Exercise and Physiotherapy For MS

M20.
405_Essentials 21_artwork 18/9/14 08:29 Page 1
Second edition, January 2011

Reviewed September 2013
MS
21 Essentials
For people living with MS
This publication is available in large print and audio CD

Call 020 8438 0999 or email shop@mssociety.org.uk
Exercise and Everyone benefits from being physically fit, including people
with multiple sclerosis (MS). However MS affects you, there
physiotherapy are exercises that can be helpful to stay as healthy and
fit as possible and to improve some of your symptoms
and their effects.
It is not always easy to find the time, but exercising regularly
will keep your body working to its full potential. To make
it easier, it is important to find exercise that suits you
something you enjoy and find worthwhile. MS affects each
person differently and you will have your own likes and
dislikes. While one person enjoys classic sports, another
may prefer tai chi or yoga. All kinds of physical movement
can be of benefit. Even gardening, cleaning and walking
short distances use your muscles and help you to stay fit.
Physiotherapy can also be particularly useful to help you
find exercises that meet your specific needs and abilities.
Contents A physiotherapist may suggest exercises that concentrate
on a particular area of the body that you wish to improve,
02 The benefits of exercise
or help you manage a specific effect of your MS.
03 What sort of exercise should
I be doing? However MS affects you, appropriate exercise can make
05 Are there precautions I need a difference to managing and living with the condition.
to take because of my MS?
07 How can a physiotherapist
help? Learn a range of gentle exercises and stretches with
09 Exercises for specific MS our Exercising with MS DVD presented by former
symptoms Olympic champion Sally Gunnell OBE. Watch online
11 How can I fit exercise into at www.mssociety.org.uk (search exercise). Order your
my life? free copy direct from http://shop.mssociety.org.uk or
12 Times when you may not be telephone 020 8438 0999.
able to exercise
12 Exercise for those more
severely affected by MS
14 Further information
M20.405_Essentials 21_artwork 18/9/14 08:29 Page 2
The benefits Getting fit and keeping fit helps the body and mind to stay as
healthy as possible. This is true for people with MS who have
of exercise milder symptoms and for those who are more severely affected.
And there is no evidence that exercise makes MS worse in the
long term, or that exercising causes relapses.1, 2 In fact, research
has suggested the opposite that exercise can:
improve the overall health of people with milder MS 1
help people with more severe MS to stay as mobile and active
as possible 1
improve walking mobility in people with MS 3
help some people manage their MS symptoms, such as fatigue,
muscle stiffness, balance difficulties, anxiety, depression, and
bladder and bowel problems 2, 4, 5
decrease the risk of heart disease 4
Avoiding the knock-on effects of MS
Loss of muscle strength and fitness

If a muscle is not used for long periods it will lose strength
and may become painful (known as deconditioning). This
in turn may make any mobility or weakness problems worse.
These problems cannot always be avoided completely, as
they are symptoms of MS. But, by finding the right exercises,
perhaps with the help of a physiotherapist, you can stop
problems becoming worse than they need to be.
Weight gain or loss

Unwanted change in weight is an issue that affects many people
with MS.6 Exercise can help with weight control, especially when
combined with a healthy, well-balanced diet. Your GP can also
refer you to a dietitian to help with any weight issues you have.
Osteoporosis
Weakened bones, including osteoporosis, may be a risk for
people with MS who do not get much exercise or have taken
Exercise and Physiotherapy MS Society 01/11
long courses of steroids.7 Gentle activity strengthens the bones

and can help prevent these problems developing.4 For example,
if you regularly use a wheelchair, a physiotherapist may suggest
you stand for a few minutes at regular intervals through the day,
perhaps supported by a frame for balance. This is known as
weight-bearing exercise and can help prevent osteoporosis.
There are also exercises that can be done sitting down that
can help.
2
What sort There is no single exercise that could be called an MS exercise.

MS affects people in different ways, so whats suitable will vary
of exercise from person to person. You may find that what you want from
an exercise regime changes over time. Whatever exercise you
should I be choose, be careful not to overdo it.
doing? The types of exercise listed below help the body keep fit in a
variety of ways. For the kinds of exercises that may help specific
MS symptoms, see page 9.
Strengthening exercises include lifting and moving small
weights, but can also involve using the bodys own weight
to strengthen muscles and bones. If you have tremor or
spasms, pulling against an elastic exercise band might be
easier than using weights.
Aerobic exercises, such as cycling, running or rowing, use
many different groups of muscles and work the heart and lungs.
Exercises that work just the arms or just the legs can also be
helpful.4 This is sometimes known as cardiovascular exercise.
The key to aerobic exercise is to maintain a moderate level of
activity for a reasonable length of time at least twenty minutes,
if possible. Whatever you are able to do, though, remember
that exercise at any level is better than none at all.
Stretching helps keep muscles supple and relaxed. It is
important to stretch before and after strengthening or aerobic
exercises.4 It can also be a useful form of exercise on its own.
Range-of-motion is often used together with stretching.
It involves moving joints so that they go through as full a range
of movement as possible. For example, moving the arms, legs,
wrists and ankles in wide reaching circular patterns.
Passive stretching can help where MS has made it hard
to control particular muscles, or has restricted the use of
an arm or leg. Passive stretching involves a physiotherapist
or carer helping to move your arms or legs to create a stretch
and move the joints.
Posture exercises help keep your feet, knees, pelvis, shoulders
and head properly aligned to reduce strain on the muscles and
bones in the body. This could involve strengthening muscles
around the back, chest and stomach areas. This gives support
to the body and helps with balance and position when standing
up and when sitting down.
3
Sports, activities and physiotherapy can all provide a good

