Multiple Sclerosis (MS) is a chronic condition that affects the central nervous system, disrupting communication between the brain and body. It can lead to a range of symptoms, including fatigue, muscle weakness, balance issues, spasticity, and cognitive changes. While MS has no known cure, research consistently shows that regular, tailored exercise can significantly improve quality of life for people living with MS.

People with MS often hesitate to engage in physical activity due to fatigue or fear of worsening symptoms. However, clinical guidelines now strongly recommend exercise as part of a comprehensive MS management plan. Far from being harmful, the right type of exercise can help counteract the physical and psychological effects of the disease.

1. Improve Brain Physiology

Exercise helps the brain by supporting new brain cell growth, protecting nerves, repairing damaged nerve coverings, and improving how brain areas connect and work together

2. Improved Strength and Mobility

MS can lead to muscle weakness and stiffness. Strength training and mobility exercises help maintain or improve muscle function, allowing individuals to perform daily activities with more ease and confidence.

3. Reduced Fatigue

Fatigue is one of the most common and disabling symptoms of MS. Paradoxically, regular moderate-intensity exercise has been shown to reduce fatigue levels over time, likely by improving cardiovascular fitness, muscle efficiency, and sleep quality.

4. Better Balance and Coordination

MS can affect balance, increasing the risk of falls. Balance and core stability exercises—such as those used in physiotherapy, yoga, or Pilates—can improve body awareness and reduce fall risk.

5. Enhanced Mood and Mental Health

Living with a chronic condition like MS can contribute to depression and anxiety. Exercise triggers the release of endorphins, the body’s natural mood lifters, and promotes better sleep, both of which are vital for mental wellbeing.

5. Increased Flexibility and Reduced Spasticity

Gentle stretching routines and activities like hydrotherapy can help reduce muscle stiffness and spasticity, common issues in MS that impact comfort and mobility.

6. Improved Cognitive Function

There is growing evidence that exercise can benefit cognitive processes such as memory, attention, and problem-solving—areas often affected by MS.

MS typically progresses through different stages or forms. Here are general exercise guidelines tailored to each stage, focusing on safety, symptom management, and quality of life.

1. Relapsing-Remitting MS (RRMS)

This is the most common form of MS, characterised by flare-ups (relapses) followed by periods of recovery (remission).

Goals:

• Improve fitness
• Build strength and endurance
• Manage fatigue and mood
• Prevent deconditioning

Recommended Activities:

Aerobic Exercise: 20–30 minutes, 3–5 times per week (e.g., brisk walking, cycling, swimming)

Strength Training: 2–3 times per week, focusing on major muscle groups with light to moderate resistance

Balance and Coordination: Tai Chi, yoga, Pilates, or physiotherapy-based exercises

Stretching: Daily gentle stretching for spasticity and joint health

Tip: Schedule exercise during times of day when energy levels are highest. Listen to your body and allow for rest after flare-ups.

2. Secondary Progressive MS (SPMS)

This stage often follows RRMS and is marked by a gradual worsening of symptoms and reduced recovery from relapses.

Goals:

• Maintain mobility and strength
• Preserve independence with daily activities
• Reduce stiffness and manage fatigue

Recommended Activities:

Modified Strength Training: Focus on functional movements (e.g., sit-to-stand, step-ups)

Low-Impact Aerobic: Stationary cycling, aquatic therapy, or seated cardio

Balance & Core Stability: Use of physiotherapy tools (e.g., balance pads, resistance bands)

Stretching and Mobility: Daily routines to prevent contractures and reduce tone

Tip: Fatigue and heat sensitivity may increase. Exercise in cool environments and allow longer rest periods.

3. Primary Progressive MS (PPMS)

This stage involves gradual worsening symptoms from the start, without relapses. Mobility is more likely to become limited earlier.

Goals:

• Prevent further physical decline
• Maximise independence
• Support respiratory health and circulation
• Prevent pressure injuries and contractures if mobility is severely reduced

Recommended Activities:

Seated or Supported Exercises: Chair-based strength and aerobic routines

Hydrotherapy: Great for reduced weight-bearing and reducing stiffness

Stretching & Passive Range of Motion: May be performed with assistance to maintain joint health

Breathing Exercises: Help maintain respiratory function, especially if mobility is reduced

Tip: Work closely with a physiotherapist or exercise physiologist to adapt activities based on current mobility and support needs.

• Progress slowly and prioritise consistency over intensity
• Avoid overheating: MS symptoms often worsen temporarily with heat (called Uhthoff’s phenomenon)
• Stay hydrated
• Pace yourself: Use activity diaries or fatigue scales to avoid overexertion
• Use assistive devices if needed: Walkers, rails, or resistance supports can make exercise safer
• Rest when needed – fatigue is a common and valid part of the process

At Everybody Physiotherapy, we help people with MS stay as active and independent as possible at any stage of their journey. Whether you’re newly diagnosed or adapting to advanced symptoms, we tailor exercise plans to your unique abilities, goals, and progression.