Exercising with multiple sclerosis: movement tips and strategies for managing fatigue

Living with multiple sclerosis (MS) can make exercise feel complicated. Some days you may feel steady and energized. But on other days you may feel fatigue, balance changes, stiffness, or heat sensitivity that can make even basic tasks feel harder. It’s also common to worry that exercising with multiple sclerosis could worsen symptoms or stir up a flare.

“An MS diagnosis can feel overwhelming,” says Krista Asprec, PT, DPT, a physical therapist at Hinge Health. “It’s natural to worry about making symptoms worse. But movement is medicine — even with a neurological condition.”

It’s true: movement can be one of your most powerful tools for managing MS symptoms. Exercise isn’t about pushing to exhaustion or proving to yourself that you can do a grueling workout. It’s about building and maintaining the strength, balance, and endurance you need to keep doing daily activities — while learning how to work with your current energy levels.

Read on to learn more about the benefits of exercising with multiple sclerosis, plus simple targeted exercises recommended by Hinge Health physical therapists that are gentle enough to do every day. Plus, get practical strategies for managing fatigue and heat sensitivity so you can continue moving with confidence.

How MS affects movement and exercise

MS is an autoimmune disorder that affects your central nervous system, which can change how your brain communicates with your muscles. Because of that, movement and exercise may feel different than they did before your diagnosis.

Not everyone with MS experiences the same symptoms or limitations. The type of MS you have, how active your symptoms are, and where lesions occur in your body can all influence how your body feels and functions. That said, many people with MS experience symptoms that can make movement more challenging. 

These symptoms include:

• Fatigue. Fatigue is often the most limiting symptom for people with MS. And it’s not the same as everyday tiredness. It can feel sudden, intense, and unpredictable — like your battery drains much faster than expected. “The biggest thing with MS is trying to find that balance between challenging yourself enough to stay strong, but not overexerting yourself to the point that you can’t function for the rest of the day,” says Dr. Asprec. That balance is key. Exercise should support your day — not make you feel completely wiped out.

• Balance and coordination changes. As MS progresses or fluctuates, coordination can decrease. Fatigue can also make balance worse. “Balance is so important for everyday activities,” says Dr. Asprec. “We need balance to get dressed in the morning, like when putting on a pair of pants.” Most movements are a balancing act, and we may not even realize it. “That’s why balance work isn’t 'extra' — it’s foundational. Improving balance boosts your stability and supports long-term independence,” Dr. Asprec says. 

• Heat sensitivity (Uhthoff’s phenomenon). Many people with MS have nerves that are sensitive to heat. Overheating can temporarily worsen symptoms like weakness, blurred vision, heaviness, numbness, or fatigue. While this can feel scary, know that this doesn’t mean you’re causing damage. It just means your nervous system was temporarily challenged is overloaded. Once you cool down and rest, symptoms often settle.

• Day-to-day symptom variability. MS symptoms can fluctuate from one day to the next. You might feel steady and energized one day, but like you’re moving through molasses or more fatigued the next. That’s why exercise routines need to be flexible. Adjusting intensity based on how you feel isn’t “giving up” — it’s about practicing mindfulness and tuning into how your body is feeling that day, trying to observe and note the experience without judgment.

• Muscle weakness. Changes in muscle strength can affect everyday movements, like climbing stairs. Strength training helps support the muscles around affected areas, making these tasks feel easier over time.

• Spasticity or stiffness. Some people with MS experience muscle tightness or spasms that limit the range of motion. Gentle mobility work, stretching, and low-impact movement can help reduce stiffness and improve comfort.

Can exercise trigger an MS flare-up?

This is one of the most common concerns when exercising with multiple sclerosis. The key here is to find your movement sweet spot so that you can move without stirring up symptoms.

Doing more than your body is ready for at that moment — especially in hot conditions — can temporarily increase symptoms.

“If someone with MS overexerts themselves, their neurological symptoms can temporarily increase,” says Dr. Asprec. “But once they rest and cool down, those symptoms usually settle.”

This temporary increase is different from a true relapse. It’s often your nervous system signaling that it needs a reset — not that you’ve caused damage.

When to check with your doctor

If your symptoms don’t improve after rest and cooling down, or if you notice new or worsening symptoms that last beyond 24 hours, it’s important to check in with your neurologist or healthcare provider.

Exercising and MS: How movement can help symptoms

It might feel counterintuitive to move when you’re fatigued, but exercising within your sweet spot — while staying cool — can be one of the best ways to manage symptoms.

Exercising with MS can:

• Improve strength for daily activities

• Support walking endurance

• Enhance balance and coordination

• Ease muscle and joint stiffness

• Boost mood and cognitive clarity

• Increase your overall resilience

Dr. Asprec recalls working with a patient who had been very athletic before her diagnosis. After developing MS, she was afraid to exercise at her previous level.

