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Exercise and MS


By Yvonne Learmonth

How does exercise help with MS

Many of the symptoms associated with MS are reduced through physical exercise. Exercise is a great way for everyone to stay strong, control weight, improve fitness and ward off chronic disease. While managing the consequences of MS, exercise represents a crucial tool and is an important approach for improving health and wellness. Unfortunately, inactivity invites consequences such as fatigue, poor strength and poor fitness. If someone is feeling fatigued, they might be less likely to exercise, and as a result they will have even more fatigue over time. Being inactive also raises the risk of developing other chronic health conditions. If you remain inactive, alongside MS, you might develop heart disease or diabetes too.

There is definite scientific evidence that exercise is associated with meaningful outcomes for persons with MS, and these outcomes range from the cellular level to quality of life. Research has indicated that persons with MS who engage in exercise have better brain health based on magnetic resonance imaging, better cognition based on speed of information processing, and increased mobility and cardiovascular health. Plus, persons with MS who engage with exercise have less fatigue, depression, anxiety, and pain and better sleep quality and quality of life. (2)


Is exercise safe for people with MS?

Yes! Exercise is not associated with any greater risk for persons with MS than for healthier individuals.  Research which summarised the risk of relapse and other adverse events associated with exercise training has shown that exercise is not associated with increased risk of relapse or risk of adverse events for persons with MS (3).


What type of exercise is best / recommended for MS?

To be effective exercise should be performed regularly at a suitable intensity. Choose exercise that you enjoy.

The Internationally recognised physical activity guidelines for adults with mild to moderate MS are a great starting point. They are important guidelines when recommending exercise to persons with MS and they are applicable to persons with mild to moderate disability. Other important recommendations have been written by the American College of Sports Medicine (ACSM) for persons with chronic diseases and disabilities (4).

Physical Activity Guidelines for adults with mild to moderate MS are:  30 minutes of moderate intensity aerobic activity two days per week and strength training for major muscle groups, including the calf muscles, leg muscles, abdominal and arm muscles on two days per week(5).

Our advice is;
If you are beginning again with exercise slowly, work up to this volume of exercise over 2 to 3 months.

Break exercise into shorter bouts of 10 to 15 minutes at a time if necessary. For strength training exercise slowly work up to doing two sets of 10-15 repetitions of each strength training exercise. Experiment with timing so that exercise is not counterproductive to the rest of your day.

Aerobic exercise

  • Can be performed in a variety of settings including individual and group training sessions on land or in water
  • Can be performed on at least two days of the week
  • Walking is the number one choice of aerobic exercise by persons with MS(6), and walking intensity can be measured by counting your steps over a period of time
  • Use of exercise bikes and elliptical trainers is preferable to the use of a treadmill when there is a risk of tripping and falls

Our advice is;
Walking 100 steps in a minute is moderate intensity aerobic exercise for persons with MS (7). Build this up to achieve your 30 minutes of aerobic exercise.

Strengthening Exercises

  • Can be performed in a variety of settings including home, community centre or gym
  • Can be performed on at least two days of the week
  • Can be performed with resistance from free or machine weights; body weight, resistance bands, or water
  • Progressive resistance with high weights and low repetitions is beneficial
  • Frequent rest breaks and alternating muscle groups during training helps minimise the effect of fatigue

Stretching & Balance Exercises

  • Can be performed in a variety of settings including home, community centre or gym
  • Can be performed on most days of the week
  • Stretching exercises can be performed using gravity or resistance bands
  • Balance exercises can be performed by challenging one normal sitting and standing posture
  • Can be useful to relieve muscle spasms and cramps
  • Can improve relaxation and sleep patterns

Overcoming Barriers


Fatigue is common in MS, exercise and fatigue management education strategies will actually help your fatigue level in the long term(8).


Heat Sensitivity and MS

Physical and sensory symptoms may temporarily increase with small increases in environmental or body temperature. People with MS should be encouraged to keep cool and well hydrated during exercise sessions, for example using cool clothing and try to exercise inside or in the shade.

Research is continuing to address what exercise and strategies are best for fatigue and heat sensitivity; for now it is recommended to follow the Physical activity guidelines, remember to build up to these guidelines slowly. Stretching exercises are important too, and continuing these when fatigue levels, or temperatures, are high is still important.


