What kind of exercise is safe with multiple sclerosis?

Is exercise safe with multiple sclerosis?

For many years people with MS were advised to avoid exertion. That advice has changed. Studies of exercise programmes in MS have not found an increased risk of relapse, and serious adverse events are uncommon. International recommendations encourage people with MS to be physically active at every stage of the condition, with the type of activity adapted to their abilities 1.

UK guidance on MS management recommends that people are encouraged to exercise regularly and offered supervised exercise programmes involving aerobic and resistance training where needed, particularly for fatigue and mobility problems 2.

What are the benefits of exercise in MS?

Regular exercise improves aerobic fitness, muscle strength and walking ability, and it can reduce fatigue, which is one of the most disabling symptoms of MS. Many people also notice improvements in mood, sleep, bladder and bowel function and overall quality of life.

Staying active also protects against the secondary effects of inactivity, such as weight gain, loss of bone density, heart disease and muscle weakness that is not caused directly by MS. These can add to disability over time if not addressed.

How much exercise is recommended?

The recommendations aim for a gradual build-up towards at least 150 minutes a week of exercise and/or at least 150 minutes a week of general physical activity, such as walking or gardening, based on the person's abilities, preferences and safety 1. For people starting from a low level, even 10 minutes of activity a few times a week is a useful beginning 1.

A balanced programme usually includes aerobic exercise such as walking, cycling or swimming two to three times a week, resistance exercises for major muscle groups two to three times a week, and balance and stretching exercises 1. The intensity should feel moderate, where talking is possible but slightly harder.

How can heat sensitivity be managed?

Many people with MS find that their symptoms temporarily worsen when their body temperature rises, whether from exercise, hot weather or a hot bath. Vision may blur, legs may feel weaker or fatigue may increase. This is known as Uhthoff's phenomenon and is caused by heat slowing conduction in damaged nerve fibres; it is not a relapse and settles as the body cools 3.

Practical measures include exercising in a cool environment, using a fan, drinking cold water, wearing cooling vests or neck wraps, exercising in the morning, splitting activity into shorter bouts, and choosing a cool pool rather than a very warm one. Cooling before exercise can help people who are very heat sensitive 3.

Which activities suit people with MS?

Walking is the most accessible option, and short walks spread through the day are often easier than one long outing. Cycling on a stationary bike is useful when balance is uncertain, because the risk of falling is low. Swimming and water exercise let people move with less effort, as the water supports body weight, and a cool pool helps with heat sensitivity.

Strength training with resistance bands, weights or machines targets the leg and trunk muscles that support walking and standing. Pilates, tai chi and balance classes train posture and coordination. Many people combine two or three activities they enjoy, which makes it easier to keep going over months and years.

How does exercise help balance and falls?

Balance problems in MS come from weakness, altered sensation in the feet, problems with coordination and fatigue. Falls are common, and fear of falling can lead people to move less, which then weakens muscles further. Balance training that challenges standing, stepping and turning in a safe setting reduces this cycle.

A physiotherapist can assess balance, suggest exercises that are challenging but safe, and recommend walking aids or orthoses where needed. Practising getting up from the floor and planning activities for times of day when fatigue is lower also make daily life safer.

What if mobility is limited?

Exercise can be adapted for any level of mobility. Seated exercises, recumbent cycling, arm ergometers, pool-based exercise and assisted standing all provide benefits. For people who use a wheelchair, upper body strength, trunk control and cardiovascular fitness remain important goals.

When mobility is very limited, exercise may need to be supported by a physiotherapist or trained assistant. The recommendations emphasise referral to specialists to ensure safe and appropriate exercise when disability increases 1.

What should you do during a relapse?

During a relapse, the priority is medical assessment and recovery. Gentle movement to maintain range of movement and prevent stiffness is usually fine, but a structured exercise programme may need to pause or be reduced until symptoms settle.

After a relapse, exercise can usually be restarted at a lower level and built up again. A physiotherapist can help rebuild strength and balance and adjust the programme to any new symptoms.

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