Exercise can be safe and effective for people with MS!

While rehab professionals and researchers used to think rigorous exercise could worsen symptoms and even cause relapses, we are learning more now that high intensity exercise can be performed safely and effectively by many people with multiple sclerosis (hereafter MS)!

The American College of Sports Medicine guidelines & MS

The ACSM recommends 150 minutes of exercise at moderate intensity, or 75 minutes at high intensity, each week. Additionally, they also recommend strength training twice per week. These guidelines recommend those with neurological conditions, including MS, still attempt to meet this goal within their abilities & resources.

Temperature Management

Common triggers that exacerbate symptoms include warmer temperatures. When swimming, call ahead and ask about the pool temperature; ideally, it should be less than 85 degrees, but tolerances and preferences vary from person to person! Other strategies can include exercising indoors with air conditioning on very hot days, staying sufficiently hydrated, and taking frequent rest breaks, all of which can reduce overall increases in body temperature.

Managing fatigue

One of the most common symptoms people with MS experience is fatigue, and per the literature, a symptom quoted as being the most debilitating. Fatigue can be caused by MS itself, but it can also be caused by deconditioning; unfortunately, pausing exercise due to fatigue may make returning to that activity even more difficult, worsening fatigue! Exercise itself, especially endurance training, can help individuals feel an improvement in their fatigue overtime. But how can we be proactive managing fatigue with physical activity?

The secret sauce: intervals!

Managing fatigue during exercise, and preventing pseudoexacerbations, lies in the exercise dosage. Specifically, interval training has been shown to be effective at improving gait speed & endurance for people with MS! Further, intervals incorporating rigorous exercise have been shown to be more efficient at improving cardiovascular health than steady-state moderate intensity exercise.

For interval training, the individual performs a bout of moderate or high intensity activity, followed by a period of rest consisting of low or no intensity exercise. For example, performing 1:2 interval exercise means performing a bout of exercise, followed by a rest period that is twice as long; this might look like 30 seconds of walking uphill, followed by 1 minute of slow walking or sitting, repeated multiple times. Each activity and rest bout is a cycle.

On the right is a sample progression of interval training. Week 1 might look like intervals of 1 minute activity, 5 minutes rest, repeated 5 times, with a moderate goal intensity during the exercise bout. Your intervals can increase in duration; e.g, week 4 interval of 1:2 might incorporate 2 minutes of activity, with 4 minutes of rest!

Want to get started? Give us a call!


As a strength coach, physical therapist, and neurological clinical specialist, owner & founder of Headstrong, Dr. Jess, is well-equipped to get you started on your journey to strength. We will work together to construct a safe, effective strength routine to keep you healthy now & beyond, regardless of your exercise and medical history.

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