Woman doing a modified yoga pose in class

How to Put Together the Right MS Exercise Plan for Your Ability Level

By Carol Caffin
Reviewed by Stephanie L. Singleton, OTD
February 12, 2024

Exercise might seem like a challenge when you have MS—especially if you’re having symptoms like mobility issues, balance or coordination issues, tingling or numbness in your limbs, or blurry vision. But regular exercise may actually help reduce some of these symptoms and make life with MS a little easier.

“Exercise can help improve strength, coordination, balance, endurance, and visual symptoms,” says Dori Cohen, an occupational therapist who works with people with neurological conditions at Rusk Rehabilitation at NYU Langone Health in New York City. “There is growing research to support that exercise can also be beneficial for cognitive function, fatigue management, and even happiness levels.”

Lauren Krupp, M.D., director of the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health, agrees that exercise is “critically important for maintaining fitness, improving function, and enhancing quality of life.” In addition, it can help reduce pain and increase stamina, energy, and flexibility.

With these potential benefits, it’s important to exercise but also to find an MS exercise plan that matches your ability level. No two people have the same abilities, and yours may even change day to day. Here’s how to take that into account and tailor your routine.

First, Talk to Your Doctor

Before you consider any exercise regimen, you should see your primary care provider or neurologist. They’re most familiar with your condition and any symptoms that could affect your ability to do certain exercises or activities. Your doctor can also refer you to the best type of professional to help you create a fitness plan for your specific situation, such as an occupational therapist (OT) or physical therapist (PT).

Consult an Occupational or Physical Therapist

These movement specialists can create an individualized MS exercise plan that’s tailored to meet your current ability as well as your overall rehabilitation goals. While either an OT or a PT can create a routine to help you stay mobile and active, seeing an occupational therapist may also be important if you need to address your ability to perform activities of daily living, as well.

“For example,” Cohen says, “for a person who is having difficulty with coordination and subsequently tying their shoes, I may educate them on a home exercise program for fine motor coordination.”

A qualified therapist will do a comprehensive assessment to evaluate any barriers to function, including issues with “fatigue and endurance, upper-extremity function (strength, coordination, sensation, spasticity, movement quality), balance, vision, safety awareness, positioning, and more,” Cohen says. OT assessments may also evaluate cognitive function, she notes.

After the assessment, your OT or PT can offer modifications to exercises so they’re effective for you while remaining safe. For instance, Cohen says, “Somebody who is working on their upper-extremity strength but who also has issues with balance may perform exercises from a seated position to ensure that they’re able to target specific muscles safely.”

If your needs change, or if you have a relapse or flare, your therapist can modify your exercises.

Modify Your MS Exercise Plan

Once you have a plan designed for you and your goals, you can tailor as needed.

Factor In Your Response to Heat

Many people with MS are sensitive to heat, so it’s crucial to avoid overheating when exercising. Factor in how you respond to a raised body temperature when you’re determining your ability level. “This could mean doing fewer repetitions and taking longer rest breaks in between each set,” Cohen says.

Other ways to stay cool? Avoid doing physical activity outdoors during the peak temperature hours in the day, about noon to 3 p.m. Swimming or other aquatic fitness activities in a pool with water that’s between 80 and 84 degrees Fahrenheit may also help ward off heat sensitivity as you exercise.

Adjust to Avoid Pain

When it comes to exercise, people with MS may need to forget the “no pain, no gain” credo. If you feel pain, you may be doing too much or doing the wrong kinds of exercise, which can lead to fatigue or injury. Here’s the general rule of thumb, according to Cohen: “If the exercise feels too easy, it’s probably not beneficial. But if it leads to pain, that can be harmful. You want a just-right challenge.”

Finding that sweet spot can take some trial and error, as experienced by Melissa, 46, a healthcare worker who lives in Huntersville, North Carolina, and has been living with relapse-remitting MS (RRMS) since 2000. “If I have pain from lifting too much, I’ll step it back.”

Start Slowly

“While some exercises may help with fatigue management, exercising itself can be very fatiguing, especially for people with MS,” Cohen says. “Often, people don’t feel fatigued or experience muscle strain until hours after they exercise.” So, Cohen recommends starting slowly and building your MS exercise plan from there.

It’s also important to pay attention to your energy levels. “Make sure that you have enough energy to safely perform the rest of your daily responsibilities,” Cohen says. Krupp adds that if you experience fatigue, you may need to take breaks during an exercise session.

Be Creative

Sometimes, it takes some creativity to adapt exercises to your ability level and goals.

“Even if you’re in a wheelchair, you may be able to move your arms,” says Rennie Rankin, 49, of North Brunswick, New Jersey, who was diagnosed with RRMS in 2003 and who teaches adaptive chair yoga. “Make arm circles or lift your arms out in front of you at shoulder height and open and close your fists, or lift hand weights, even water bottles. Just keep the movement going.” Your OT or PT can offer suggestions for these types of modifications and advise you on whether your activities are safe.

Yoga also offers many benefits for people at all levels of mobility. Talk to your doctor about any symptoms you have that you’re hoping exercise could help. For example, Melissa practices yoga and stretches regularly to reduce her nerve and muscle pain. She says the practice is also great for her mobility and balance and for strengthening her core.

Some research also suggests that therapeutic yoga (that is, yoga used for the purpose of symptom management) can help reduce depression and fatigue, increase lung capacity, improve bladder function, and reduce stress in people with MS.

Find the Exercises That Work for You

Regardless of what MS exercise plans you settle on, try to be consistent. “An exercise program ideally should be all year round,” Krupp says, “and if not daily, then several days a week.”

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