balance of these various types of exercise. If your situation
changes, you might want to try a new sport, adjust what
you do already, or work with a physiotherapist to discover
specific exercises that could benefit you. Adapted sports
and complementary therapies are popular options that many
people try. There is a huge range of sports available to people
of all abilities. For further information about complementary
therapies such as tai chi, Pilates and yoga, see the MS
Society publication Complementary and alternative medicine.
Exercising does not have to mean playing a sport you can get
exercise simply by being active. Walking, gardening, dancing,
boccia, and playing with pets can all provide exercise. Just like
the different sports available, these kinds of activities vary in the
type of work out that they provide. Combined with sports or
a programme of physiotherapy exercises, they can be helpful
in keeping fit.1
If you cant or dont want to join a gym or exercise outside,
there are a number of online exercise websites which offer
downloadable and streamed workouts for you to do at your own
pace. A number of exercise DVDs have routines you can follow
at home, some of which are MS specific. See Further reading
at the back of this booklet for more information. There are also a
number of virtual reality computer games which can be played
at home and can help you keep moving, for example Wii Fit.
Water-based exercise
Water can be a particularly good environment for many exercises
not only swimming and water aerobics classes are offered
at lots of sports centres. Water supports the body, reducing
the risk of falls and lessening the stress placed on joints and
muscles.1 Strengthening, stretching and aerobic exercise can
all be done in a pool, and you can tailor activities to your own
needs. Some people who are sensitive to heat also find it good
to exercise in cool water. Others may even find that a warm pool
is beneficial.8 As with any exercise, you need to find the right
environment for you. Some local pools offer a warm water day
each week and have special sessions for people with disabilities.
Some areas of the UK offer free swimming for the over 60s.
Check with your local pool or leisure centre.
4
Are there There are precautions that everyone should take when exercising
and, depending on how MS affects you, there may be particular
precautions things you need to think about.
I need to take
Speak to your GP
because of
If you have not exercised for a while, or are thinking of
my MS? significantly increasing the amount you do, you should speak
to your GP beforehand, to be sure what you do is safe.
Your GP may recommend you see a physiotherapist.
Just like anyone else, if you have other health issues, such as
asthma, a heart condition or osteoporosis, these need to be
taken into account with any exercise plans.
Start slowly with any new regime

Dont try to do too much, too soon. Starting slowly with a new
regime lets your body get used to the new activity and also helps
you judge whether that choice of exercise is comfortable for you.
Over time, you will be able to gauge what your limits are. You
may notice your limits change as your abilities and fitness levels
change, so adjustments here and there might be beneficial.
Warm up and cool down

To guard against injury or making any existing muscle problems
worse, you should always warm up, with gentle stretching, before
any strenuous activity. If you are doing aerobic exercise, you
should start slowly, to build the heart rate gradually. To avoid
muscles becoming tight and stiff, stretching should also be
done as a cool-down afterwards.9
Adapting to MS symptoms
The symptoms you experience may have an influence on the
exercise you choose to do, but having MS does not mean that you
automatically need to stop doing activities and exercise you enjoy.
For example, if you experience vision problems you might opt
for alternative forms of exercise or adapted sports where eyesight
is not so important. Muscle stiffness or painful sensations could

make contact or movement uncomfortable, but by working
with a physiotherapist you might find more comfortable, but still
effective, activities. Some people with MS experience difficulties
with memory and with understanding complex explanations
(known as cognitive problems) and may find it useful to have
written notes and diagrams from a physiotherapist or trainer.
A family member or carer might also be able to learn the
exercises with you to help remember them accurately.
5
You may want to use sports centres, exercise classes or personal

