Neurological August 2026 6 min read

Exercise Physiology for Multiple Sclerosis: Managing Fatigue and Maintaining Function

A common misconception about multiple sclerosis (MS) is that exercise worsens the condition or accelerates decline. The opposite is true. Exercise is now recognised as one of the most effective interventions for managing MS symptoms — particularly fatigue, the most disabling and common symptom of MS.

Exercise and multiple sclerosis — what the evidence shows

Multiple sclerosis is a neurological condition where the immune system attacks the myelin sheath surrounding nerve fibres, causing a range of physical and cognitive symptoms. For many years, exercise was avoided in MS out of concern it would worsen symptoms. Decades of research have overturned this view.

Regular supervised exercise has been shown to:

  • Reduce MS-related fatigue — the most significant symptom for most people with MS
  • Improve walking speed, endurance and balance
  • Maintain and improve upper and lower limb strength
  • Reduce depression and anxiety
  • Improve cognitive function and reduce "brain fog"
  • Support healthy weight — important given mobility limitations and some medication effects
  • Potentially have neuroprotective effects by promoting brain plasticity

Uhthoff's phenomenon: Some people with MS notice temporary worsening of symptoms when body temperature rises during exercise (Uhthoff's phenomenon). This is temporary and not harmful. Your exercise physiologist will manage this through appropriate exercise intensity, timing, cooling strategies and rest periods.

What does an MS exercise program include?

  • Aerobic exercise — walking, cycling, swimming and aquatic exercise improve cardiovascular fitness and reduce fatigue. Intensity is carefully managed to avoid heat-related symptom exacerbation.
  • Resistance training — progressive strength training maintains muscle function and reduces fall risk. Upper and lower limb programs adapted to the person's current capacity.
  • Balance and coordination — targeting the balance impairment characteristic of MS to reduce falls and maintain confidence with mobility.
  • Hydrotherapy — particularly valuable for MS. Cool water hydrotherapy avoids heat sensitivity, while the buoyancy makes exercise accessible regardless of disability level.
  • Fatigue management — your EP teaches energy conservation principles and designs programs that maximise benefit while managing the unique fatigue of MS.

MS exercise physiology in south-east Melbourne

Exercare provides mobile exercise physiology for multiple sclerosis. NDIS (plan and self-managed), Medicare CDM, aged care and private health. Mobile visits across south-east Melbourne.

NDIS intake Medicare & private

Written by the Exercare team. Exercare provides mobile exercise physiology for multiple sclerosis across south-east Melbourne. Start your NDIS intake →