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Exercise2026-03-076 min read

Multiple Sclerosis Exercises: Stay Active and Manage Symptoms

Exercise and Multiple Sclerosis

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

  • Exercise is safe and doesn't trigger relapses
  • It improves strength, balance, and mobility
  • It reduces fatigue (counterintuitive but true)
  • It may have neuroprotective effects
  • It improves mood and quality of life
  • The key is exercising appropriately for your symptoms and energy levels.

    Common MS Challenges

    Understanding these helps target your program:

  • **Fatigue:** The most common symptom
  • **Weakness:** Especially in legs
  • **Balance problems:** Due to sensory and motor changes
  • **Spasticity:** Muscle stiffness and spasms
  • **Heat sensitivity:** Symptoms worsen when body temperature rises
  • **Coordination issues:** Affecting movement quality
  • Managing Heat Sensitivity

    Many people with MS have heat sensitivity (Uhthoff's phenomenon):

    Cooling Strategies:

  • Exercise in air conditioning
  • Use cooling vests
  • Exercise in water
  • Morning exercise (cooler body temperature)
  • Pre-cooling with cold drinks
  • Avoid hot showers immediately before
  • Know the difference: Heat temporarily worsens symptoms but doesn't cause damage. Symptoms improve when you cool down.

    Fatigue Management

    MS fatigue is different from normal tiredness:

    Exercise Timing:

  • Exercise when energy is highest (often morning)
  • Avoid exercise during typical low-energy times
  • Don't exercise when already exhausted
  • Pacing:

  • Shorter sessions may work better than long ones
  • Rest between exercises
  • Interval training approaches
  • Listen to your body
  • Paradox: Regular exercise actually reduces overall fatigue, even though individual sessions may tire you.

    Strengthening Exercises

    Lower Body (Priority for Mobility)

    Seated Leg Extensions

    1. Sit in sturdy chair

    2. Straighten one leg

    3. Hold 3 seconds

    4. Lower slowly

    5. 10-15 each leg

    Bridges

    1. Lie on back, knees bent

    2. Lift hips toward ceiling

    3. Hold 5 seconds

    4. Lower slowly

    5. 10-15 repetitions

    Standing Hip Exercises (hold support)

    1. Leg lifts to side (abduction)

    2. Leg lifts backward (extension)

    3. 10-15 each direction

    Squats (modified as needed)

    1. Use chair for support or sit-to-stand

    2. Lower to comfortable depth

    3. 10-15 repetitions

    Upper Body

    Seated Rows (resistance band)

    1. Sit tall, band around feet

    2. Pull elbows back

    3. Squeeze shoulder blades

    4. 10-15 repetitions

    Wall Push-Ups

    1. Stand facing wall

    2. Hands shoulder-width

    3. Lean in, push back

    4. 10-15 repetitions

    Arm Raises

    1. Sit or stand

    2. Raise arms to shoulder height

    3. Lower slowly

    4. 10-15 repetitions

    Balance Training

    Balance problems are common. Train daily:

    Seated Balance

    Weight Shifts

    1. Sit on edge of chair (no back support)

    2. Shift weight side to side

    3. Maintain control

    4. 10 each direction

    Reaching

    1. Sit without back support

    2. Reach in various directions

    3. Maintain sitting balance

    4. 10 reaches

    Standing Balance (Use Support as Needed)

    Narrow Stance

    1. Stand with feet close together

    2. Hold 30 seconds

    3. Progress: reduce support

    Tandem Stance

    1. Stand heel-to-toe

    2. Hold 30 seconds

    3. Switch feet

    Single Leg Stance

    1. Lift one foot

    2. Hold 10-30 seconds

    3. Progress as able

    Dynamic Balance

    Weight Shifts

    1. Stand with support available

    2. Shift weight side to side

    3. Shift forward and back

    4. 10 each direction

    Stepping

    1. Step in place

    2. Step forward/back

    3. Step side to side

    4. 10 each direction

    Stretching for Spasticity

    Stretching helps manage stiffness:

    Hamstring Stretch

    1. Lie on back

    2. Lift one leg, use strap if needed

    3. Hold 30-60 seconds

    4. Repeat each leg

    Calf Stretch

    1. Stand facing wall

    2. Step back with one leg

    3. Keep heel down

    4. Hold 30-60 seconds each

    Hip Flexor Stretch

    1. Kneeling lunge or standing

    2. Push hips forward

    3. Hold 30-60 seconds each

    Adductor Stretch

    1. Sit with soles of feet together

    2. Gently press knees down

    3. Hold 30-60 seconds

    Aerobic Exercise

    Cardiovascular fitness matters:

    Best Options

    Aquatic Exercise

  • Water cools the body
  • Buoyancy supports movement
  • Excellent for MS
  • Pool temperature 80-84°F ideal
  • Stationary Cycling

  • Seated (less balance demand)
  • Can use fan for cooling
  • Adjustable intensity
  • Recumbent if needed
  • Walking

  • Use assistive device if needed
  • Indoor for temperature control
  • Treadmill with harness if balance poor
  • Guidelines

  • Start with 10-15 minutes
  • Progress to 30 minutes, 3-5 days/week
  • Moderate intensity (can talk)
  • Stop if symptoms worsen significantly
  • Cool down and rest after
  • Yoga and Tai Chi

    Both offer benefits for MS:

    Benefits:

  • Improves balance
  • Reduces spasticity
  • Manages stress
  • Adaptable to abilities
  • Modifications:

  • Chair yoga for balance issues
  • Seated tai chi
  • Props for support
  • Shorter sessions
  • Sample Weekly Program

    Daily (10-15 minutes):

  • Stretching routine
  • Balance exercises
  • 3x/Week:

  • Strengthening exercises (20-30 minutes)
  • Alternate upper/lower body or full body
  • 3-5x/Week:

  • Aerobic exercise (15-30 minutes)
  • Aquatic, cycling, or walking
  • During Relapses

    If you're having a relapse:

  • Reduce or stop intense exercise
  • Gentle stretching may continue
  • Rest is appropriate
  • Resume gradually as you recover
  • Consult your neurologist
  • Working with Professionals

    Consider:

  • Physical therapist experienced with MS
  • Exercise physiologist
  • MS-specific exercise programs
  • Aquatic therapy
  • The Bottom Line

    Exercise is one of the best things you can do for MS:

    1. Start where you are

    2. Manage heat and fatigue

    3. Build strength, especially legs

    4. Train balance daily

    5. Stretch for spasticity

    6. Stay aerobically active

    Your body can adapt and improve, regardless of your current level.


    Foundational Rehab provides adaptable programs suitable for neurological conditions including MS.

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