trainers at gyms. If you do, consider any adjustments you might
need the centre or trainer to make to take account of your MS.
This could include access to the facilities and whether the trainer
has an understanding of MS. Has anyone else with MS in the
area worked with the same trainer? The local branch of the MS
Society might be aware of suitable groups or trainers. If you have
a physiotherapist, they may be able to talk with trainers to help
them understand MS.
Heat sensitivity
Many people with MS though not all are sensitive to heat.8
Some people also say that humidity can affect them too.
Illness or infection, hot weather and exercise can all raise the
bodys temperature, which can make existing MS symptoms
feel temporarily worse or bring about fatigue, weakness or
vision problems. This is known as Uhthoffs phenomenon
and it probably occurs in MS because heat makes it harder for
messages to pass between the brain and the rest of the body.10
Uhthoff symptoms fade away after the body cools down again
and these temporary changes need not be a reason to avoid
exercise.1 Some people adjust the exercise they choose, to be
sure they are safe even if Uhthoffs symptoms occur. Others find
effective ways to stay cool and keep effects to a minimum. Here
are some practical things you can try if you are heat sensitive:
Avoid overly hot swimming pools. How warm is too warm
will vary for different people, but as a rough guide, try to
find a pool where the water temperature is below 29 degrees
Celsius.1
You might want to break up exercise sessions into smaller
sections, with regular breaks, to stay cool.
Drinking ice drinks, wearing a cooling vest and taking a cool
bath before exercising might help you avoid temporary Uhthoffs
symptoms and allow you to exercise for longer.8 Cooling sprays
can also provide temporary relief from hot conditions.
Some people find that a cooling bath or shower after exercise
can help speed up recovery.
Wherever you exercise, try to keep the space well ventilated.

A fan might help.
Be careful if applying ice or cold packs directly to the skin, or
when using cooling garments or cold water to cool the body.
MS can cause changes to the way you experience temperature,
distorting the feeling that would normally tell you when something
is too hot or too cold. Care should be taken not to damage the
skin. Your GP, physiotherapist, occupational therapist or MS nurse
can help make sure cooling techniques you try are not harmful.
6
How can a Physiotherapy is often recommended when there is a specific

problem or ongoing symptoms that affect day-to-day activities,
physiotherapist mobility and independence. It can help whatever your level
of disability, but can be particularly valuable when physical
help? symptoms progress or you are recovering from a relapse.
A physiotherapist works with you to assess your physical
difficulties and help you to improve your movement and other
functions of the body. Exercise is one of the key ways in which
they do this. If MS is affecting the sports or activities you are able
to do, they might suggest new ways to stay fit, or ways to adapt
your preferred exercises to suit your situation. A physiotherapist
can also suggest particular exercises to treat and manage
specific problems such as difficulties with mobility, balance,
posture and fatigue. Bladder problems, pain and muscle spasms
and stiffness can also be targeted by physiotherapy. Where
appropriate, physiotherapy might involve the physiotherapist
working hands-on with you. For example they may hold and
move your limbs for passive stretching and range-of-motion.
Sports equipment and aids

Some people with MS benefit from using sports equipment
and aids when exercising, and some of these may be suggested
by a physiotherapist. For example, exercise bikes and rowing
machines can offer quite strenuous exercise in a controlled
environment which could be useful if vision, coordination
or balance problems make these kinds of activities difficult
outdoors. A standing frame can be an aid to weight-bearing
exercise and weights strapped around the wrists or ankles
might help strengthen arms or legs.
Aids and equipment can also help compensate for difficulties
with balance, muscle weakness or other symptoms. For example,
trekking poles and walking sticks can help you keep balanced if
you go walking. If you have more strength in your arms than your
legs, a hand-cycle might be an option this is a bike powered
by pedals for the hands instead of the feet, and both indoor
and outdoor versions exist.
Some people say they benefit from a technique called
whole-body vibration. This involves standing on a vibrating
platform (sometimes two platforms, one for each foot) for several
minutes at a time. A number of small studies have looked at
the possible benefits of this kind of vibration, including posture,
mobility and muscle tone. However, they have not found
conclusive evidence that it helps people with MS.11, 12, 13 At the
moment it is not a widely used therapy and you should speak
to your GP or physiotherapist if you are considering it.
7
How do I get physiotherapy?

Your GP, neurologist or MS nurse can refer you to a
physiotherapist. You may also be able to refer yourself.
The guidelines on how MS should be treated in the NHS
recommend physiotherapy to help with many symptoms of
the condition, including walking difficulties, muscle spasms and
stiffness, swallowing difficulties and muscle weakness. However,
access to a physiotherapist varies from place to place and you
may not receive ongoing treatment on the NHS, but instead be
given a limited number of sessions. For some, it might be offered
following a relapse, for others it may be suggested when there
is a change in symptoms such as increased muscle stiffness
or mobility problems.
A physiotherapist will sometimes teach you exercises that
can be continued between appointments, possibly with the help
of a family member or carer. Ideally, your progress with these
exercises should be monitored from time to time to assess what
works for you and what does not. Changes can then be made
to ensure the programme is effective.
Physiotherapy is most commonly available as an out-patient
treatment where you visit the hospital just for the treatment
appointment and then leave again. Alternatively, if fatigue,
spasticity or other symptoms associated with MS prevent you
from travelling to the local hospital, a physiotherapist may be
able to visit you in your own home. Some areas also have MS
or neurological rehabilitation teams that include specialist neuro-
physiotherapists. It is always worth asking your GP, neurologist
or MS nurse if there is a team in your area and whether you can
be referred to them.
Local access to physiotherapy is sometimes available at non-
specialist rehabilitation clinics, or sessions may be organised
by your local branch of the MS Society. Many Multiple Sclerosis
National Therapy Centres and Multiple Sclerosis Centres
Scotland also have physiotherapy clinics see the useful
organisations on page 16 for details. Your local MS Society
branch can be found in your local phone book. They are also
listed on the MS Society website, or you can contact the MS
Society UK Information team on 020 8438 0799.
Physiotherapy is also available privately. If you are considering