“She was such a go-getter,” says Dr. Asprec. “But she would overdo it and then be so exhausted she couldn’t make a meal. I helped her find the right balance so she could still enjoy movement without setting herself back for the rest of the day.”

It’s a mindset shift: even low intensity exercises provide excellent health benefits.

Can exercise slow MS progression?

While exercise isn’t a cure for MS and doesn’t replace your medical treatments, it does play a vital role in your overall health. Emerging research suggests regular movement supports brain health in people with MS. Even if exercise doesn't directly repair nerves, it can help improve your cognitive function and many other health benefits — which is a big win.

“Exercise also helps you maintain the strength you need for everyday activities,” says Dr. Asprec. “Staying consistent with an exercise routine can help you feel like you’re able to do more in your daily life because it helps improve your balance, coordination, and strength.”

Best types of exercise for multiple sclerosis

There is no single “perfect” workout for multiple sclerosis. The best routine is one that includes a mix of different movements to support your body in different ways. 

Here are the top types of exercise recommended by Hinge Health physical therapists:

• Aerobic exercise. Walking, cycling, and swimming help build endurance and manage fatigue long-term. Consider starting with 10-15 minutes and gradually do a little more as you feel ready. If that feels like too much, break it up. “One strategy I often recommend is doing mini workouts,” says Dr. Asprec. “Instead of one long session, try 10- or 20-minute bouts throughout the day. That way you’re still moving, but you’re not exhausting yourself.”

• Strength training. Strength training builds muscle to support balance and daily function. If traditional squats feel difficult, try modifying it by doing a sit-to-stand exercise from a chair. Use armrests for support. Raise chair height if needed. “You’re still building the blocks of strength,” says Dr. Asprec. “You just modify what you can do.” Aim for two strength sessions per week to start, then gradually ramp up as tolerated..

• Balance and flexibility. Yoga, Pilates, and tai chi can all help you become more flexible and release stored tension in your body. They improve coordination and strength without overwhelming your body. Low-impact exercise is often ideal because it builds strength and stamina without causing too much fatigue.

• Water-based exercise. Water exercise (under 84 degrees F) is especially helpful if you are sensitive to heat. “It helps with overheating, and it’s low-impact,” says Dr. Asprec. “If you don’t like swimming, you can do yoga or pilates on land — just make sure you stay cool.” 

What exercises should I avoid with MS?

It’s not that you need to avoid certain exercises — your body is resilient and capable of doing all types of movement. Rather than avoiding specific exercises, focus on preventing:

• Overheating

• Exercising to exhaustion

• Movements where you feel unsteady without support

• Environments that make it hard to stay cool (like a heated studio)

• Pushing until you feel wiped out

“Think about it like this: when working out with MS, try to stop before you feel completely tired,” says Dr. Asprec. “The goal is to finish with enough energy to continue your day.”

Creating a routine: How to start

If you’re wondering how to exercise with MS safely, the goal isn’t to overhaul your routine overnight. Instead, the goal is to build a routine that feels sustainable, customizeable, and supportive of your energy — not one that drains it.

Before beginning a new routine, especially if you’ve had recent flares, mobility changes, or frequent falls, check in with your neurologist or a licensed physical therapist. They can help you find an intensity that feels right for you, modify exercises for balance or weakness, and create a plan tailored to your symptoms and mobility level. If possible, work with a PT familiar with neurologic conditions. 

Other tips for creating a sustainable workout routine include:

• Start low and go slow. Begin with just five to 15 minutes of gentle activity. That might mean a short walk, a few bodyweight resistance exercises, or a brief yoga flow. As you get stronger, gradually increase either time or intensity, but not both at once. Think of it as layering progress, not rushing it.

• Try mini workouts. If a 20- or 30-minute session feels intimidating, break it up. As mentioned above, Dr. Asprec recommends doing two or three short bouts of five- to 15-minute workouts throughout the day, especially on a day when you’re feeling MS-related fatigue. Mini workouts allow you to build consistency without overwhelming your body.

• Choose cool times and places. Heat sensitivity can temporarily worsen symptoms, so exercise in air-conditioned spaces or during cooler parts of the day. Morning or early evening may feel better than midday. If you’re outside, look for shade and breeze.

• Have a heat management plan. Prepare ahead of time so you don’t have to guess in real-time what to do if you start feeling overheated. Cooling down early is a smart way to manage your energy. Helpful strategies include:

  • Drinking cold water before and during exercise

  • Wearing lightweight, breathable clothing

  • Using a fan indoors

  • Keeping a cool towel or cold water bottle nearby

  • Taking a cool shower before or after activity

• Use supports for balance. If your balance feels unsteady, use a wall, countertop, sturdy chair, or railing for support. Modifying a movement doesn’t make the movement “less effective.” It just makes it more accessible, which can make you feel encouraged and capable of keeping up with the exercise routine. If you regularly have persistent balance issues, please use an assistive device like a walker or a cane to reduce risk of falls.

