Multiple sclerosis is a chronic autoimmune disease of the central nervous system in which the immune system attacks myelin, the protective sheath around nerve fibres. This disrupts nerve signal transmission and manifests very differently depending on the person: fatigue, spasticity, muscle weakness, balance and coordination problems, cognitive changes or pain.
The disease can follow different courses: relapsing-remitting (the most common), primary progressive or secondary progressive. This variability means any exercise programme must be strictly individualised.
Benefits of Exercise in Multiple Sclerosis
Systematic reviews and meta-analyses published in the Cochrane Database and Multiple Sclerosis Journal have consistently demonstrated that exercise in people with MS produces:
- Reduced fatigue: paradoxically, regular exercise reduces chronic fatigue, one of the most disabling symptoms of MS.
- Improved muscle strength and endurance: combats the weakness and physical deconditioning that commonly accompanies the disease.
- Better balance and coordination: reduces fall risk, which is frequent in people with MS.
- Cognitive benefits: aerobic exercise improves working memory, processing speed and attention in people with MS.
- Improved mood and reduced depression: MS is associated with high rates of depression; exercise is an effective intervention in this regard.
- Possible neuroprotective effect: emerging evidence suggests exercise may have effects on white matter integrity and disease progression.
Important Precautions
The Uhthoff Phenomenon
Some people with MS experience a temporary worsening of symptoms when their body temperature rises — through exercise, environmental heat or fever. This is called the Uhthoff phenomenon, and it is important to distinguish it from a true relapse: symptoms disappear once temperature normalises, usually within minutes to a few hours.
The solution is to exercise in cool environments, stay well hydrated, wear appropriate clothing and avoid the hottest parts of the day. It should never be a reason to abandon exercise altogether.
Adapting Exercise During Relapses
During an acute MS relapse, high-intensity exercise should be suspended or significantly reduced. However, maintaining gentle mobility and stretching can help prevent stiffness and deconditioning. The therapist should adjust the programme accordingly during these phases.
Managing Fatigue
Fatigue in MS is not the same as ordinary tiredness: it is a deep, sometimes unpredictable exhaustion that can appear independently of activity level. The exercise programme must therefore be planned to respect the patient’s energy fluctuations, distributing effort throughout the day and prioritising the most important activities.
Recommended Types of Exercise in MS
- Moderate-intensity aerobic exercise (walking, swimming, stationary cycling): improves cardiovascular function, fatigue and mood.
- Strength training: combats muscle weakness and improves functional capacity.
- Adapted yoga and Pilates: improve balance, flexibility and body control with low risk of overload.
- Aquatic exercise (hydrotherapy): especially useful for those sensitive to heat, as cool water allows exercise with reduced risk of the Uhthoff phenomenon.
Our Approach at Rehabot
At Rehabot we design exercise programmes for people with multiple sclerosis adapted to their stage, symptoms and lifestyle. We work both in clinic and at home, and adjust the programme in real time according to how the patient feels each week. The goal is for exercise to be a life tool, not another obligation.
📌 Do you have multiple sclerosis and want to know what type of exercise is right for you? Consult with us. First assessment in Málaga, Marbella and across the Costa del Sol.