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 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!