paying for physiotherapy, registered therapists who specialise
in neurology can be found through the Chartered Society
of Physiotherapy. Their details can be found at the back
of this booklet.
8
Exercise for As well as improving your general health, exercise and

physiotherapy may help with specific MS symptoms.
specific MS A physiotherapist can assist you to find the most effective
level and style of exercise for your symptoms.
symptoms
Fatigue
Fatigue is one of the most common problems for people with
MS.14 It seems to almost go against common sense to exert
yourself if you have fatigue. But exercise can bring improvements
in strength, fitness and mood all of which might help you
to manage your fatigue.2 However, it is important to balance
exercise with rest and to keep cool while you exercise, especially
if you find that getting hot during exercise makes fatigue worse.
Good posture can also help your body to work more efficiently,
causing less strain and using less energy. This too may help with
managing fatigue.14 One clinical trial showed that yoga helped
reduce some peoples levels of fatigue.15
For further information see the MS Society publication Fatigue.
Balance and walking difficulties

People with MS often find balance is a problem, and there can
be a number of reasons for this. Changes in sensation, vision
problems and MS-related damage in the brain or spinal cord
can all upset someones balance.16 This can cause problems
with walking, as can loss of strength in the legs, muscle stiffness
or spasms.
Carefully designed physiotherapy programmes can help
people improve their balance and ability to walk.1 These might
concentrate on stretching, strengthening and posture. Research
does suggest that the positive effects wear off quickly if the
exercise programme is stopped.1 To maintain improvements,
a physiotherapist might find exercises that you can continue
between check-ups, either on your own or with the assistance
of a member of the family or carer.
Some people feel that exercises that focus on balance and
breath control help their walking and balance. Popular examples
are yoga, tai chi and Pilates. Clinical trials have found some
benefits from tai chi, including improved walking speed.17 One

small study looking at the effect of Pilates-based core stability
training in people with MS who can walk found that it improved
their balance and mobility.18 While it generally does not cause
people any serious problems, be careful not to strain joints or
muscles when doing exercises like tai chi. Outdoor walking and
aerobics may also help with balance.1 For further information
see the MS Society publication Balance and MS.
9
Muscle spasms and stiffness

Muscle spasms and stiffness affect almost 50 per cent of
people with MS, though the effects vary from person to person.
At least 20 per cent of the people affected in this way will
experience muscle spasm.19 Physiotherapy, including stretching
and range-of-motion exercises, is a key part of treating and
managing these symptoms. These are gentle stretching exercises
that move each joint as far as possible in all directions. Normal
daily activities do not take joints through their full range of motion.
Yoga may also improve your flexibility and reduce muscle
stiffness.1 And research has found some benefits from tai chi
exercise, including reduced muscle stiffness.17, 20 Pilates may
also help, although there has been limited research in this area.
A small study on people who did not have MS showed Pilates
improved flexibility.21 For further information see the MS Society
publication Muscle spasms and stiffness.
Bladder and bowel problems

People with MS can experience a variety of bladder problems.
Some people experience an urgent or very frequent need to go
to the toilet known as urgency and frequency. Others find
that exercising, sneezing or coughing causes leakage. This
is called stress incontinence. Strengthening the muscles that
support the bladder the pelvic floor may help some people
with these bladder problems.22 A continence advisor, MS nurse
or physiotherapist can help you with pelvic floor exercises.
Bowel problems are less common, but can be awkward and
distressing.23 Keeping physically active may help some people
with bowel control. One study found that people with MS had
improvements in their bowel functions following a 15-week
course of aerobic training.5
For further information see the MS Society publications
Managing bladder problems and Managing the bowel in MS.
Low mood, anxiety and depression

MS can affect your emotions as well as your body. If issues such
as low mood, anxiety or depression do arise, exercise may help.

Regular aerobic exercise has been shown to be beneficial in
relieving mild to moderate depression.4 Tai chi has also been
reported to offer social and emotional benefits.17, 20 On top of
this, you may find that exercise is a good opportunity to meet
new people.
10
How can I fit To be effective, exercise needs to be a regular part of your life.
It is therefore important to find the right activities and exercises
exercise into for you ones that you enjoy doing, suit your lifestyle and match
your physical needs. When considering different sports and
my life? activities, you might want to ask yourself the following questions:
When are the best times for me to exercise? Symptoms and
drug side effects may vary through the day, so you might need
to consider this when planning to exercise.
What motivates me? Some people prefer competitive sports,
or exercising in a group. Others work better alone, with personal
goals to achieve.
Is there good access to the facilities I need? As well as being
able to get around the changing rooms, gym or hall, think about
transport to and from the venue. Voluntary groups, such as the
local MS Society branch can sometimes help.
What are the costs? Some activities are free, but if you pay for
exercise classes, sports clubs, special clothing or equipment,
there could be costs to consider. There may be groups running
cheaper classes in your area, perhaps linked to the MS Society
local branch. And remember that effective exercising does not
have to be expensive. For example, a physiotherapist can help
you find ways to get the same physical workout at home as you
might achieve in a members gym. Many local sports centres
have reduced rates if you receive benefits such as Disability
Living Allowance. In some areas, doctors prescribe exercise
as well as medicines and arrange for you to exercise for
free at a local fitness centre. There are many local initiatives
called Inclusive Fitness Initiatives (IFI) that could help you to
access fitness. Most of these are in England, although there are
some in other areas of the UK. The IFI website has details of all
accredited initiatives contact details are at the back of this
booklet.
If MS symptoms change, you may have to adjust the exercise
you do. However, if you feel able to carry on with existing
exercises, then there is no reason to automatically stop. But
listen to your body its important to be realistic. An unrealistic
exercise plan can be frustrating and energy-sapping and actually
make it harder to stay motivated. By contrast, if you find something
that works for you, it can be inspiring and energising.

