Multiple Sclerosis (MS) & Exercise

Multiple sclerosis exercise like aqua therapy can assist with better quality of life for those with neurological conditions

We have previously written an article on Multiple Sclerosis (MS) giving a general overview of what MS is, how exercise can impact MS and what considerations you need to be mindful of when exercising with MS.

But exactly what type of exercises should you be doing and how much is too much when you have MS?

What type of exercise?

For many years people diagnosed with MS were advised against exercise in fear of the exercise worsening or accelerating the disease progression.  But fortunately, in the last 10 – 15 years, there have been many studies that have proven that exercise is not only safe to do, but also improves strength, balance, functional capacity, respiratory function, and quality of life as well as decreasing disability scores.  The main forms of exercise that have been studied include cardiovascular training, strength training, and aqua therapy.

As in most situations, it is important to get clearance from your specialist before starting any new exercise routine. Whether this is supervised by your biokineticist or a home program that you are following.  When choosing an exercise routine, take into consideration what your capabilities are and what exercises it is that you enjoy doing (to improve exercise adherence). As well as what activities may potentially cause flare-ups. And how much is enough vs too much.  It is important to remember that each person responds differently to exercise. Therefore, there is no ‘one size fits all’ when it comes to exercise. And it may be in this situation where a Biokineticists (or other health care practitioner that has experience with MS and exercise) would be useful in providing you with guidance on what would yield the best and safest results.

Guidelines for supervised exercise

Should you go the supervised exercise routine, it is important that your Biokineticist (or other appropriate healthcare professional) do a full evaluation. This would include medical history taking, a thorough physical examination, as well as a neuromuscular/functional assessment.  Screening for other risk factors such as cardiovascular, respiratory, and metabolic disorders should also be included.  And then last but not least, a cardiorespiratory and musculoskeletal fitness test should be performed.  All this information is then reviewed, and a treatment program would be formulated accordingly to meet your specific needs, address your main complaints, and achieve the goals that you have set out.

Guidelines for home exercise

Here are some general exercise guidelines MS clients can follow should they decide to continue on their own at home:

The Staircase Model

The Staircase Model has been suggested for exercise prescription and progression for MS patients.  This is broken down into the base step which includes passive range of motion exercises that should be done daily.  The next step includes active range of motion exercises. While the third step includes integrated exercises that combine strength, flexibility, balance, etc. Aqua therapy is a good example of integrated exercises.

Aerobic Exercise

Aerobic exercises can include bicycle ergometer, arm ergometer, arm-leg ergometer, aqua therapy, and treadmill (be cautious of balance). These exercises should be performed 2 – 5 days per week for a duration of 10 – 40 minutes per session (this could be split up into bouts as well).  This is all dependent on the individual’s current disability score, fitness level and tolerance.  It is advised that aerobic training and strength training be performed on different days of the week.  And overall, the intensity of exercise should be perceived as fairly light to somewhat hard.

Resistance Training

When it comes to resistance exercise, you can make use of either weight machines (this is preferred over free weights to reduce the risk of losing balance, etc.), elastic bands or body weight exercises. Ideally, you should perform resistance exercises 2 to 3 days a week.  Sets would start off at 1 – 3 sets with a maximum of 15 reps per set with 2 – 4 minutes rest periods in between sets. Looking at a full body program, you want to do 4 – 10 different types of exercises. And you should give preference to larger muscle groups before smaller muscle groups, multi-joint exercises vs single-joint exercises and lower body exercises over upper body exercises. This will change once you reach secondary and primary progression stages. As you would then need to train your upper body more to support your lower body and enable you to continue with activities of daily living.

Flexibility Training

It is also important to incorporate flexibility training on a daily basis, as muscles are more prone to shortening due to spasticity and immobility.  Stretches should be slow and gentle and should be in a range that might be slightly uncomfortable but not painful.

Balance & Coordination

Balance and coordination exercises should also be practiced every day, and these can include weight-shifting, responding to external stimuli, being seated on a swiss/pilates ball, etc.  A great way of practicing balance and coordination exercises is by doing these in shallow water.  This allows you the freedom to try more than you would have on land. But without the risk of falling and injuring yourself.

How much exercise is too much?

As mentioned in our previous article as well, when doing an exercise program exercise-related fatigue, heat intolerance, and balance (falling) should be considered at all times. And adjustments to the exercise program should be made accordingly.  Other factors such as urinary incontinence, cognitive deficit, and spasticity should also be considered when planning your exercise program.

Should you need more advice or want to start your journey to a better quality of life with a Biokineticist, please feel free to contact us at or visit our website for more information.

*Please note that the information provided in this article are merely guidelines. Fish and Field Biokineticists will take no responsibility for any injury or damage that results from a person doing exercise training without consulting us for a full assessment and individualized exercise program.

Image Credit: High resolution photo created by –


Collazo, I., 2022. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendationsBMC Neurology, [online] 17(1).

Reynolds, E., Ashbaugh, A., Hockenberry, B. and McGrew, C., 2018. Multiple Sclerosis and Exercise: A Literature Review. American College of Sports Medicine, [online] 17(1), pp.31-34, doi: 10.1249/JSR.0000000000000446. PMID: 29315107.

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