Multiple Sclerosis Society of Canada

The Guidelines

To achieve important fitness benefits, adults (aged 18-64 years) with multiple sclerosis who have mild to moderate disability need at least:

  • 30 minutes of moderate intensity aerobic activity 2 times per week
  • Strength training exercises for major muscle groups 2 times per week
  • Meeting these Guidelines may also reduce fatigue, improve mobility and enhance elements of health-related quality of life.

Detailed Guidelines

Aerobic Activity Strength Training Activity
How often? Two times per week Two times per week
  • Aerobic and strength training activities can be done on the same day
  • Rest your muscles for at least one day between strength training sesions
How much?

Gradually increase your activity so that you are doing at least 30 minutes of aerobic activity during each workout session.

Repetitions are the number of times you lift and lower a weight.

Try to do 10-15 repetitions of each exercise. This counts as 1 set.

Gradually work up to doing 2 sets of 10-15 repetitions of each exercise.

How hard?

These activities should be performed at a moderate intensity.

Moderate-intensity physical activity is usually a 5 or 6 on a scale of 10, and causes your heart rate to go up.

As a general rule if you're doing moderate-intensity activity you can talk, but not sing a song, during the activity.

Pick a resistance (free weights, cable pulleys, bands, etc.) heavy enough that you can barely, but safely, finish 10-15 repetitions of the last set.

Be sure to rest for 1-2 minutes between each set and exercise.

How to?

Some options for activity include:

Aerobic activities

  • Upper Body Exercises: arm cycling
  • Lower Body Exercises: walking, leg cycling
  • Combined Upper and Lower body exercises: elliptical trainer

Strength training activities for the upper and lower body

  • Weight machines
  • Free weights
  • Cable pulleys

Other types of exercise that may bring benefits

  • Elastic resistance bands
  • Aquatic exercise
  • Calisthenics

Questions and Answers

Who are the Guidelines for?

These Guidelines are appropriate for adults (aged 18-64 years) with minimal to moderate disability resulting from either relapsing-remitting or progressive forms of multiple sclerosis.

Who should use the Guidelines?

People living with multiple sclerosis, their families, health care professionals and organizations that promote exercise or serve adults with MS may use these Guidelines as a tool for making exercise recommendations or developing exercise programs.

Why were the Guidelines developed?

The Guidelines were developed to provide a basis for exercise prescription, target goals for promoting physical activity and serve as a benchmark for monitoring activity levels among individuals with MS.

The Guidelines address a significant gap in informational resources available for individuals with MS as well as health care professionals and provide a foundation for program and policy development.

What will the Guidelines tell me?

The Guidelines outline how a person with MS can include safe, appropriate and effective physical activity into their daily routine. They also provide a reference to what are appropriate physical activity levels.

Specifically, the Guidelines provide the minimum frequency, intensity, duration and type of physical activity necessary for improved fitness among adults with MS.

Where can I find the Guidelines?

The Guidelines are available here and on the Canadian Society of Exercise Physiology (CSEP) website.

How will the Guidelines help adults with MS?

Following the Guidelines can improve aspects of fitness related to aerobic endurance and muscle strength. Improved fitness is especially important for people with multiple sclerosis for whom rates of inactivity are high and deconditioning is common.

Meeting these Guidelines may also reduce fatigue, improve mobility and enhance elements of health related quality of life. Experts agree that currently there is no scientific evidence that following these Guidelines will result in relapse of multiple sclerosis symptoms or worsen fatigue or health related quality of life. The potential benefits exceed the potential risks associated with physical activity.

What if I am unable to meet all of the Guidelines?

For those who are currently physically inactive, activities performed at a lower intensity, frequency and duration than recommended may bring some benefit. It is appropriate for inactive adults to gradually increase duration, frequency and intensity as a progression towards meeting the Guidelines.

While participating in either aerobic activity or strength training will yield some specific fitness benefits, participating in both types of activity will yield a broader range of fitness benefits.

Who created the Guidelines and how were they created?

The Guidelines were developed using a rigorous process that is considered the international standard for guideline development. First, researchers conducted a systematic review of relevant literature related to MS and exercise. A consensus panel met to review the research evidence. This panel included researchers with expertise specifically related to exercise and MS along with key stakeholders including health care professionals and service providers. The consensus panel discussed the reviewed evidence and developed a guideline based on the evidence. The newly developed Guidelines were circulated to over 300 health and fitness professionals and people living with MS for feedback. The Guidelines were revised based on the feedback and finally approved by the members of the consensus panel.

Who is releasing the Guidelines?

The Canadian Society of Exercise Physiology is releasing the Guidelines in partnership with the MS Society of Canada and ParticipACTION.

The Canadian Institutes of Health Research (CIHR) were involved in the funding of the development process.

How do these Guidelines differ from the Canadian Physical Activity Guidelines for Adults and other population specific guidelines?

The Guidelines for adults with MS recommend a dose that is lower than the amount suggested for the general population (150 minutes of moderate-to-heavy intensity aerobic activity each week, and strength training 2 times per week). This variation is a function of differences in a) the evidence used to inform the current Guidelines and b) the lower basal fitness levels of adults with MS. Thus, individuals with MS are likely to experience improvements in fitness from a smaller dose of exercise than adults in the general population.

The Guidelines also differ from those recommended for adults with spinal cord injury. The recommended dose of physical activity for adults with MS is greater in duration yet lower in intensity than that recommended for adults with spinal cord injury. Again, these differences reflect differences in the evidence base informing each specific guideline.

What about surveillance and monitoring?

The physical activity patterns of adults with MS have not previously been monitored. However, with the development of the new Guidelines, activity levels of individuals with MS can now be assessed by the North American Committee on MS (NARCOMS) which currently monitors disease management activities related to multiple sclerosis.

More information for health practitioners

Improved fitness is especially important for people with multiple sclerosis for whom rates of inactivity are high and deconditioning is common. Following these Guidelines can improve aspects of fitness related to aerobic endurance and muscle strength. While participating in either aerobic activity or strength training will yield some specific fitness benefits, participating in both types of activity will yield a broader range of fitness benefits.

These Guidelines refer to activities that should be performed in addition to usual activities of daily living. Adults with MS may wish to speak to a health professional to find out what types and amounts of physical activity are appropriate for them. Those who are pregnant or have other medical conditions in addition to MS should talk to a health professional before beginning an exercise program. A health professional might include a doctor, a physiotherapist or a qualified exercise professional. Supervised exercise is advisable but not essential when starting or returning to exercise.

For those who are currently physically inactive, activities performed at a lower intensity, frequency and duration than recommended may bring some benefit. It is appropriate for inactive adults to gradually increase duration, frequency and intensity as a progression towards meeting the Guidelines.

Meeting these Guidelines may also reduce fatigue and improve mobility. Experts agree that currently there is no scientific evidence that following these Guidelines will result in relapse of multiple sclerosis symptoms or worsen fatigue or health-related quality of life. The potential benefits exceed the potential risks associated with physical activity.