Multiple Sclerosis (MS): Exercise and Home Rehabilitation

3.1 millionPeople living with MS worldwide (Atlas of MS, 2026)

32Average age at diagnosis; 7 in every 10 people with MS are women

150 minWeekly target for exercise and/or lifestyle physical activity in expert recommendations

56%People with MS who fell at least once in 3 months, in an analysis of 537 people

What is it?

In multiple sclerosis, the immune system damages the protective covering (myelin) that surrounds the nerve fibres in the brain and spinal cord; the signals carried by the nerves slow down or are interrupted. Symptoms depend on where the damage is: fatigue, difficulty with walking and balance, muscle stiffness, numbness, and problems with vision and bladder control can all occur. For most people the condition follows a pattern of relapses and periods of recovery; for some, symptoms progress gradually.

Drug treatment for MS is managed by a neurologist. Rehabilitation does not replace that treatment; it complements it and aims to keep you independent in daily life.

What does home rehabilitation aim for?

Reducing fatigue and spreading your energy across the day
Improving walking and balance, and preventing falls
Maintaining muscle strength and fitness
Coping with muscle stiffness
Making everyday tasks such as getting up from a chair and climbing stairs easier
Adapting walking aids and the home to you when needed

Is exercise safe, and does it work?

The UK guideline (NICE, 2022) recommends encouraging people with MS to exercise: regular exercise may have beneficial effects on MS and has no harmful effects. In a review of 26 studies and 1,295 people, the relapse rate was 4.6% among those who exercised and 6.3% among those who did not; exercise did not increase the risk of relapse.

In a Cochrane review covering 45 studies and 2,250 people with MS, exercise reduced fatigue significantly compared with no exercise. Endurance exercise, programmes combining several types, and exercise such as yoga were found to be effective. Expert recommendations published in 2020 set a target for everyone with MS of at least 150 minutes of exercise and/or at least 150 minutes of lifestyle physical activity a week, and recommend an early assessment after diagnosis by a physiotherapist or occupational therapist experienced in MS.

According to NICE, aerobic, resistance and balance exercises, yoga and pilates may help MS-related fatigue. Vestibular rehabilitation can also be considered for people whose standing balance is limited. It is recommended that people with MS who have mobility problems are assessed by rehabilitation specialists and physiotherapists experienced in MS, and that individual goals are set.

Heat and fatigue

About 6 in every 10 people with MS are sensitive to heat. When body temperature rises (exercise, hot weather, a hot bath, a fever), symptoms can get worse temporarily. This does not usually mean new damage; once body temperature returns to normal, symptoms are expected to settle within a few hours.

NICE notes that MS-related fatigue may be brought on by heat or by physical and emotional stress. So rather than giving up exercise, the answer is to adjust the conditions you exercise in.

Exercise at the cooler times of day, in a cool, well-ventilated room.
Drink cold water before and during exercise.
Break your exercise into short bouts and rest in between.
Choose the times when your energy is at its best; spread tiring tasks across the day.
Cool down gradually after exercise; a lukewarm or cool shower can help.

Exercises at home

Strength, balance and endurance: six exercises

For the standing movements, stay next to a solid support such as a worktop. If your fatigue or symptoms get worse, stop and rest. The programme varies from person to person; the exercises below are a general starting point.

Sit-to-stand from a chair

Sit towards the front of a sturdy chair with your feet a little way back. Lean forwards, stand up and sit back down in a controlled way. If it is difficult, use the arms of the chair or a worktop in front of you for support. Leg strength is the foundation for walking and for moving from bed to chair.

8–10 reps, 1–2 sets

Bridge

Lie on your back with your knees bent and your feet on the floor. Squeeze your buttocks and lift your hips until there is a straight line from your shoulders to your knees, hold for 3 seconds and lower slowly. Because it is done lying down, it also suits days when you are tired.

8–10 reps, 1–2 sets

Heel raises holding the counter

Hold on to the kitchen worktop with both hands. Rise up onto your toes, pause for a moment and lower slowly. Then stand on your heels and lift your toes off the floor. The calf and ankle muscles carry the foot as you step.