• Listen to your body. Some mild symptom changes during exercise — like temporary heaviness or warmth — can happen. That’s different from pushing into exhaustion or sharp symptom spikes. If your symptoms significantly worsen and don’t improve after cooling down and resting, stop and reassess. It may mean your intensity was too high for that day. Dialing back the following day (or for the following week) may be helpful. 

• Build rest into your routine. Rest isn’t quitting, it’s a necessary part of training. Many people do well exercising every other day. Others prefer shorter sessions spread throughout the week. “Strategic rest helps your body adapt and keeps fatigue manageable,” Dr. Asprec says.

These movements improve strength and balance in the muscles that support your joints and everyday function. Building strength around your hips, legs, core, and shoulders helps your body handle more movement with less effort, supporting mobility and independence over time.

“Consider starting with one set of six to 10 repetitions for strength exercises, or 10-30 seconds for balance or plank holds,” Dr. Asprec says. If your fatigue comes on quickly, do a portion now and another portion later in the day. Remember, your mini workouts throughout the day add up.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Strategies for managing fatigue during exercise

MS fatigue is different from everyday tiredness. It can feel sudden, heavy, and unpredictable, like your energy tank drains faster than expected. Remember, the end goal isn’t to push through that fatigue, it’s to work with your current energy so movement supports your day instead of wiping it out. 

Consider these Hinge Health physical therapist-backed strategies:

• Exercise earlier in the day. Many people with MS notice they have more energy in the morning. If that’s true for you, schedule movement during that window. Even a short session early in the day can set a positive tone without draining your energy.

• Hydrate and stay cool. Heat can increase fatigue and other MS symptoms. Drink water before and during exercise. Wear lightweight, breathable clothing. Bring cooling towels, or place a cold water bottle on your neck or wrists and use a fan if you’re indoors. Exercising in air-conditioned spaces or cooler outdoor temperatures can also make a noticeable difference.

• Use the talk test. A simple way to check your effort: you should be able to speak comfortably during exercise. If you’re too out of breath to hold a light conversation, slow down. Mild to moderate intensity is usually more sustainable — and more beneficial — than pushing to your limit.

• Finish with energy in the tank. This is key. The goal is to stop before you feel completely wiped out. “You should finish with enough energy to continue your day,” says Dr. Asprec. Exercising to exhaustion can make it harder to cook, work, or care for your family later.

• Track your patterns. Pay attention to what helps and what drains you. Do certain times of day feel better? Does strength training feel easier than cardio? Noticing patterns helps you adjust your routine to fit your energy instead of fighting it.

• Give yourself grace. “Have some grace for yourself,” says Dr. Asprec. “If it’s a truly fatiguing day, it’s okay to rest and pick things up tomorrow. Even just doing one small exercise that day is good.” This can look like a five-minute gentle yoga flow or a short walk around your neighborhood. Consistency matters more than intensity.

When to see a doctor 

Managing MS is a team effort. While exercise is a powerful tool, if you have MS, make sure to partner with a neurologist. It’s important to have a clear plan with your provider to ensure your exercise routine is the best fit for your specific needs.

PT tip: Find your movement sweet spot

“There’s no set number of reps or fixed duration you need to do to reap the benefits of movement,” says Dr. Asprec. “Everyone with MS is different.” Your movement sweet spot is where you feel challenged, but comfortable. “Even a little bit of exercise can help you stay active and maintain your independence,” says Dr. Asprec.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. Halabchi, F., Alizadeh, Z., Sahraian, M. A., & Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology, 17(1). doi:10.1186/s12883-017-0960-9

3. Kim, Y., Lai, B., Mehta, T., Thirumalai, M., Padalabalanarayanan, S., Rimmer, J. H., & Motl, R. W. (2019). Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease. American Journal of Physical Medicine & Rehabilitation, 98(7), 613–621.

4. Panginikkod, S., Rayi, A., Rocha Cabrero, F., & Rukmangadachar, L. A. (2022, October 24). Uhthoff Phenomenon. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470244/

5. Bilek, F., Deniz, G., Elidar, G., Ercan, Z., & Demir, C. F. (2026). Exercise induces structural brain changes and elevates irisin levels and enhances functional performance in multiple sclerosis a pilot randomized study. Scientific Reports, 16(1), 3463. doi:10.1038/s41598-025-33434-4

6. Declerck, L., Bobitt, J., Herman, C., & Motl, R. W. (2025). Exercise Training in Multiple Sclerosis: Preparing for Dissemination and Implementation Based on Integrating the NIH Stage Model of Intervention Development. Multiple Sclerosis and Related Disorders, 102, 106623. doi:10.1016/j.msard.2025.106623