In the past, people with multiple sclerosis were advised to avoid exertion. It was felt that as many people with MS experienced fatigue and found their symptoms worsened when hot, it was best to avoid activities that could be seen as tiring.
Regular, moderate exercise is now recognised as an important element in maintaining general health and wellbeing for people with MS.
A research study in 1996 showed specific benefits of exercise for people with MS. The trial compared a group of people with mild to moderate MS who followed an exercise programme for 15 weeks with a similar group who didn't exercise. None of the people in either group had been exercising before the trial.
At the end of the trial, people from the exercise group were showing reduced fatigue levels and improvements in strength, mobility and bowel and bladder function. They also reported improved mood and showed a reduction in stored fat and markers associated with the risk of cardiovascular disease. Similar effects have been seen in a number of subsequent studies into exercise and MS.
There is no right or wrong exercise. However, the nature of MS may mean that you have to be more aware of what you can achieve than someone who doesn't have MS. If you have concerns about undertaking certain activities, talk to a relevant health professional (eg a neurologist, GP, MS specialist nurse, physiotherapist, occupational therapist) beforehand.
You have to learn to listen to your own body and be honest with what it is telling you. As recovery time can be longer for someone with MS, be prepared to stop before your body tells you have reached your limit.
Exercise to combat fatigue
Fatigue - the overwhelming feeling of exhaustion unrelated to physical activity - is a very common symptom of MS.
Exercise can help combat fatigue. Muscles that are not used regularly become weakened and require more energy to carry out tasks. This can lead to a cycle of decline, as an already weak muscle that is not used will become weakened further, a process known as atrophy. Regardless of whether you have MS or not, a lack of activity will make any activity more tiring.
For many years people with MS were advised to avoid exercise due to the impact it could have on weakness and fatigue. It is now felt that exercise is beneficial if it works on building up endurance and strength in muscles without increasing fatigue and that it is important to try to remain as fit and active as possible.
It is important to acknowledge, both when exercising and in daily life, that it is not a good idea to 'work through' fatigue - you may end up feeling worse, often for days afterwards.
Temperature can also affect fatigue. Everyone can feel drained of energy in hot or humid weather, but with MS the effect is often exaggerated. If heat is a problem, try using a fan or a cold water spray when exercising or having a cool bath before you start.
- See also the MS Trust book Living with fatigue
What sort of exercise?
There is no right or wrong exercise, but there are some simple guidelines to help you decide what suits you best. If you try an activity and it does not make your symptoms worse, then it is most likely to be fine for you. Some people have a misguided belief that if you push hard enough and it hurts then it must be doing some good. If you spend more time recovering from an activity than doing it, you may not have the balance quite right!
The attitude of 'no pain, no gain' does not apply in MS. Whilst someone without MS can push themselves to exhaustion and then recover within half an hour, a person with MS should be prepared to stop before their body is telling them they have reached their limit.
It is important to find exercise that you enjoy doing because then you will keep it going. Everyone is individual and some people like to exercise in a group setting - in a class or as part of a team. Others like to work individually whether that is at the gym, swimming pool or at home. Find what is right for you.
When you start your programme, pick out a couple of exercises that you know you will be able to do and build up gradually. At first you could pick maybe two exercises and do them every day at least once - perhaps in the morning and in the afternoon.
Then pick a day in the week and a good time in the day. Select a few more different exercises and go through a longer programme. There's no point in setting your target so high that you will not be able to reach it.
You may find you can do more repetitions of each exercise but it is sensible to start with a low number and build up gradually. When you want to increase the number of exercises only add one or two repetitions for at least three days before you do anything more. Make sure you check how you feel - especially for signs of increased fatigue - before challenging yourself further.
It may be that you need to have someone to help you, so you may need to time your exercises to coincide with their being around.
In the beginning you might consider enlisting help from a physiotherapist who will be able to give you some tips and pointers as to which exercises best meet your needs. If you work with a fitness instructor it is important that they are aware that you may need to work at a slightly slower pace or maybe with more frequent breaks.
Finally, when you are exercising, it's important to breathe! A lot of people hold their breath when they exercise and that's not a good idea!
When you have finished, make sure you rest.
As well as exercises that work on maintaining or building strength, it is also important to keep yourself fit, making your cardiovascular system - heart and lungs - do the work.
You may already be doing activities that make you breathe a bit deeper and get your heart rate going faster. It doesn't have to be 'exercise' as such, it may be anything such as dancing, swimming, gardening or walking.
It is possible to just tweak some activities to make them challenge your cardiovascular fitness - perhaps walk faster for part of your route (between certain landmarks such as seats in the park, shops on the High Street etc), climb the stairs instead of using the lift or escalator, dig the garden a bit more vigorously. The increase in speed or effort need only be for part of the activity but you should be aware of breathing deeper and feeling a bit warmer from the effect on your circulation.
If you find it difficult to make yourself breathe deeper and get your heart rate going because your balance is not so good or your legs tire very quickly then there are things you can do sitting in a chair.
Get your arms and legs pumping as if you are running but stay seated. Even if you keep going for just one minute you will find your heart rate has gone up and you are breathing deeper. You can also split your arms and legs so that you can simply 'arm jog' or keep your arms still and 'march' with your legs.
Punch your arms alternately forward or upward. This one is good if you are feeling a bit stressed - you can imagine all sorts of people or situations that have made you feel a bit fed up and punch them away!
It is good to have a trigger to remind you to exercise. Maybe do one of these exercises when the adverts or weather come on the television, or when waiting for the kettle to boil. Exercise in short bursts will still make a difference to your fitness.
To help guide you, we have developed a series of exercises in partnership with specialist neuro-physiotherapist Liz Betts.
The exercises have been divided up into different categories based on the starting position (sitting, standing, kneeling or lying) and the issues they help address (such as balance, posture and strength). This may help you to decide which ones are appropriate for you and how to fit them in with your daily activities.
For instance, you may want to pick a standing exercise to do when standing in the kitchen waiting for the kettle to boil or before you wash up. Or you may pick a sitting exercise to do when at the table before you have your meal or while watching the television. If you just want to keep an eye on your posture rather than developing a keep fit routine there are exercises to help.
You can watch the demonstration of each exercise on the website or they can be downloaded individually as a pdf to allow you to build up your own programme.
- See also Move it for MS, a series of exercise videos for people with MS featuring Mr Motivator
- Annals of Neurology 1996;39:432-441. Summary Impact of aerobic training on fitness and quality of life in multiple sclerosis.
Last updated: 12 August 2014
This page will be reviewed within three years