Finding support

Support to help you exercise is not to be underestimated. Research indicates that learning about exercise, working with other to overcome your barriers and identifying facilitators to exercise will make you more successful (9). Tell your friends, family, work colleagues and neighbours about the benefits of exercise for you and tell them that you want to be more physically active and they might join you too. Exercise is beneficial for everyone.

You might seek out help from a physiotherapist or exercise physiologist to give you specific instructions, ask them to help you overcome any exercise barriers you might have and make sure they know about the Exercise Guidelines


Using technology to your advantage

Your physiotherapist, or exercise trainer may live far from you but you can still access them using the telephone, email and telehealth option for ideas and advice.

Online videos and resources are engaging and will offer education on exercises for persons with MS. Suggested websites are listed below.

Mobile Apps for your smartphone are useful for monitoring physical activity, connect with professionals over video-chat and track your progress. Downloading these apps to your smartphone is very easy, and many are free, suggested mobile Apps available at the time of publication are listed below.

Connect to wearable technology such as digital devices worn as a wristwatch or band, these can track your step count, heart rate and sleep. Wearables allow you to monitor your activity without thinking about it.


Online Resources

Exercise is Medicine Australia

Multiple Sclerosis Australia – the national website of MS Australia

Find an Accredited Exercise Physiologist

Find an Accredited Physiotherapist

Exercise Right

Yoga and Non-Cardio Exercises: Your Allies in Managing MS Symptoms and Improving Overall Health- telelearning brought to you by the National MS Society and Can Do MS

Workout Your Worries: Anxiety and Exercise in MS- telelearning brought to you by the National MS Society and Can Do MS

Your Mind is a Muscle, Too: The Relationship Between Exercise and Cognition- telelearning brought to you by the National MS Society and Can Do MS

ChairFit with Nancy- series of free exercise videos developed by a physical therapist with years of experience working with people with MS.

The MS Trust’s (United Kingdom) series of exercise videos for people with MS can be done in a seated or standing position to address balance, endurance, strength and flexibility.

14 Weeks to a Healthier You - free, personalized, web-based physical activity and nutrition program targeted to people with mobility limitations, chronic health conditions and physical disabilities. Created by National Center for Health, Physical Activity and Disability (NCHPAD), the program can help you get moving and make healthy nutrition choices.

The Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis can help adults with mild to moderate disability, resulting from relapsing or progressive forms of MS, to improve their fitness.

The Aquatic Physical Therapy and MS video produced by Laura Diamond, MS, PT, Diamond Physical Therapy Associates, PC, and Jill McElligott, PT, DPT, offers an introduction to the potential benefits of aquatic physical therapy for managing MS symptoms and enhancing fitness. It also provides interviews with a neurologist, a physiatrist and an aquatic physical therapist, all of whom specialize in working with people with MS, as well as with people with MS about their perspectives on aquatics exercise.


Health Focused Mobile App Examples (available in 2017)

MySidekick for MS

MSAA — My MS Manager

Charity Miles


1. Klaren RE, Motl RW, Dlugonski D, Sandroff BM, Pilutti LA. Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil. 2013;94(12):2342–8.

2. Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8(9):487–97.

3. Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci. 2014;343(1–2):3–7.

4. Moore G, Durstine JL, Painter P, Medicine AC of S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities, 4E. Human Kinetics; 2016.

5. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta A, Mackibbon KA, et al. The effects of exercise training on fitness, mobility, fatigue, and health related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94(9):1800–28.

6. Weikert M, Dlugonski D, Balantrapu S, Motl RW. Most Common Types of Physical Activity Self-Selected by People with Multiple Sclerosis. Int J MS Care. 2011 Jun;13(1):16–20.

7. Agiovlasitis S, Beets MW, Motl RW, Fernhall B. Step-rate thresholds for moderate and vigorous-intensity activity in persons with Down syndrome. J Sci Med Sport Sports Med Aust. 2012 Sep;15(5):425–30.

8. Pilutti LA, Greenlee TA, Motl RW, Nickrent MS, Petruzzello SJ. Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis. Psychosom Med. 2013;75(6):575–80.

9. Sangelaji B, Smith CM, Paul L, Sampath KK, Treharne GJ, Hale LA. The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: A systematic review and meta-analysis. Clin Rehabil. 2016;30(6):559–76.