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Exercise and MS: Moving Your Body Safely

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Regular exercise offers powerful 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. As we head into the New Year, there's no better time to explore what…

Why Exercise Matters

If you’re living with MS, you’ve likely wondered whether exercise is safe for you—or whether it might make your symptoms worse. The good news is that research consistently shows that exercise training yields substantial improvements in fitness, mobility, fatigue, depression, and quality of life for people with MS, and it does so safely.

Perhaps you’re thinking about getting more active as we approach the New Year, or maybe you’d simply like to understand what exercise could do for you. You don’t need to become an athlete or push yourself to exhaustion. The goal is to find sustainable ways to move your body that fit your abilities, your energy levels, and your daily life.

Key Takeaways

  • Exercise is safe and beneficial for most people with MS, with research showing improvements in strength, balance, fatigue, and mood
  • Starting gently and building up gradually is more important than intensity—any movement is better than none
  • Pacing strategies help you manage fatigue and avoid the "boom-bust" cycle
  • Simple cooling strategies like drinking cold water can help you exercise comfortably in Australian heat
  • Working with a physiotherapist or exercise physiologist can help you develop a program that suits your needs

  • The Evidence-Based Benefits

    Exercise has moved from being viewed with caution to being recognised as an essential part of MS management. The safety profile of exercise in MS is well-established, with studies showing that the rate of adverse events is only 2.0% for exercise training compared to 1.2% for control groups—no different from the general adult population.

    The benefits are substantial. A 2024 systematic review found that exercise significantly improves balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Exercise can improve the overall neurological function of the brain and minimise neuronal damage in MS, and it also helps stimulate neuroplasticity.

    For regional Australians, this matters even more. With fewer MS specialist services available and hot summers that can trigger heat sensitivity, knowing how to exercise safely at home or in your community is a valuable tool.

    What Types of Exercise Work Best?

    Aerobic Exercise

    Exercise guidelines for MS recommend 2 to 3 days per week of aerobic training, 10-30 minutes per session at moderate intensity.

    Practical examples for regional Australians:

    • Walking around your neighbourhood or local park (early morning or late afternoon to avoid heat)
    • Swimming or water aerobics at your local pool
    • Cycling on flat paths or using a stationary bike at home
    • Arm cycling or seated exercises if lower body mobility is limited

    Start with just 10 minutes if that’s what feels manageable, and gradually build up. Moderate intensity means you should be able to talk in short sentences but not hold a full conversation comfortably.

    Resistance Training

    Guidelines recommend 2 to 3 days per week of resistance training, with 1-3 sets of 8-15 repetitions each. You can do this with hand weights, resistance bands at home, bodyweight exercises like chair stands, or equipment at a local gym if you have access.

    Balance and Flexibility

    Resistance and aerobic training exercises should be supplemented by balance exercise to prevent falls. Balance exercises should be practised in a safe environment, ideally when supervised by an accredited health professional such as a physiotherapist.

    Balance work might include tai chi, gentle yoga, standing on one foot while holding a chair, or walking heel-to-toe in a straight line.

    Pacing: The Key to Sustainable Exercise

    One of the most important concepts for exercising with MS is pacing—spreading your activity throughout the day and week to avoid exhausting yourself.

    Activity pacing is a strategy to divide daily activities into smaller, more manageable portions, in a way that should not exacerbate symptoms, which then allows gradual progressive increases in activity. Think of it as managing your energy like a budget—spending it wisely rather than splurging it all at once.

    Activity pacing is a self-management strategy that can help alter inefficient activity patterns (underactivity and overactivity) and stimulate long-term engagement in an active lifestyle. Many people with MS fall into an “all-or-nothing” pattern—overdoing activity on good days, then needing several days to recover. Pacing helps you avoid this boom-bust cycle.

    Practical Pacing Strategies

    1. Start Below Your Limit: Begin with an amount of activity you know you can handle comfortably, even on a harder day.
    2. Be Consistent: Try to do similar amounts of activity each day rather than big variations.
    3. Plan Your Activity: Schedule your exercise for times when you typically have more energy.
    4. Take Regular Breaks: Don’t wait until you’re exhausted. Break longer activities into smaller chunks.
    5. Progress Gradually: Overall progression should start with increases in either duration or frequency. Progressions in intensity should only come after duration and frequency are well tolerated.

