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A Balancing Act - How to get your exercise routine started


By Adam Browne

Why and how does exercise help?

Regular physical activity and exercise can play a role in helping you live with MS. Research has found that exercise does not trigger an exacerbation or have adverse effects on your MS. Regular exercise is beneficial for maintaining general fitness and strength as well as helping to reduce the impact of specific MS symptoms.

The reported benefits of regular physical activity include:

  • Reduced fatigue levels  
  • Improved endurance (cardiovascular fitness)
  • Improved balance and coordination
  • Improved muscle strength
  • Improved posture and flexibility
  •  Improved mood, confidence and sense of wellbeing
  • Improved alertness and concentration
  • Improve ability to do everyday tasks
  • Reduce risk of falls        
  • Optimise symptom recovery after a relapse
  • Increased energy levels


What is the best exercise for people with MS?

For exercise to be effective it needs to be performed regularly and at a suitable intensity. As already mentioned exercise has been found to be beneficial for people with MS, currently exercise recommendations are to have an exercise program that incorporates a combination of strength, cardiovascular (fitness) and stretching. It is important to remember to choose activities that you find enjoyable and match your individual physical capabilities and needs.


Strengthening Exercises

Strengthening exercise programs may be better tolerated by some individuals than cardiovascular (fitness) training due to a potential reduced effect of impact on core body temperature which has been discussed in our previous article “The Power if Keeping Cool”

Strengthening exercises can be performed in many settings including: home, community centre or gym and are able to be performed using different methods of resistance like: free weights or machine weights, body weight, resistance bands, or water resistance (pool based).  Strengthening exercises have been found to have greater benefit with a focus on higher weight (resistance) and lower repetitions with regular rest breaks and alternating muscle groups during training as this helps to minimise the effect of fatigue during training.  


Cardiovascular (Fitness) Exercises

Can also be performed in many different settings including: individual and/or group training sessions, land based or water based, indoor or outdoor. The use of stationary exercise bikes and cross/elliptical trainers are also a good preference for those who have less confidence or have a history of falls over the use of a treadmill when there may be a risk of tripping and falls (every individual has different capabilities and this must be taken into account when prescribing an exercise program). It is important for everybody to start at low intensity and duration and to increase the intensity and duration of the exercise program gradually.

Some tips for cardiovascular (fitness) training:


Stretching and Balance Exercises

Balance impairment is a reported problem for approximately 75% of people with MS at some point in their lifetime. Impaired balance has been found to affect people in the early stages of MS even with minimal or no disability. Balance can cause difficulties with walking, and this may be due to coordination, mobility or as a result of loss of strength in the legs. Specific exercise program including stretching for mobility, strength straining and balance exercises can help to improve balance and walking ability.

Other benefits of stretching and balance exercises include:

  • Improved posture and flexibility
  • Decreased muscle spasms and cramps
  • Improved relaxation and sleep patterns
  • Decreased fatigue

Attached to this article is a home based exercise program which focuses on balance exercise you can begin to use as part of a structured exercise program. Remember to know your individual capabilities and to seek advice if you are unsure. It is always important with balance exercises to perform them under supervision if possible and always have something nearby to grab hold of if need be so you don’t fall and feel comfortable.


How do I get started with my exercise program?

Before starting any exercise program it is always important to discuss with your doctor your intentions and expectations and then consider seeking help and advice with the prescription of your program by making an appointment with an exercise physiologist, your physiotherapist or physical therapist who will be able to design an individual program for you. Your physiotherapist or exercise physiologist will be able to assess and develop an appropriate exercise program and monitor you through regular consultation or supervision. Below I have listed some key tips and ideas to assist with getting started with your exercise program and some ideas to assist with motivation:

Start slowly with any new exercise program and don’t try to do too much, too soon. Starting slowly allows your body get used to the new activity and adapt as well as helping you to determine the appropriateness of your exercise program and if it is comfortable for you. Over time, as your abilities and fitness levels change, you can increase and adjust your program appropriately

  • Warm up and cool down
  • Be aware of fatigue as this is one of the most common symptoms of MS. It is important to balance exercise with rest and to keep cool while you exercise
  • Doing something is better than doing nothing
  • Do something that is realistic & that fits well into your life
  • Find a local walking group
  • Exercise with someone else
  • Do something you enjoy
  • Schedule it into your week in advance
  • Think about the time of day you exercise
  • Monitor post exercise fatigue levels
  • Take breaks and recover well
  • Choose suitable exercise
  • Do shorter more frequent sessions if need be (at least 10 minutes)
  • Alternating and vary exercises (upper/lower body, cardiovascular/strength exercises)
  • Set yourself goals using the SMART technique (Specific, Measurable, Attainable, Relevant, Time Frame)
  • If you have an exacerbation, take a break and when you resume: reduce intensity and or duration and gradually build up


Some key points to remember about exercise and MS:
  • Doing something is better than doing nothing
  • Exercise will not make your MS worse
  • Start slowly and gradually increase activity
  • Choose enjoyable/motivating activities
  • Exercise with others or in a group
  • Choose activities that fit conveniently into your weekly routine
  • Be sensible about resting and recovering
  • Monitor your progress


  1. Dalgas, U, Stenager, E. (2012). Exercise and disease progression in multiple sclerosis; can exercise slow down the progression of multiple sclerosis? Therapeutic Advances in Neurological Disorders, 5 (2) 81-95 2.
  2. Dalgas, U., E. Stenager, et al. (2008). Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance and combined training. Multiple Sclerosis 14(1): 35-53. 3.
  3. Morrison, E. H., D. M. Cooper, et al. (2008). Ratings of perceived exertion during aerobic exercise in multiple sclerosis. Archives of Physical Medicine & Rehabilitation 89(8): 1570-4 5.