You might find the MS Society DVD Exercising with MS useful.
It presents a range of simple, gentle exercises and stretches you
might want to try. They are suitable for people with varying levels
of ability. See the front cover of this booklet for how to see it.
11
Times when you There may be times when you do not feel able to exercise,
or when it would be wise to do less than usual. If you experience
may not be a relapse you should not try to carry on exercising until after
symptoms have levelled out and you have completed any
able to exercise steroid treatment.1 A physiotherapist can guide you to maintain
muscle tone and mobility following a relapse, and help get
you back into a routine as you recover a process known
as rehabilitation.
The symptoms of MS can change from day to day as well
as over longer periods of time. If you notice any symptoms
changing, or if new symptoms appear, you may need to adjust
how much you do. For example, if you have a week or two
where fatigue is worse than normal, you may decide to rest
a little more and exercise a little less to conserve energy for
other tasks. If this goes on for longer, a physiotherapist might
suggest new ways to exercise so you can stay fit despite
the fatigue.
Remember that there may also be reasons quite separate from
your MS that stop you from exercising; for example, if you catch
a cold. It is often a good idea to rest and recover from an illness
rather than push yourself too hard.
Whatever your reasons for taking a break from exercise, remember
to start again slowly. If you need to, set yourself lower targets
to begin with and build up gradually to a level you can manage
realistically.
Exercise is good for everyone, including people with high levels

Exercise for of disability. If you are quite severely affected by MS, you may
those more need to work with a physiotherapist to tailor exercises that meet
the specific needs you have and ensure they are comfortable
severely for you. By doing this, you should be able to find exercises that
affected help you manage your symptoms and limit the knock-on effects
of MS. For further information see the MS Society publication
by MS Support for people severely affected by MS.
Passive stretching and range-of-motion

As mentioned on page 10, these exercises can help with muscle
stiffness. In particular, they can prevent joints from locking up

and muscles from becoming painful and deconditioned through
lack of use.
If passive stretching and range-of-motion exercises are helpful,
your family and carers might be able to assist you with this in
between physiotherapy sessions. A physiotherapist can work
with them to demonstrate how such exercises should be done
and to give carers confidence to help. However, paid carers or
carers from social services are not always able to carry out these
12
kinds of duties because of legal restrictions. To get the assistance

you need, it may help if you ask for stretching and range-of-motion
exercises to be written into your social services (social work in
Scotland) care package. This means they will be recognised as
essential parts of the care you need, and should therefore be
provided.
Strength and posture

Having good posture can make a significant difference to your
comfort and health if you spend a lot of time sitting or lying
down. Some people also find that muscle spasms and difficulties
with swallowing trouble them less if they adjust their posture.24, 25
Breath control can also be helped by an upright posture which
allows the lungs and throat to open more easily.
Muscle strength is important for good posture, and, to ensure
muscles are strong, a physiotherapist may suggest strengthening
exercises. These can work alongside stretching and range-of-
motion exercises which make moving from one position to another
easier, for example, using the toilet, or getting into bed.
Finding exercise in everyday activities

There may be everyday tasks and movements that can provide
useful exercise. Sweeping the kitchen floor, wiping down
a table top or reaching and stretching for things can all
be good exercise. It all depends on working to your abilities.
A physiotherapist, or occupational therapist, might suggest
subtle adjustments to get the maximum physical benefit from
the activities you do. By altering the layout of things you have
around you, for example, you may be able to create stretches
for your arms. Keeping something that is in regular use at full
reach creates some exercise each time it is needed, for instance
(but take care that it is safe to do so). Fitting exercise into your
daily life like this makes it easier to do a little every day and get
the benefits of regular stretching, strengthening and movement.
13
Further MS Society publications

The MS Society has publications on a wide variety of topics,
information including information for people just diagnosed, types of MS,
managing relapses, and social care services. Find out more and
UK Information Team
order at www.mssociety.org.uk/publications or call 020 8438 0799
020 8438 0799
(weekdays 9am-4pm).
infoteam@mssociety.org.uk
MS Society website and members magazines

