Role of Exercise in Multiple Sclerosis Management: A Complete Guide for Africans

By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer and Datelinehealth Africa (DLHA) volunteer. Medically reviewed by A. Odutola. MB BS, PhD, FRCSEd.

November 11, 2025

 A smiling female sitting in a wheelchair. Image credit - Freepik

 

Highlights

• Multiple sclerosis (MS) is a condition in which your immune system attacks the nerve coatings in your body, thereby causing slowing of brain and nerve communication and several disabling effects over time.

• Physical therapy for MS improves mobility, independence, and quality of life, while also preventing complications. It shows promise as an effective, affordable treatment option.

• Strength and mobility training in MS focuses on building leg strength, improving endurance, and managing spasticity (muscle cramps) through active and passive exercises, specialised techniques, and regular stretching.

• Aerobic and balance exercises help improve stability, reduce fall risk, and enhance heart and lung function in MS patients, leading to better fitness, reduced fatigue, and improved quality of life.

• Aerobic exercises like walking, cycling, or aquatic workouts improve heart and lung health, emotional well-being, and quality of life in MS patients, especially those with mild to moderate disability.

 

Introduction

Living with multiple sclerosis (MS) shouldn't mean giving up on active lifestyle as regular iexercise is one of the most powerful tools for managing MS symptoms and improving quality of life.

While MS affects millions worldwide with symptoms like fatigue, muscle weakness, and balance issues, research shows that targeted physical activity can help patients regain control. Recent studies reveal that carefully planned exercise programs can reduce fatigue, strengthen muscles, improve balance, and support brain health. [1]

Up to 80% of MS patients experience walking difficulties, but those who exercise regularly often see remarkable improvements in mobility and function. [1]

This comprehensive guide covers everything you need to know about how to safely include exercise into your MS management plan—

• Understanding the science-backed connection between physical activity and symptom relief
• Discovering the best exercise types for different MS symptoms 
• Learning the practical steps to start exercise safely at any fitness level. 

Whether you're newly diagnosed or managing ongoing symptoms, you'll learn how to use exercise as a powerful tool in your MS management journey.

 

Understanding Multiple Sclerosis and the Exercise Connection 

Multiple sclerosis is a long-term brain and nervous system condition where your body's own immune system gets confused and starts attacking healthy tissue instead of just fighting off infections like it's supposed to. This usually starts happening to people in their twenties and thirties. [2]

To learn more about Multiple sclerosis and its symptoms, click here.

Info poster: Multiple sclerosis symptoms. Adapted from Freepik

 

Benefits of Exercise for Multiple Sclerosis

Physical therapy programs are tailored to each person's specific symptoms, which is great because they can tackle multiple issues at once. These therapies don't just focus on reducing symptoms - they work on several important goals:

Physical benefits:

1. Improves muscle strength
2. Reduces muscle stiffness
3. Reduces muscle weakness
4. Reduces Fatigue 
5. Improves balance and co-ordination

Cardiovascular benefits

Mental and cognitive benefits [3]

I. Physical Benefits

a. Improves Muscle Strength and Mobility

Strength training involves working your muscles against resistance to build power and endurance. Research shows some real benefits for people with MS: [4]

• Lower body focus - This is especially important since MS often hits leg strength earlier and harder than arms and hands. 
• Improved endurance - Helping you stay active longer throughout the day. 
• Better overall function - Stronger muscles mean easier daily activities.

b. Reduces Spasticity (Muscle Stiffness and Spasms)

About 90% of people with MS deal with spasticity at some point, and it can really impact quality of life. It can limit your range of motion and normal movement and cause pain. [3] Physical therapy uses several strategies which includes -  

• Active exercises - movements you do yourself 
• Passive exercises - using equipment like motorized bikes or having someone help move your limbs 
• Specialized techniques - methods like Bobath, Vojta, or PNF (proprioceptive neuromuscular facilitation). No single approach is definitively better - the most important thing is doing them regularly and with enough intensity. Light stretching of tight muscles for 20-60 seconds before and after exercise. [3]

c. Reduces Muscle Weakness (Paresis)

Muscle weakness creates various challenges like walking difficulties and problems with fine motor skills. Since there aren't effective medications for this (and some anti-spasticity drugs might actually make weakness worse), physical and occupational therapy are your main tools.

