5 Key Benefits of Managing Multiple Sclerosis With Exercise
— Plus, My Clinical Approach to Tailoring Exercise Plans Based on Fatigue
Table of Contents
Understanding Multiple Sclerosis
Multiple Sclerosis (MS) is a progressive neurological condition marked by immune-driven damage to the myelin sheath of the central nervous system. Symptoms range widely and can include fatigue, spasticity, weakness, poor coordination, cognitive challenges, and heat sensitivity. While there is no cure, exercise is a proven strategy for improving physical capacity, managing symptoms, and enhancing quality of life — when dosed correctly.
The Role of Exercise: My Approach to Titrating Based on Fatigue
As an exercise physiologist working with people diagnosed with MS, fatigue is by far the most nuanced and misunderstood barrier to long-term progress. In my experience, the key isn’t just prescribing exercise — it’s learning how to dose it properly, adjusting in real-time based on physical and neurological feedback.
Here’s how I titrate exercise based on fatigue:
1. Start Low, Monitor Closely
Initial sessions often last no more than 10–15 minutes, combining low-impact aerobic movement and seated mobility work. I watch for:
Delayed-onset fatigue (30–60 minutes post-exercise)
Muscle tremors during tasks
Declining posture, speech slurring, or fogginess
These are early red flags for overexertion.
2. Use the "Fatigue Floor + Ceiling" Strategy
Rather than chasing performance, I teach clients to find their “fatigue floor” (minimum effective dose) and “fatigue ceiling” (the limit before symptoms worsen). We aim to exercise below the ceiling and gradually raise the floor.
For example, a client might begin by walking 5 minutes, resting 2 minutes, then continuing another 3 minutes. If they feel just as functional 30 minutes later, we’ve hit the right dose.
3. Split Sessions for Energy Conservation
Instead of one long session, we often break movement into two or three mini-sessions across the day. This reduces post-exercise crashes and increases frequency of activation without cumulative fatigue.
4. Incorporate Cooling Protocols
Especially during warmer months or during flare-prone periods, I incorporate:
Cooling vests
Aquatic therapy
Fans or cold towels
These allow clients to work harder without heat-induced symptom flare-ups.
5. Monitor with Symptom Anchoring
Clients track symptoms daily (e.g., leg heaviness, mental clarity, energy levels) alongside training volume. This feedback loop allows for smarter weekly adjustments — increasing duration, reps, or intensity based on trends rather than arbitrary goals.
5 Key Benefits of Exercising with MS
1. Improved Physical Function
Strength and Endurance: Resistance training builds muscle, improves walking capacity, and reduces reliance on aids.
Mobility and Balance: Aerobic training, balance drills, and aquatic therapy reduce fall risk and improve reaction time (MS Australia).
Research shows aerobic and resistance training enhance gait speed, mobility, and lower limb strength — even in people with mild to moderate disability (PubMed).
2. Fatigue Reduction
Contrary to fear, structured and well-paced exercise reduces fatigue by improving mitochondrial efficiency and cardiovascular capacity. Over time, clients report:
Fewer daily energy crashes
Shorter recovery periods
Improved stamina for basic tasks
Fatigue severity scores improve significantly with moderate aerobic and resistance training, especially when performed 2–3x/week (PMC).
3. Symptom-Specific Relief
Spasticity: Stretching and resistance training help manage muscle stiffness and involuntary spasms.
Bladder/Bowel: Core and pelvic floor exercises improve control and reduce urgency.
Cognitive Fog: Regular movement improves blood flow to the brain, boosting mental clarity and mood (Mayo Clinic).
4. Mental Health and Resilience
Regular movement improves:
Mood regulation via endorphin release
Self-efficacy by setting and achieving fitness goals
Social engagement through group or community-based sessions
Exercise is comparable to antidepressants in improving mood among people with MS, according to a meta-analysis on depression and physical activity in neurological conditions (Pubmed).
5. Slowing Progression and Preventing Comorbidities
Exercise has been shown to:
Delay loss of independence
Reduce risk of osteoporosis, obesity, and heart disease
Potentially slow neurodegeneration by encouraging neuroplasticity and immune modulation
Emerging studies suggest physical activity may protect against MS progression via reduced inflammation and improved remyelination (Frontiers).
Final Thoughts
MS may make exercise more complicated, but it also makes it more essential.
When approached with the right mindset and clinical support, movement becomes a therapeutic tool, not just a health activity. The goal isn’t maximum effort — it’s maximum benefit within the body’s limits.
Whether it’s through seated strength circuits, aquatic balance drills, or brief walks broken up throughout the day — consistency, personalization, and pacing are what turn exercise into medicine.