Keep up to date with news relating to MS with the MS Society
website www.mssociety.org.uk and UK members magazine,
MS Matters. Members in Northern Ireland, Scotland and Wales
also receive national magazines. To join the MS Society call
020 8438 0759 or go to www.mssociety.org.uk/joinus
MS Helpline
The award-winning MS Helpline offers confidential emotional
support and information to anyone affected by MS, including
family, friends, carers, the newly diagnosed or those who have
lived with the condition for many years. Information about
MS is available in over 150 different languages by speaking
to a Helpline worker via an interpreter. Call freephone
0808 800 8000 (weekdays 9am-9pm, except bank holidays)
or email helpline@mssociety.org.uk
MS Society National Centre, Information Centre

Based at the MS National Centre in London, the Information
Centre is equipped for visitors to read or locate books and
journals or view videos and DVDs. To request publications,
research articles or other information about MS, visit
www.mssociety.org.uk/library or call 020 8438 0799.
Local information centres

There are MS Society local information and support centres
in many locations around the country. These centres are
staffed by volunteers who can help you with information
about MS and services in your area. Call 020 8438 0799
for the details of your nearest centre.
Local branches
The MS Society has a network of over 300 local branches
across the UK. The branches run by trained volunteers
provide information about MS and local services, a chance
to meet others affected by MS and take part in a range
of activities. For more information, check the MS Society
website or call 020 8438 0944.
14
Further reading
MS Essentials Factsheets: Posture and movement. Reviewed

and edited by neuro-physiotherapists, these factsheets aim to
help people make the most of their physical abilities and move
safely while maintaining as much independence as possible.
They also recommend ways to maintain good posture the
essential foundation for good movement.
Physical activity for neurological conditions by Dr Helen

Dawes. Published by Oxford Brookes University (2010).
A handbook to help people with neurological conditions, including
MS, to exercise more easily and safely. Includes advice on
how to plan an exercise routine. Available on loan from the
MS Society Information Centre in London. See opposite for
contact details.
Exercises for people with MS by Liz Betts. Published by the

Multiple Sclerosis Trust (2004), ISBN: 1-904156-05-3. This book
includes diagrams and explanations of exercises that can be
done when lying down, sitting, kneeling or standing. It also
has tips on good posture. Available to download from the MS
Trust website: www.mstrust.org.uk
Yoga tips for people with multiple sclerosis by Sue Lee.

Published by Class Publishing, London (2009), ISBN
1859592287. Includes a series of straightforward yoga exercises
and breathing techniques to benefit people with MS, aimed at
helping to ease and manage problems such as muscle stiffness
and spasticity.
Stretching for people with MS. An illustrated manual

by Beth E. Gibson. Published by the National MS Society (2007).
Diagrams and descriptions of exercises that you can do alone.
This booklet is available to download from the website
of the American MS society, www.nationalmssociety.org
Stretching with a helper for people with MS. An illustrated

manual by Beth E. Gibson. Published by the National MS

Society (2007). Diagrams and descriptions show a range of
exercises including passive stretching and range-of-motion.
This booklet is available to download from the website
of the American MS society, www.nationalmssociety.org
15
Exercise DVDs and videos
All these DVDs and videos are available on loan from the MS
Society library. Contact the UK Information Team.
Move it for MS! The fun way to exercise with Mr Motivator.

Published by the MS Trust. (2007) A DVD of exercises developed
by an MS physiotherapist in conjunction with Mr Motivator, made
especially for the MS Trust. Available from the MS Trust.
Telephone 01462 476700 or go to www.mstrust.org.uk
Pathways: exercise video for people with limited mobility.

Produced on video and DVD by Mobility Limited (1993) in the
USA. The video demonstrates exercises that can be done alone
or with a carer.
Yoga with Sue Lee. Four yoga routines (DVDs) designed to loosen
the entire body and improve posture and breath. There are also
a number of exercises online at www.yoga4pwms.co.uk
Leannes chair workout by Leanne Grose. Published by

Ilc Media (2007). A DVD of exercises for people who use
wheelchairs. Not MS specic.
Single chair yoga volume 1 by Lakshmi Voelker. (2007)

A yoga DVD for people who use wheelchairs. Not MS specic.
Available from www.gettwhereyousit.com
Yoga for MS and related conditions by S. Crotzer. Published

by Pathways Notes Canada (1993). Exercise DVD for people
with limited mobility.
Useful organisations
Chartered Society of Physiotherapy

The professional body for physiotherapists in the UK.

