94]. Exercise tasks should be initially performed with minimal resistance. Individuals with cognitive impairments may require additional supervision during exercise to ensure their safety [18].
Lack of coordination in extremitiesConsider using a synchronized upright or recumbent arm/leg ergometer to ensure balance and safety [53–55, 94].
Sensory loss and balance problemsPerform all exercises preferably in a seated position; use machines or elastic bands instead of free weights [53–55, 94].
Higher energy cost of walking (2–3 times greater than age-matched healthy persons)Adjust workloads to maintain target heart rate and check heart rate regularly [13, 53–55, 94].
Daily variations in symptomsProvide close exercise supervision and make daily modifications to exercise variables [13, 53–55, 94].
Urinary incontinence /urgencyEnsure adequate hydration, and schedule exercise in close proximity to restrooms [53–55, 94].
Symptom exacerbationDiscontinue exercises and refer the patient to a physician. Resume exercise program.
Once symptoms are stable and the patient is medically ready to continue [13, 53–56, 94].