Multiple sclerosis (commonly known as “MS”) is an autoimmune disease that affects the central nervous system. It’s characterised by the formation of areas of demyelination (plaques) throughout the brain and spinal cord. This damage to the central nervous system results in slow or interrupted transmission of nerve impulses and causes a wide range of symptoms.

Symptoms of MS include physical and cognitive disability, extreme fatigue, temperature sensitivity, and depression. There is currently no known cause or cure for MS.

MS affects over 25,600 people in Australia. Most of these people are diagnosed between the ages of 20-40, but it can affect younger and older people too. MS is roughly three times more common in women than in men.

The benefits of exercise

Today, exercise is considered safe for people with MS.

Many of the symptoms associated with MS are reduced through physical activity and exercise. Research has indicated that persons with MS who engage in exercise have:

• less relapses
• increased mobility
• increased strength
• increased cardiovascular health
• lower levels of fatigue
• lower incidence of depression and anxiety
• less pain
• better balance
• better quality of life

Any exacerbation of symptoms associated with exercise are normally fully reversed 30 minutes after the end of the exercise session. Including exercise in your life as soon as possible after diagnosis is expected to prevent early progression of the disease.

Types of exercises recommended

The physical activity and exercise guidelines for adults with mild to moderate MS are:

• 30 minutes of moderate intensity aerobic activity, 2 days per week, and
• strength training for major muscle groups, including the calf muscles, leg muscles, abdominal, and arm muscles, on 2 days per week.

If you are already undertaking exercise, the guidelines for mild to moderate MS are:

• 40 minutes of vigorous intensity aerobic exercise, 5 days per week, and
• strength training for major muscle groups, including the calf muscles, leg muscles, abdominal, and arm muscles, on 2 days per week.

You should also be completing exercise to work on your balance and flexibility as often as each day of the week.

Aerobic exercise can be performed in a variety of settings including individual and group training sessions on land or in water. Use of exercise bikes and elliptical trainers is preferable to the use of a treadmill when there is a risk of tripping and falls. Research has shown that walking is the number one choice of aerobic exercise by persons with MS.

It’s best to start small and gradually increase your exercise intensity and duration. How fast can you already walk? How long can you walk for? Build this up to achieve your 30 minutes of moderate aerobic exercise.

For strength training exercise, slowly work up to doing two sets of 10-15 repetitions of each strength training exercise. Experiment with timing so that exercise does not tire you out for the rest of your day.

Some guidelines for strength training with MS include:

• Exercises can be performed in a variety of settings including home, community centre or gym.
• You can use resistance or machine weights, body weight, resistance bands, or water.
• Progressive resistance with heavier weights and low repetitions is beneficial.
• Frequent rest breaks and alternating muscle groups during training helps minimise fatigue.

Stretching and balance exercises can be helpful to improve posture and flexibility and can be done on most days of the week. You can do these strength and balance exercises using gravity or resistance bands, or by challenging normal sitting and standing posture.

Getting started

If you’re new to exercise, it’s important to start slowly. We recommend working up to the recommended volume of exercise over two to three months and break exercise into shorter bouts of 10 to 15 minutes at a time if necessary. Remember that all exercises can be modified by an Accredited Exercise Physiologist to suit your ability.

The most important thing is to choose exercise that you enjoy, and remember, something is always better than nothing!

Things to be aware of

Fatigue – fatigue is common in MS; exercise and fatigue management education strategies will actually help your fatigue level in the long term.

Heat sensitivity and MS – physical and sensory symptoms may temporarily increase with small increases in environmental or body temperature. People with MS should be encouraged to keep cool and well hydrated during exercise sessions.

Spasticity and contractures – A person with spasticity may find it difficult to walk or perform certain exercise activities. By performing stretching exercises daily, this can help make muscles longer, helping to decrease spasticity and prevent contracture.

Finding support – support to help you exercise is not to be underestimated. Research indicates that learning about exercise, working with others to overcome your barriers, and identifying facilitators to exercise will make you more successful in increasing your activity levels.

Speak to the exercise professionals

A health professional, like an Accredited Exercise Physiologist, can help you tailor exercise so that they are safe and suit your individual needs. They can also show you how to gradually increase your training load so that you minimise the risk of injury or are able to better manage your fatigue.

Getting support from an accredited exercise professional can also help you with goal setting and motivation to help make regular exercise and physical activity a part of your day-to-day life.

Click here to find an Accredited Exercise Physiologist near you.

Expert contributor: Dr Yvonne C Learmonth, Physiotherapist, Discipline of Exercise Science; Centre for Molecular Medicine and Innovative Medicine, Murdoch University, & Perron Institute for Neurological and Translational Science