They can provide details of registered physiotherapists
who specialise in neurological conditions such as MS.
14 Bedford Row
London WC1R 4ED
Telephone 020 7306 6666
www.csp.org.uk
16
Inclusive Fitness Initiative (IFI)

Supports the fitness industry to become more inclusive,
increasing participation by disabled people
www.inclusivefitness.org
Telephone 0114 257 2066
Textphone 18001 0114 257 2066
Multiple Sclerosis National Therapy Centres

A federation of therapy centres around the UK. They offer
a variety of therapies. Some centres offer physiotherapy clinics
and water-based exercise.
PO Box 126
Whitchurch SY 14 7WL
Telephone 0845 367 0977
www.msntc.org
Multiple Sclerosis Therapy Centres Scotland

Duncrievie House
College Road
Methven
Perth PH1 3PB
Telephone 01738 840357
www.mstherapycentres.org.uk
References
1 Brown, T. R. and Kraft, G. H. (2005) Exercise and rehabilitation

for individuals with multiple sclerosis. Physical Medicine and
Rehabilitation clinics of North America, 16, 513-55.
2 Rietberg, M. B. et al. (2004) Exercise therapy for multiple
sclerosis. The Cochrane Database of Systematic Reviews,
Issue 3, Art. No. CD003980.
3 Snook, E. M. and Motl, R. W. (2009) Effect of exercise training
on walking mobility in multiple sclerosis: a meta-analysis.

Neurorehabilitation and neural repair, 23, 108-116.
4 White, L. J. and Dressendorfer, R. H. (2004) Exercise
in multiple sclerosis. Sports Medicine, 34(15), 1077-100.
5 Petajan, J. H. et al. (1996) Impact of aerobic training on fitness
and quality of life in multiple sclerosis. Annals of Neurology, 39(4),
432-41.
17
6 MS Society (2008) Diet and nutrition. Third edition. London,

MS Society.
7 Caldis-Coutris, N. et al. (2002) Nutritional management of multiple
sclerosis. Canadian Pharmaceutical Journal/RPC, 135(5), 31-40.
8 Karpatkin, H. I. (2005) Multiple sclerosis and exercise. A review of
the evidence. International Journal of MS Care, 7, 36-41.
9 The Chartered Society of Physiotherapy (2000) Warm
up to exercise CSP 277. London, CSP.
10 Frohman, E. M. et al. (2000) Neuro-opthalmic signs
and symptoms. In: J. S. Burks and K. P. Johnson (eds.)
Multiple sclerosis. Diagnosis, medical management
and rehabilitation. New York, Demos. p341-76.
11 Schuhfried, O. et al. (2005) Effects of whole-body vibration
in patients with multiple sclerosis: a pilot study. Clinical
Rehabilitation, 19, 834-42.
12 Wunderer, K. et al. (2009) Effects of whole body vibration
on strength and functional mobility in multiple sclerosis.
Physiotherapy Theory and Practice, 26, 374-384.
13 Schyns, F. et al. (2009) Vibration therapy in multiple sclerosis: a
pilot study exploring its effects on tone, muscle force, sensation
and functional performance. Clinical Rehabilitation, 23, 771-781.
14 MS Society (2009) Fatigue. Second edition. London, MS Society.
15 Oken, B. S. et al. (2004) Randomized controlled trial of yoga
and exercise in multiple sclerosis. Neurology, 62(9), 2058-64.
16 Herndon, R. M. and Horak, F. (2000) Vertigo, Imbalance, and
Incoordination. In: J. S. Burks and K. P. Johnson (eds.) Multiple
sclerosis. Diagnosis, medical management and rehabilitation.
New York, Demos. p333-9.
17 Husted, C. et al. (1999) Improving quality of life for people with
chronic conditions: the example of tai chi and multiple sclerosis.
Alternative Therapies, 5, 70-74.
18 Freeman, J. A. et al. (2010) The effect of core stability training
on balance and mobility in ambulant individuals with multiple
sclerosis: a multi-centre series of single case studies. Multiple
Sclerosis, 16, 1377-84.

19 National Institute for Health and Clinical Excellence (2003) NICE
Clinical Guideline 8. Multiple Sclerosis: management of multiple
sclerosis in primary and secondary care. London, NICE.
20 Mills, M. and Allen, J. (2000) Mindfulness of movement as a
coping strategy in multiple sclerosis. A pilot study. General
Hospital Psychiatry, 22, 425-31.
18
21 Segal, N. A. et al. (2004) The effects of Pilates training on

flexibility and body composition: an observational study.
Archives of Physical Medicine and Rehabilitation, 85, 1977-81.
22 MS Society (2009) Managing bladder problems. Fourth edition.
London, MS Society.
23 Dasgupta, R and Fowler, C. J. (2003) Bladder, bowel and sexual
dysfunction in multiple sclerosis. Management strategies. Drugs
2003, 63(2), 153-66.
24 Haselkorn, J. K. and Loomis, S. (2005) Multiple sclerosis and
spasticity. Physical Medicine and Rehabilitation Clinics of North
America, 16, 467-81.
25 Logemann, J. A. (2000) Dysphagia. In: J. S. Burks and K. P.
Johnson (eds.) Multiple sclerosis. Diagnosis, medical
management and rehabilitation. New York, Demos. p485-90.
Authors and contributors
This edition edited by Jude Burke