    Managing Heat Sensitivity

    If you experience heat sensitivity, you can still exercise safely with the right strategies. Many people with MS experience heat sensitivity, which can temporarily flare up other symptoms. For some people, even a small 0.2 to 0.5°C increase in body temperature can lead to a worsening of MS symptoms.

    The good news: Research from the University of Sydney found that drinking 250ml of cold (1.5°C) water every 15 minutes increased the capacity of people with MS to continue exercising in a warm (30°C) environment by about 30%. Remarkably, this worked despite no change in core body temperature—researchers think that stimulating cold-sensitive receptors in the mouth and throat may blunt the development of MS-related fatigue.

    Other Practical Cooling Methods

    • Exercise in a cool or shady environment and take breaks often
    • Wear lightweight, loose clothing in the hotter months
    • Have a cold shower before activity
    • Use misting spray or cooling gel
    • Exercise early morning or late evening when temperatures are cooler
    • Keep an icy drink nearby during exercise

    Getting Started Safely

    Exercise training programmes should be prescribed and delivered by qualified exercise professionals. If possible, work with a physiotherapist or exercise physiologist who understands MS. Your physiotherapist or exercise trainer may live far from you, but you can still access them using telephone, email, and telehealth options.

    Many regional areas now have better access to telehealth services, which can connect you with specialists who can help design an exercise programme for you. Online videos and resources are engaging and will offer education on exercises for people with MS. Mobile apps are useful for monitoring physical activity and tracking your progress.

    A Note on New Year and Exercise Goals

    As we head into the New Year, you might be feeling that familiar pull to set ambitious fitness goals. Here’s the thing about exercise and MS: consistency beats intensity every time. Rather than promising yourself you’ll exercise every day, consider setting smaller, achievable goals that you can sustain.

    Perhaps it’s three 10-minute walks per week. Maybe it’s joining a local gentle yoga class or doing some chair exercises while watching your favourite show. These seemingly modest goals are actually the ones that lead to lasting change and real benefits.

    The New Year isn’t about transforming yourself—it’s about finding sustainable ways to support your body as you navigate life with MS. Start gently, be patient with yourself, and remember that any movement is better than none.

    Frequently Asked Questions

    No. In general, exercise doesn’t trigger an MS relapse or adversely affect the disease process. Some symptoms may temporarily worsen during or immediately after exercise (especially in the heat), but this is not a relapse and symptoms return to baseline once you’ve rested and cooled down.

    Inactivity actually invites symptoms 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. The key is starting very gently and building up slowly. Even 5-10 minutes of gentle movement can be beneficial.

    Yes, with the right strategies. Drink cold water regularly during exercise, exercise in the coolest part of the day, stay in the shade or air-conditioned spaces, wear light clothing, and take regular breaks. Remember that heat-related symptom worsening is temporary and doesn’t cause permanent damage.

    Final Thoughts

    Exercise offers genuine, research-backed benefits for people living with MS. It can improve your strength, balance, mobility, mood, and fatigue—but only if you approach it in a way that’s sustainable for you.

    The three most important principles to remember are: start gently, pace yourself, and stay cool (especially during Australian summers). Work with health professionals when you can, use telehealth if needed, and don’t be afraid to ask for help.

    As we approach the New Year, exercise doesn’t have to mean dramatic transformation or exhausting workouts—it simply means finding ways to move your body regularly that feel manageable and sustainable for you. Whether it’s a short walk around the block, some gentle stretching in your lounge room, or a swim at the local pool, every bit of movement matters.

    If you’re not currently active, talk to your MS nurse, GP, or a physiotherapist about how to get started safely. The evidence is clear: exercise is one of the most powerful tools you have for living well with MS. The trick is finding your own sustainable path to moving your body 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. Motl, R. W. (2023). Multiple sclerosis minute: Physical activity & MS. Practical Neurology. https://practicalneurology.com
    8. MS Australia. (2021). Exercise and MS. https://www.msaustralia.org.au/news/exercise-and-ms/
    9. MS Australia. (2020). Exercise and multiple sclerosis: Information for people living with MS. https://www.msaustralia.org.au/publication/exercise-and-ms/
    10. 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
    11. 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
    12. MS Australia. (2021). Heat sensitivity. https://www.msaustralia.org.au/symptom/heat-sensitivity/
    13. MS Australia. (2023). Heat sensitivity in MS. https://www.msaustralia.org.au/news/heat-sensitivity-ms/
    14. 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

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