Multiple Sclerosis and Exercise– How Much Exercise is Safe?

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (i.e. the central nervous system). MS is a condition that causes the immune system to attack its protective sheath (called myelin) that surrounds every nerve. This protective sheath is very important when it comes to the health and efficiency of your nervous system as it is the communication between your brain and the rest of your body. MS can be a stable or progressive disease and can lead to permanent damage or deterioration of nerves.

Similar to my other blog posts, I like to emphasize that every neurologic condition is different for each individual. This is even more true for a condition such as MS! Multiple Sclerosis can present more as a brain injury, spinal cord injury, or a mixture of both depending on which part of nervous system is affected. Here are some common deficits that people with MS experience: numbness, weakness, changes in sensation, change in coordination or balance, vision problems, pain, dizziness, heat intolerance, and fatigue.

Fatigue is the most common symptom of MS, impacting 75-95% of patients. There is “neurologic fatigue” as well as “secondary fatigue”. Secondary fatigue is due to deconditioning and an overall a decrease in activity. Regular exercise is one of the main treatments to either improve and/or prevent this secondary fatigue. Heat intolerance is another very common symptom of MS. Exercise naturally increases your body temperature, however, with people with MS this can cause an increase in symptoms temporarily and leaves some people “scared” to exercise.

According to current research and clinical practice, exercise does not cause MS episodes or exacerbations. However, many report an increase in symptoms approximately 30 minutes after exercise. This change in symptoms is not permanent and is not causing any damage. The tough part is there are no recommendations for exercise for the MS population based on research. So, the following recommendations are just that – what I recommend based on my experience and knowledge of the diagnosis.

Benefits of Exercise With MS

One of the most important benefits of exercise is to reduce and prevent secondary deficits and fatigue! Sometimes these secondary deficits can be equally as debilitating and add to your MS symptoms. These are some of the benefits of regular, daily exercise for the MS population:

1) Improve cardiovascular fitness – prevent deconditioning and heart disease
2) Improve bowel and bladder function
3) Reduce secondary fatigue, as it adds to fatigue from MS
4) Prevention of bone density loss (osteopenia and osteoporosis)
5) Mood enhancement and decrease depression
6) Pain management – exercise releases endorphins in your body that reduces pain
7) Increase participation in social activities
8) Improvement in cognitive function
9) Weight management to maintain an ideal body weight for moving around

Exercise Recommendations

The following recommendations come from the American Heart Association. Again I want to emphasize that these are just recommendations, therefore, I often have many patients exercise more or less than these recommendations. It is strongly encouraged to consult your doctor and physical therapist before starting a regular exercise routine.

table of exercise recommendations for ms

In my practice of physical therapy, I often use the term “Rate of Perceived Exertion” or RPE to monitor the intensity of exercise. Therefore, you should feel like you are working “light to somewhat hard” when you complete any aerobic exercise. Exercising harder is not necessarily better for you! Later in this blog, we will go over more about what can be considered aerobic exercise as it is not just standard exercise.

borg's RPE scale

Types of Exercise

Give yourself credit for activities you do everyday that can be considered exercise! As well as remember, some may be able to perform lower or higher levels of intensity depending on their function and individual symptoms. Before you start or change your routine, I would challenge you to do the following:

  1. Have a mixture and variety of exercise. If you are able, try to mix up your routine to include at least two of the categories. That way you are continuing to challenge your body and you will see better results.
  2. Use the list below to help manage fatigue. You may want to prioritize, delegate, or pace/spread out certain activities that may be moderate-vigorous for you.

BLUE EXERCISES – light exercise (RPE 6-9)

  • Light household chores like dusting, making the bed, emptying the trash, etc.
  • Cooking simple meal in standing or complex meal in sitting
  • Relaxing Yoga
  • Tai Chi

GREEN EXERCISES – moderate exercise (RPE 10-13)

  • Gardening
  • Heavy household chores, like laundry, vacuuming, deep cleaning, putting away groceries, etc.
  • Strength training with light to moderate weights (<15#)
  • Aquatic Exercise
  • Walking Program – continuous >10min or faster speeds
  • Stairs when complete more than x1 flight
  • Pilates

YELLOW EXERCISES – vigorous exercise (RPE 14-17)

  • Biking with light to moderate resistance
  • Errands like grocery shopping
  • Yard work like raking leaves, push lawn mower, etc.
  • Dancing
  • Swimming
  • Jogging/Running 

Specific MS Considerations For Exercise

Here is some common evidence I provide my patients with MS to help improve tolerance to exercise as well as considerations for safety.

  • Stay hydrated!
  • Best to do exercises in AM when your body temperature is lowest and the environment around you is cooler
  • Wear light exercise clothes, recommend fabrics that wick moisture or are a lightweight material (not cotton clothes)
  • Don’t follow the “no pain-no gain” rule. You can over exercise as there is a neurologic fatigue factor which is not something to push through
  • Interval training (with rest breaks in between) is often more tolerable than continuous exercise
  • Perform both a warm-up and cool-down – approx. x5 minutes each at low effort
  • Cooling garments or fans for those who are heat sensitive with exercising (The National MS Society can help provide garments so visit the following website for more details

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