Recovery Insights Blog | Foundational Rehab

Exercise and Multiple Sclerosis

For decades, people with MS were told to avoid exercise. We now know the opposite is true:

Exercise benefits for MS:

Improves strength and endurance

Enhances balance and walking ability

Reduces fatigue (paradoxically)

Improves mood and cognitive function

May slow disease progression

Maintains independence longer

Exercise is safe and beneficial for most people with MS.

Understanding MS and Exercise

The Challenge

MS causes:

Fatigue (often the most limiting symptom)

Heat sensitivity (symptoms worsen when hot)

Weakness and spasticity

Balance problems

Variable symptoms day-to-day

The Solution

Exercise timing and intensity management

Cooling strategies

Individualized programming

Flexibility in approach

Types of Beneficial Exercise

Aerobic Exercise

Benefits:

Improves cardiovascular fitness

Reduces fatigue over time

Enhances mood and cognition

Good Options:

Walking (with or without assistive device)

Stationary cycling (recumbent if balance is concern)

Swimming or water exercise (cool water preferred)

Arm ergometer (if legs are more affected)

Guidelines:

Start with 10-15 minutes

Build to 30 minutes, 3-5x per week

Moderate intensity (can talk but not sing)

Cool environment or cooling strategies

Strength Training

Benefits:

Maintains muscle mass

Improves functional ability

Helps with walking and transfers

Key Exercises:

Seated Leg Press (or Sit-to-Stand)

Functional leg strength

Use support as needed

2-3 x 8-12 reps

Seated Row or Resistance Band Rows

Upper back strength

Important for posture

2-3 x 10-12 reps

Wall Push-Ups

Upper body strength

Adjust angle for difficulty

2-3 x 8-12 reps

Hip Abduction

Side-lying or standing with support

Important for walking stability

2-3 x 10-12 each side

Balance Training

Critical for fall prevention in MS.

Exercises:

Standing Weight Shifts

Hold support

Shift weight side to side, forward/back

Progress to less support

Single-Leg Stance

Hold support initially

Goal: 30 seconds each leg

Progress to no support, then eyes closed

Tandem Stance

Heel to toe

Hold 30 seconds

Progress to tandem walking

Sit-to-Stand Practice

Use support as needed

Focus on control

Build to no hands

Flexibility and Stretching

Helps manage spasticity and maintain range of motion.

Focus Areas:

Hip flexors (often tight from sitting)

Hamstrings

Calves (especially if spasticity present)

Chest and shoulders

Guidelines:

Hold stretches 30-60 seconds

Gentle, no bouncing

Breathe and relax into stretch

Daily if spasticity is significant

Managing Heat Sensitivity

About 60-80% of people with MS have heat sensitivity. Strategies:

Cooling:

Exercise in air conditioning

Use cooling vests

Cool water swimming

Cool towels on neck/wrists

Pre-cooling before exercise

Timing:

Exercise in morning (cooler)

Avoid hottest parts of day

Stop if symptoms worsen

Environment:

Fan or AC

Cool room temperature

Avoid hot showers immediately after

Managing Fatigue

MS fatigue is different from normal tiredness. Strategies:

Energy Conservation:

Exercise when energy is best (often morning)

Rest before you're exhausted

Break exercise into shorter sessions

Pacing:

Don't push to exhaustion

Moderate intensity

Allow recovery between sessions

Paradox:

Regular exercise actually reduces overall fatigue

Short-term tiredness leads to long-term energy

Sample Weekly Program

Beginner (Just Starting)

Week Structure:

3 days exercise, 4 days rest/light activity

Each Session (20-30 min):

Warm-up: 5 min easy movement

Aerobic: 10-15 min walking or cycling

Strength: 2-3 exercises, 1-2 sets

Balance: 5 min

Stretching: 5 min

Intermediate (Building Fitness)

Week Structure:

4-5 days exercise

Sample Week:

Mon: Aerobic 20-30 min + stretching

Tue: Strength training 20-30 min

Wed: Rest or gentle stretching

Thu: Aerobic 20-30 min + balance

Fri: Strength training 20-30 min

Sat: Light activity (walking, swimming)

Sun: Rest

Exercise Modifications

If Balance Is Limited

Use seated exercises

Hold support during standing

Consider recumbent bike vs. upright

Water exercise (buoyancy helps)

If Fatigue Is Severe

Shorter sessions (10-15 min)

Multiple sessions per day

Lower intensity

Rest when needed

If Spasticity Is Present

Gentle stretching before and after

Avoid positions that trigger spasms

Aquatic exercise often helpful

Stretching throughout day

When to Stop or Modify

Stop exercise if:

Significant symptom worsening

Unusual weakness

Dizziness or confusion

Chest pain or shortness of breath

Modify program if:

Relapse (reduce or pause)

Hot weather (cool strategies or skip)

Increased fatigue over days (reduce)

The Bottom Line

Exercise for MS:

1. Essential — Benefits outweigh risks

2. Start slow — Build gradually

3. Manage heat — Cooling strategies

4. Expect fatigue — But it improves over time

5. Be flexible — Adapt to daily symptoms

Foundational Rehab offers MS-specific exercise programming and guidance.

Exercises for Multiple Sclerosis: Stay Active and Manage Symptoms