Previous edition written by James Bailey and edited by
Sarah Westlake
With thanks to: Paul Bradbury, Dr Alasdair Coles, Cath Heynes,
Alison Johnson, Liz Norton, Max Oates, Dr Carolyn Young
and all those people affected by MS who contributed to
this publication.
Disclaimer: We have made every effort to ensure that the
information in this publication is correct. We do not accept liability
for any errors or omissions. The law and government regulations
may change. Be sure to seek local advice from the sources listed.
Suggestions for improvement for future editions are welcomed.
Please send them to infoteam@mssociety.org.uk
Multiple Sclerosis Society 2011
First edition, September 2006
Second edition, January 2011 (reviewed September 2013)

This title will be reviewed within three years.
19
MS Society
Multiple sclerosis (MS) is the most common disabling
neurological disorder affecting young adults and we estimate
that around 100,000 people in the UK have MS. MS is the result
of damage to myelin the protective sheath surrounding nerve
fibres of the central nervous system. This damage interferes with
messages between the brain and other parts of the body.
For some people, MS is characterised by periods of relapse
and remission while, for others, it has a progressive pattern.
For everyone, it makes life unpredictable.
The MS Society is the UKs largest charity dedicated to supporting
everyone whose life is touched by MS. We provide a freephone
MS Helpline; grants for home adaptations, respite care and
mobility aids; education and training; support for specialist MS
nurses; and a wide range of information.
Local branches cater for people of all ages and interests and are
run by people with direct experience of MS.
The MS Society also funds around 80 vital MS research projects
in the UK.
Membership is open to people with MS, their families, carers,
friends and supporters. You can help the work of the MS Society by:
becoming a member
making a donation
offering your time as a volunteer
Contact information
MS National Centre MS Society Cymru
372 Edgware Road Temple Court
London NW2 6ND Cathedral Road
Cardiff CF11 9HA
Telephone 020 8438 0700
Telephone 029 2078 6676
MS Society Scotland
National Office National MS Helpline
Ratho Park Freephone 0808 800 8000
88 Glasgow Road (weekdays 9am-9pm)
Ratho Station www.mssociety.org.uk
Newbridge EH28 8PP
Multiple Sclerosis Society.
Telephone 0131 335 4050 Registered charity
nos 1139257 / SC041990.
MS Society Northern Ireland
Registered as a limited
The Resource Centre
company in England and
34 Annadale Avenue
Wales 07451571.
Belfast BT7 3JJ
Telephone 028 9080 2802 ES21/0913/2

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M20.

405_Essentials 21_artwork 18/9/14 08:29 Page 1

Second edition, January 2011

This publication is available in large print and audio CD

Avoiding the knock-on effects of MS

Loss of muscle strength and fitness

Weight gain or loss

long courses of steroids.7 Gentle activity strengthens the bones

What sort There is no single exercise that could be called an MS exercise.

Sports, activities and physiotherapy can all provide a good

Start slowly with any new regime

Warm up and cool down

is not so important. Muscle stiffness or painful sensations could

You may want to use sports centres, exercise classes or personal

Wherever you exercise, try to keep the space well ventilated.

How can a Physiotherapy is often recommended when there is a specific

Sports equipment and aids

How do I get physiotherapy?

Physiotherapy is also available privately. If you are considering

Exercise for As well as improving your general health, exercise and

Balance and walking difficulties

benefits from tai chi, including improved walking speed.17 One

Muscle spasms and stiffness

Bladder and bowel problems

Low mood, anxiety and depression

as low mood, anxiety or depression do arise, exercise may help.

that works for you, it can be inspiring and energising.

Exercise is good for everyone, including people with high levels

Passive stretching and range-of-motion

stiffness. In particular, they can prevent joints from locking up

kinds of duties because of legal restrictions. To get the assistance

Strength and posture

Finding exercise in everyday activities

Further MS Society publications

MS Society website and members magazines

MS Society National Centre, Information Centre

Local information centres

for the details of your nearest centre.

MS Essentials Factsheets: Posture and movement. Reviewed

Physical activity for neurological conditions by Dr Helen

Exercises for people with MS by Liz Betts. Published by the

Yoga tips for people with multiple sclerosis by Sue Lee.

Stretching for people with MS. An illustrated manual

Stretching with a helper for people with MS. An illustrated

manual by Beth E. Gibson. Published by the National MS

Exercise DVDs and videos

Move it for MS! The fun way to exercise with Mr Motivator.

Pathways: exercise video for people with limited mobility.

Leannes chair workout by Leanne Grose. Published by

Single chair yoga volume 1 by Lakshmi Voelker. (2007)

Yoga for MS and related conditions by S. Crotzer. Published

Chartered Society of Physiotherapy

The professional body for physiotherapists in the UK.

Inclusive Fitness Initiative (IFI)

Multiple Sclerosis National Therapy Centres

Multiple Sclerosis Therapy Centres Scotland

1 Brown, T. R. and Kraft, G. H. (2005) Exercise and rehabilitation

on walking mobility in multiple sclerosis: a meta-analysis.

6 MS Society (2008) Diet and nutrition. Third edition. London,

Sclerosis, 16, 1377-84.

21 Segal, N. A. et al. (2004) The effects of Pilates training on

Authors and contributors

This edition edited by Jude Burke