Exercises for MS

Key takeaways

Here’s how to start exercising with MS:

• Discuss the benefits of exercise on MS with your neurologist. It may improve your balance, reduce fatigue, and help other cognitive symptoms.
• Incorporate multiple forms of exercise into your routine—aerobic exercise, stretching, resistance training, balance, and agility.
• Start small and schedule your exercise around your highest energy times. Avoid high temperatures, hydrate well, and keep cool to avoid flare-ups.
• Use assistive devices or try adaptive exercises to fit exercise into your abilities and interests.
• Learn about new research from Mass General Brigham Neuroscience Institute that shows hormones released during exercise may protect your neurons from damage.

Multiple sclerosis (MS) is a chronic disease that disrupts the communication between the brain and body. This disruption causes a wide range of symptoms that impact movement. Exercise is key for managing these symptoms and keeping MS from getting worse.

“Physical activity in general is helpful for maintaining mobility and can also help with non-motor symptoms like depression,” says Sarah Bell, PT, a Mass General Brigham physical therapist. She specializes in working with patients with neurological disorders like MS.

Christiane Wrann, PhD, DVM, a neuroscientist with Mass General Brigham Neuroscience Institute, shares new research showing that exercise may even protect the brain and spinal cord neurons from damage and reduce MS symptoms.

Bell shares how exercise can help symptoms of MS and which exercises are best.

Managing symptoms of MS

MS occurs when the immune system attacks a substance (myelin) that covers the nerves in the brain and spinal cord. Like the plastic coating that covers electrical wires, myelin protects the nerves from damage. It also helps electrical impulses travel along the nerves. MS causes this protective layer to wear down, leading to symptoms that can impact movement.

The symptoms of MS vary depending on the affected nerves. But fatigue tends to be the most common symptom — it affects about 4 in 5 peoplewith MS.

Other symptoms of MS include:

• Blurred vision
• Depression
• Dizziness or a spinning sensation (vertigo)
• Increased sensitivity to heat
• Muscles that become stiff or suddenly contract (spasticity), making them difficult to control
• Muscle weakness
• Numbness and tingling in the arms and legs
• Trouble maintaining balance when standing or walking

These symptoms can make it difficult to exercise safely and comfortably with MS. “When people have some breakdown of myelin, there’s an interruption in the electrical stimulation from the brain telling our muscles what to do,” Bell says.

The benefits of exercise for MS

Researchfinds that exercise helps people with MS improve their:

• Ability to walk from one place to another
• Balance
• Fatigue
• Quality of life

Physical activity is also good for the brain. “Exercise may not bring the myelin back, but it may help protect the areas of the brain that haven’t been impacted by MS,” Bell says.

In one studyof people with MS, researchers found that exercise didn’t lead to negative changes in the brain. As brain damage in people with MS tends to worsen over time, exercise may keep MS from worsening. A Mass General Brigham Neuroscience Institute study using mouse models of MS found that a hormone released during aerobic exercise could have a neuroprotective effect on MS, preventing injury or damage of healthy neurons. The hormone—called irisin—reduced clinical symptoms of MS and the loss of neurons.

Dr. Wrann, senior and corresponding author of the study says, “We are optimistic that our study will open up further developments of irisin as a therapeutic for, in particular, progressive MS.”

Dr. Wrann continues, “Our findings strengthen the argument that irisin released during aerobic exercise can help protect neurons in the context of multiple types of neurodegenerative diseases.”

The best exercises for MS

Bell says the best activities for people with MS fall into 4 categories:

1. Aerobic

Aerobic exercise can reduce fatigue and boost fitness. It’s also helpful for preventing heart disease, which is more common in people with MS.

Bell suggests aiming for 150 minutes of moderate-intensity aerobic exercise per week. Interval training, which alternates bouts of work with periods of rest, may make exercise easier for those with fatigue. Try walking quickly for 20 seconds and slowing or stopping to rest 20 seconds. Alternate for a total of 30 minutes a day, 3 to 5 times a week. You can do the same workout on a stationary bike, elliptical machine, or in the water.

2. Stretching

“Stretching is important for people with MS, particularly those who have spasticity (stiff, tight muscles),” Bell says. Involuntary muscle contractions can cause specific muscle groups to get tight and become painful. Stretching regularly can help reduce the risk of muscle contractions.

Muscles that tend to get tight and need the most attention are the calves, hamstrings, and hip flexors. Stretches that target these muscle groups can be beneficial.

Bell suggests doing 3 or 4 stretches a few times a day, holding each stretch for 20 to 30 seconds. A physical therapist can create a stretching program to address your personal needs.

3. Resistance training

Resistance training helps strengthen muscle groups weakened by MS. “It can also help regulate muscle spasticity,” Bell says. She recommends performing a full-body strength routine 2 to 3 days a week, with a recovery day in between.

4. Balance and agility

A targeted balance and agility program helps prevent falls. It’s best to do your balance training with a physical therapist, but you can work on it at home, too.

Try this simple home exercise: Stand on one foot for up to 30 seconds without using your hands to balance. Then, switch feet. To make it harder, close your eyes or stand on an uneven surface. Stand in a corner or next to a counter for safety.

How to start exercising with MS

Bell recommends consulting a physical therapist who specializes in treating neurological conditions before you begin an exercise program. A physical therapist evaluates how the MS has impacted your daily function. They also assess your strength and balance to create an exercise program that’s safe and effective — and personalized for you.

Here are a few strategies you can use to make it easier to exercise with MS:

• Start with small amounts of exercise: “Fatigue tends to be one of the symptoms that restricts activity levels for people with MS,” Bell says. If you struggle to exercise, start with 10 minutes, 3 days a week and build from there, she suggests. Gradually increase the duration and frequency of exercise before you increase the intensity.
• Use assistive devices: If you need balance support when walking, use a cane or ankle brace to lower your chances of tripping. Using walking aids or devices can also help you move more efficiently and reduce fatigue.
• Consider adaptive sports for exercise: Swimming, cycling, horseback riding, skiing, and even snowboarding can be adapted with equipment and training.
• Schedule exercise for high-energy moments: It can also help to plan your exercise for times when you tend to have the most energy.
• Use cooling techniques: Some people with MS are sensitive to heat. “If your core temperature goes up, symptoms will get worse,” Bell says. It may help to wear cooling garments like a vest and drink ice-cold water during exercise. Swimming in a cool-water pool can also be a good form of exercise for someone who’s more heat-sensitive. “The cool water can help regulate your body temperature,” Bell explains.

Exercise is just one of the many things that can help you live better with MS. Talk to your neurologist and a physical therapist to understand how exercise can work together with your treatment plan to improve your daily life.