Articles
Exercise and Multiple Sclerosis

Reading time

Published on

Regular exercise offers potential benefits for people with MS, from improved balance and reduced fatigue to better mood and stronger muscles. With the right approach, starting gently, pacing yourself, and staying cool, you can build physical activity into your life safely and sustainably.

Why Exercise Matters

If you have MS, you might wonder if exercise is safe or if it could make things worse. Research shows that exercise safely improves fitness, movement, fatigue, low mood, and quality of life for people with MS [10].

The goal is finding ways to move that work for your body, energy levels, and daily routine.

What Exercise Can Do for You

Exercise can be intimidating, but we now know that exercise is a key part of managing MS [4]. Finding the right type of exercise that you can consistently commit to, can have many potential benefits. Exercise can improve balance, walking, stamina, fatigue, and quality of life [1].

Exercise also has neuroprotective effects, can improve cognitive function, and also promote the brain’s neuroplasticity [3].

What Types of Exercise Work Best?

Aerobic Exercise

Aim for 2-3 days per week, 10-30 minutes each time, at a moderate pace [6].

Examples:

-Walking around your neighbourhood or local park

-Swimming or water exercises

-Cycling or using a stationary bike

-Arm cycling or seated exercises

Start with 10 minutes if that’s all you can do, then slowly increase. Moderate pace means you can talk in short sentences but not chat easily.

Strength Training

Aim for 2-3 days per week. Do 1-3 sets of 8-15 repetitions of each exercise [6].

Examples:

-Hand weights or resistance bands at home

-Bodyweight exercises like chair exercises

-Gym equipment if you have access

Balance and Flexibility

Balance exercises can help prevent falls by strengthening ankles, hips and legs [6]. Practice in a safe space, ideally with a physiotherapist at first.

Examples:

-Tai chi or gentle yoga

-Standing on one foot while holding a chair

-Walking heel-to-toe in a straight line

Pacing: The Key to Success

Pacing means spreading your activity throughout the day and week so you don’t wear yourself out [7, 8].

Think of your energy like a budget, spend it wisely instead of using it all at once. Many people with MS overdo it on good days, then need days to recover. Pacing helps you avoid this cycle [8].

How to Pace Yourself:

Start below your limit: Begin with activity you can handle comfortably, even on harder days [7]

Be consistent: Do similar amounts each day rather than big ups and downs [8]

Plan ahead: Exercise when you usually have more energy [7]

Take breaks: Don’t wait until you’re exhausted. Break activities into smaller chunks [7]

Go slow: Increase how long or how often you exercise before making it harder [5]

Dealing with Heat Sensitivity

Heat sensitivity symptoms often happen during exercise. Even a small increase in body temperature (0.2-0.5°C) can worsen symptoms.

What to do: Drinking a cup of cold water every 15 minutes helps you exercise longer in warm weather [9]. This works even though your core temperature doesn’t change. Cold water in your mouth and throat may reduce MS-related fatigue[9].

Other Cooling Tips:

-Exercise somewhere cool or shady

-Wear lightweight, loose clothing

-Take a cold shower before activity

-Use a spray bottle or cooling gel

-Exercise early morning or late evening

-Keep a cold drink nearby

Getting Started Safely

Work with a physiotherapist or exercise specialist who knows about MS if possible [4].

Setting Realistic Goals

If you’re thinking about New Year’s resolutions, remember: consistency beats intensity [5]. Instead of promising to exercise every day, set smaller goals you can actually keep.

For example; three 10-minute walks per week, or joining a gentle yoga class, or doing chair exercises while watching TV. Starting with realistic goals lead to real, lasting benefits.

Start gently, be patient with yourself, and remember that any movement is better than none.

Key Takeaways

Exercise offers real benefits for people with MS. It improves strength, balance, movement, mood, and fatigue, but only if you do it in a way that works for you [1, 10].

Remember three things:

  1. Start gently

2. Pace yourself

3. Stay cool (especially in summer)

Exercise doesn’t mean exhausting workouts. It means moving your body regularly in ways that feel manageable. A short walk, gentle stretching, or a swim—every bit counts.

Talk to your MS nurse, GP, or physiotherapist about starting safely. Exercise is one of the most powerful tools for living well with MS [4]. The key is finding your own way to move safely and regularly.

References

  1. Du, L., Xi, H., Zhang, S., Zhou, Y., Tao, X., Lv, Y., Hou, X., & Yu, L. (2024). Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Frontiers in Public Health, 12, 1387658. https://doi.org/10.3389/fpubh.2024.1387658
  2. Pilutti, L. A., Platta, M. E., Motl, R. W., & Latimer-Cheung, A. E. (2014). The safety of exercise training in multiple sclerosis: a systematic review. Journal of the Neurological Sciences, 343(1-2), 3-7. https://doi.org/10.1016/j.jns.2014.05.016
  3. Zameer, U., & Kamran, A. (2024). Empowering minds and bodies: The impact of exercise on multiple sclerosis and cognitive health. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 10(2). https://doi.org/10.1177/20552173241244819
  4. Pilutti, L. A., & Donkers, S. J. (2024). Exercise as a therapeutic intervention in multiple sclerosis. Multiple Sclerosis Journal, 30(13), 1551-1568. https://doi.org/10.1177/13524585241301613
  5. Motl, R. W., Russell, D. I., Pilutti, L. A., Sandroff, B. M., & Learmonth, Y. C. (2024). Advancements and challenges in exercise training for multiple sclerosis. Neurology and Therapy, 13(5), 1375-1399. https://doi.org/10.1007/s40120-024-00656-z
  6. Hoang, P. D., Lord, S., Gandevia, S., & Menant, J. (2022). Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. Journal of Science and Medicine in Sport, 25(2), 146-154. https://doi.org/10.1016/j.jsams.2021.08.015
  7. Elbers, R. G., Rietberg, M. B., van Wegen, E. E. H., Verhoef, J., Kramer, S. F., Terwee, C. B., & Kwakkel, G. (2021). Effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. International Journal of Environmental Research and Public Health, 18(1), 17. https://doi.org/10.3390/ijerph18010017
  8. van den Akker, L. E., Beckerman, H., Collette, E. H., Eijssen, I. C. J. M., Dekker, J., & de Groot, V. (2020). Associations between activity pacing, fatigue, and physical activity in adults with multiple sclerosis. Journal of Clinical Medicine, 9(6), 1941. https://doi.org/10.3390/jcm9061941
  9. Chaseling, G. K., Filingeri, D., Barnett, M., Hoang, P., Davis, S. L., & Jay, O. (2018). Cold-water ingestion improves exercise tolerance of heat-sensitive people with MS. Medicine & Science in Sports & Exercise, 50(4), 643-648. https://doi.org/10.1249/MSS.0000000000001496
  10. Latimer-Cheung, A. E., Pilutti, L. A., Hicks, A. L., Martin Ginis, K. A., Fenuta, A. M., MacKibbon, K. A., & Motl, R. W. (2013). 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. Archives of Physical Medicine and Rehabilitation, 94(9), 1800-1828. https://doi.org/10.1016/j.apmr.2013.04.020

Table of Contents