• Water therapy - Even people with severe leg weakness can practice standing and moving because water reduces gravity's effects 
• Standing frames - Help people who can't stand on their own to work their core, limb, and breathing muscles while protecting heart function 
• Range of motion exercises - For people with limited mobility, moving joints near the affected areas. Most research has focused on people with mild to moderate MS symptoms, so we need more information about how these approaches work for people with more advanced disease. [3]

d. Fatigue Management

Fatigue, characterized as excessive physical and mental exhaustion disproportionate to prior exertion, represents a common manifestation in MS that typically proves challenging to manage. 

Roughly 75-90% of MS patients encounter fatigue throughout their disease course. 

Beyond cooling interventions, moderate physical activity, especially aerobic exercise, appears to positively influence fatigue levels. Since fatigue typically intensifies as the day advances, exercise sessions should occur during morning hours and must avoid overtaxing the individual. [3]

e. Enhanced Balance and Coordination

Balance control deficits are common manifestations in individuals with MS, limiting their everyday functional abilities and elevating their fall risk. Evaluating balance capabilities such as upright stance and ambulation, along with patients' subjective balance perception, is crucial. The seated nature of cycling exercise offers benefits for patients with stability issues. Limited research has examined how exercise interventions affect balance and coordination in MS, with even fewer studies selecting these measures as their main outcomes.

II. Cardiovascular Benefits

Aerobic exercise has received more research attention than resistance training in MS populations. Through aerobic training, patients engage multiple muscle groups against minimal resistance with the goal of enhancing cardiovascular conditioning.

Overall, low-to-moderate intensity aerobic exercise effectively improves cardiovascular fitness, emotional well-being, and QOL (quality of life) in MS patients with EDSS scores below 7. This exercise modality is both safe and well-tolerated among many MS individuals. MS patients demonstrate significant improvements in cardiorespiratory fitness even with brief exercise periods (such as 4 weeks).

In MS, cardiorespiratory exercise training correlates with enhanced VO2 Max or VO2 peak levels and work capacity, improved respiratory function, and decreased fatigue.(4)

III. Mental and Cognitive Benefits

45-70% of MS patients experience cognitive difficulties including diminished information processing velocity, attention deficits, and episodic memory impairments while 60-70% encounter mood alterations. Some studies shows a positive relationship between aerobic activity and cognitive function plus brain health in healthy populations. Among MS patients, advantageous effects of consistent physical activity and exercise on emotional state and life quality have been found. [3]

 

Best Exercises for Multiple Sclerosis 

Table comparing different exercises plans and how to undertake them.

 

A. Aerobic Exercise (Low to Moderate Intensity)

Aerobic exercise engages numerous muscle groups against minimal resistance, primarily aiming to enhance cardiovascular and pulmonary conditioning. Consider activities such as walking, aquatic exercise, or cycling on a stationary bike - exercises that elevate your heart rate while remaining sustainable rather than depleting. This exercise modality is most effective for MS individuals with EDSS (disability measurement) scores below 7 - essentially those who maintain ambulatory (walking) function without requiring continuous support.

Primary Advantages

• Enhanced cardiovascular conditioning - more efficient cardiac and pulmonary performance 
• Better emotional well-being - physical activity can address MS-related psychological difficulties 
• Elevated quality of life - overall improvement in daily functioning and well-being

The majority of MS patients can participate in this exercise type without substantial complications. Individuals commonly find aerobic programs sustainable over time. MS patients can achieve notable cardiovascular fitness gains in training periods as brief as 4 weeks. [4]

Good exercise options include stationary cycling, arm cycling, water exercise, and treadmill walking. Rowing and running are only for patients with good functioning.

Robot-assisted treadmills also show good results.

How to Start Aerobic Exercises

Exercise 2-5 times weekly on days you're not doing strength training. Start at 40-70% of VO2max, 60-80% of max heart rate, or use a perceived effort scale of 11-13 (fairly light to somewhat hard). Since MS can affect heart rate response, using the effort scale is recommended. [4]

Start with 10-40 minutes per session based on your disability level. You can break this into three 10-minute sessions if needed. For the first 2-6 months, gradually increase how long or how often you exercise. After that, check if you can handle higher intensity. If yes, you can add one interval training session (up to 90% of VO2 max). [4]

B. Resistance Training

It is important that resistance training should be supervised for safety by an experienced staff until the MS patient is contended with the program. Other than safety concerns, it has been shown that supervised training is more effective than non-supervised resistance training. 