10 reps of each

Standing on one leg

Stand tall in front of the worktop, holding on lightly with one or both hands. Lift one foot off the floor and keep your balance. As it gets easier, hold on with just one finger. Keep a chair behind you; at first, have someone with you.

10–15 seconds, 3 times on each foot

Wall calf stretch

Place your hands on the wall and take one leg back. Keep your back knee straight and your heel on the floor; bend your front knee and feel the stretch in your calf. Stretch slowly, without bouncing; sudden, fast stretching can increase muscle stiffness.

30 seconds, 3 reps on each leg

Brisk walking

Walking or a stationary bike

Walk, or pedal a stationary bike, at a pace at which you can still talk. Start with bouts of a few minutes, rest in between and increase the time from week to week. Choose the cooler hours and keep cold water with you.

Start with 5–10 minutes; aim for 150 minutes a week in total

If your mobility is very limited or you use a wheelchair, exercise is still recommended. According to the expert recommendations, in this situation exercise should be done with the support of a trained assistant.

Practical tips for everyday life

In the analysis that followed 537 people with MS, 65% of falls happened indoors. Small changes both improve safety and protect your independence.

Remove slippery rugs, light the hallway at night and have grab rails fitted in the bathroom.
Keep the things you use often within easy reach.
Put short rests between tiring tasks; do not try to fit everything into one day.
Do not smoke; NICE states that smoking increases the progression of disability in MS.
If you are at risk of falling, have a look at the fall prevention guide.

Frequently asked questions

Can exercise trigger a relapse?

Research does not show this. In a review of 26 studies and 1,295 people, the relapse rate was 4.6% among those who exercised and 6.3% among those who did not; exercise did not increase the risk of relapse. The UK guideline (NICE) also states that regular exercise has no harmful effects on MS.

My symptoms get worse after exercise. Am I doing harm?

When body temperature rises, MS symptoms can get worse temporarily. This does not usually mean new damage; once your body cools down, symptoms are expected to settle within a few hours. Exercising in a cool place, with breaks and with cold water to drink, helps. If a new symptom or a worsening lasts for more than 24 hours, contact your neurologist.

I am very tired. Should I still exercise?

Yes, but start low and go slow. In a Cochrane review covering 45 studies, exercise reduced MS-related fatigue significantly compared with no exercise. Plan your exercise for the times when your energy is at its best, and break it into short bouts. Problems such as poor sleep, depression or anaemia can also add to fatigue; talk to your doctor about these.

How much exercise should I do?

According to expert recommendations, the target is at least 150 minutes of exercise and/or at least 150 minutes of lifestyle physical activity a week (such as walking to the shops, housework and gardening). You work up to this target gradually, and the programme is adjusted to your situation.

When to seek help right away

Contact your neurologist or a doctor without delay if you have any of the following:

A new symptom, or a clear worsening of existing symptoms, lasting more than 24 hours (it may be a relapse)
A sudden loss of vision, double vision, or eye pain that gets worse when you move your eyes
Signs of infection, such as a fever or burning when you pass urine
Difficulty swallowing, frequent coughing during meals or a feeling of choking
A fall that causes an injury, or frequent repeated falls
Sudden weakness in the face, an arm or a leg, or slurred speech (call 112)

Sources

Multiple Sclerosis International Federation. Atlas of MS 2026: a global update on MS prevalence, incidence, and the gaps that remain. London: MSIF; 2026.
National Institute for Health and Care Excellence. Multiple sclerosis in adults: management (NG220). London: NICE; 2022.
Kalb R, Brown TR, Coote S, et al. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler. 2020;26(12):1459-1469.
Heine M, van de Port I, Rietberg MB, et al. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2015;(9):CD009956.
Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci. 2014;343(1-2):3-7.
Nilsagård Y, Gunn H, Freeman J, et al. Falls in people with MS—an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler. 2015;21(1):92-100.
MS Trust. Heat sensitivity and MS (Uhthoff's phenomenon). 2026.