For resistance training, weight machines (closed kinetic chains) are safer than free weights (open kinetic chains), especially when starting out. If weight machines aren't available, use elastic bands or body weight exercises at home instead. However, these alternatives typically don't provide the same benefits as weight machines. [4]

How to Start Resistant Training Exercises

Start with 1-3 sets of each exercise, gradually increasing to 3-4 sets over a few months. Rest 2-4 minutes between sets and exercises. [4]

C. Flexibility and Range of Motion

MS patients often have stiff, tight muscles due to spasticity and lack of movement. Flexibility exercises help loosen muscles, reduce stiffness, improve joint movement, and enhance balance and posture. Do these exercises daily for 10-15 minutes.

How to Start Flexibility nd Range of Motion Exercises

Stretch before and after workouts, including both upper and lower body muscles used in your program. Pay special attention to: neck extensors, front shoulder muscles, hip flexors, hamstrings, inner thigh muscles, and calf muscles.

Focus especially on stiff, spastic muscles. Stretch slowly and gently—never rush. Stretch until you feel mild tension (not pain) and hold for 20-60 seconds. Don't bounce while stretching. If you need help stretching, use a towel, rope, or have someone assist you. For patients who can't move on their own, a trained therapist can do passive stretching. Deep breathing, light massage, and muscle relaxation techniques may also help. Higher-functioning MS patients might enjoy supervised yoga or tai chi classes. [4]

D. Balance and Coordination Training

Include activities that improve balance and coordination.

How to Balance and Corrdination Training Exercises

Practice shifting your weight and responding to cues. Exercise ball workouts with coordinated movements using both sides of your body can improve coordination and balance while also building strength and flexibility. Tai Chi with its slow, controlled movements can also help maintain balance, strength, and flexibility.

For patients who aren't stable or strong enough for these activities, try balance exercises in shallow water. Water reduces fall risk and injury, while providing support that makes challenging movements possible. Water exercise can improve posture, flexibility, coordination, and muscle tone. [4]

 

Exercise Guidelines and Recommendations

Start by increasing how long or how often you exercise, and only increase the intensity when you feel ready.

Rest 2–4 minutes between sets and muscle groups, and take at least one day off between strength training sessions.

You can do aerobic and strength exercises on the same day if you feel comfortable. Make sure to talk with your doctor or physiotherapist about symptoms like fatigue or heat sensitivity before starting an exercise routine. [5]

 

Safety Considerations and Precautions 

People with MS face unique challenges when exercising. They tire more easily, can't handle heat well, and are more likely to fall. Other issues like muscle stiffness, thinking problems, or bladder control can also affect their ability to exercise, so their workout plans need special adjustments.

For those sensitive to heat, experts suggest cooling down before exercising. This can include:

• Using cooling packs or vests
• Soaking the lower body in cold water
• Taking a cool bath 20-30 minutes before (and after) working out
• Wearing lightweight workout clothes or a special cooling vest
• Exercising in a cool room with fans or air conditioning

People with MS who have trouble with balance, coordination, or body awareness need extra care to prevent falls. These safety concerns should be carefully considered when designing and monitoring their exercise routines. [4]

 

Conclusion 

Incorporating regular exercise into your routine can make a meaningful difference in managing multiple sclerosis. By starting slowly, staying safe, listening to your body, and choosing activities you enjoy, you can improve strength, balance, and overall well-being. While challenges may arise, working with a physical therapist and pacing yourself ensures that exercise becomes a sustainable and empowering part of your life. Remember, every small step counts, and consistency is the key to long-term benefits.

 

References:

1. Du L, Xi H, Zhang S, Zhou Y, Tao X, Lv Y, et al. Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Front Public Health 2024 Apr 10;12:1387658. Available from here.

2. National institute of Neurological Disorders and Stroke. Multiple sclerosis. [Internet]. Last reviewed 2025 Jan. 31. [Cited 2025 Sep 25]. Available from here.

3. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis -- an integral component of disease management. EPMA J. 2011 Dec 24;3(1):2. Available from here.

4. Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 2017 Sep 16;17:185. Available from here.

5. Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH, et al. Exercise training guidelines for multiple sclerosis, stroke, and Parkinson’s disease: Rapid review and synthesis. Am J Phys Med Rehabil 2019 Jul;98(7):613–21. Available from here.

 

Related: Multiple sclerosis in Africa - An overview 

 

Published: November 11, 2025

© 2025. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content for non-commercial purposes without alteration or modification and subject to source attribution.