Exercise & MS: An interview with Dr. Albert Lo

Following our June 11 webcast, Living Well with MS: Lifestyle, Diet and Complementary Therapies, we sat down with Dr. Albert Lo to get answers to your questions about exercise and MS. Here is the first half of our interview with Dr. Lo.

Are there any specific workouts, keeping one's personal limits in mind, that are recommended?

First of all, I just want to be transparent that I’m approaching this subject as a physician and neurologist who is involved in translational clinical research. I’m not an exercise physiologist, physiatrist or physical therapist, and therefore don’t have their specialized training or perspective.

Physical activity and exercise are important for everyone’s wellness as they reduce the risk of diabetes, hypertension, obesity, cardiovascular disease and dementia. If you exercise as little as 75 to 100 minutes a week, you decrease your risk for all of these. The majority of Americans don’t get enough of just plain physical activity – partially due to our changes in work environments over the years –  and there is a difference between physical activity that you engage in for health promotion and the training you do for cardiovascular fitness or for a particular athletic event.

We can all increase our amount of physical activity. Just because you have a diagnosis of MS doesn't change your need for physical activity for health reasons. It actually may be even more important. The recommendation for all Americans is:

At least 30 minutes of moderate exercise five times a week;


At least 25 minutes of vigorous exercise three times a week;


Moderate to high intensity strengthening activity at least 2 days a week.

For those without significant mobility issues, moderate exercise can include walking, mowing the lawn, sweeping, vacuuming or mopping. Vigorous exercise may include jogging, shoveling the snow, loading hay or other farm work. If you have mobility issues, consider a hand ergometer, which is basically a hand operated bicycle-like crank with hand-holds rather than pedals. There have been studies using these devices and they have resulted in beneficial fitness gains as well as production of important growth factors (BDNF) within the nervous system. You should check with your physician who may be able to write a prescription.

Currently, there’s no one size fits all specific workout for MS. A lot of the guidelines I recommend to my patients are based on the American College of Sports Medicine or American Heart Association guidelines. When they ask about exercise for rehabilitation, one of the first things I look at is the purpose of the workout – is it for cardiovascular fitness? Aerobic fitness? Muscle strengthening? Cardiovascular fitness may require more endurance training, while strengthening often involves progressive weight training.

It’s also important to keep in mind that specific exercise recommendations may be different for each person with MS, depending on your level of stamina, how active you are, how old you are, and if you have other health issues. Everyone has different abilities. If you haven’t exercised regularly, you may want to see a specialist who can help you evaluate how much – and what types of – exercise you should be doing. You may also want to check with a physician and exercise physiologist if you have cardiovascular risk factors.

Is there anything I can do to fight fatigue?

As we all know, many people with MS experience fatigue, and many of those people are also heat-intolerant. When you increase your core body temperature even by less than one degree, the wire-like nerve axons that have lost their myelin coating due to MS don’t conduct your body’s messages very well. Therefore, if you are sensitive to heat, you may need to try to cool yourself more actively during workouts by using fans, drinking cold water or wearing a cooling vest. You may also need to take a few more breaks, especially during endurance activities. Fatigue also tends to be worse at the end of the day, so you may want to try exercising early in the day to see if that makes a difference.

If the ideas above don’t seem to do the trick, there are also some medications that can help with fatigue. It’s also important to get enough sleep, as lack of sleep can greatly impact fatigue levels.

Please tune next week as we discuss the effects of over-exertion, exercise for people with mobility issues and rehabilitation exercise with Dr. Lo.
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Albert Lo, MD, PHD, CPH

Dr. Albert C. Lo is an Associate Professor in the Departments of Neurology and Community Health of Brown University, and is an Associate Director of the Center of Excellence for Regenerative and Restorative Medicine at the Providence VA Medical Center.

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  • RoseJean Zucuskie   Jun 26, 2013 2:52 PM
    Thank You Dr. Lo. I was diagnosed 11 years ago with MS. I worked 8 years as a medical asssistant until MS made me take my disability. I have asked all these years why I get so fatigued especially when I am active. Through your explaination of exercise and heat and how it effect the nerves and the nerves that are effected by MS, I now know and understand why when I do things and get over heated I also get very fatigued and have to lay down. Iver the years I noticed when it's hot out and the humidity is high I get more fatigue and have to rest more, Now I understand why. Thank you at least I don't feel like I'm going crazy anymore.
  • Karen Phillips   Jun 26, 2013 3:03 PM
    HI, was DX with PP MS in Jan of 05 , and have always exercised. My balance is bad (only walk with a walker/roller) but my strength is strong and my transfer ability is really good because my strength is strong from exercising. I do leg liftes with a 5lb wt,leg push-outs, stretches and ride a stationary bike (for 3 miles) 5 days a week. It really works! It's the only thing that works. Thanks for the good words! Karen
  • Bonnie Burkley   Jun 26, 2013 4:37 PM
    I was dx 1980 at the age of 33. I am 66 and have lived with MS half my life. For the last 15yrs, I have taken Avonex. Last MRI showed slowing of lesions. I can walk, see, normal until heat and fatigue set in.....been hesitant about exercise....I am a homemaker...so I clean and do my regular chores. I am curious if I should do "work-outs" with a Physical Therapist? On some days I'm to tired to accomplish anything!! We are on fixed income. I don't know if Medicare would cover my expenses for help. Either way, I'm an ole hand in this battle....I depend on My Lord...I am His....He is mine!!!
  • limerick6  Jul 1, 2013 12:05 PM
    I have heard mixed reports from patient and Dr.'s telling me that Cardio is not good for MS survivors. I am curious to know what you think about this and if it is ok how long is too long to keep my body temp up during said exercise? I am very heat sensitive.
  • mary   Jul 2, 2013 1:37 PM
    Recently I had physical therapy for my back. I was also suppose to have strengthening exercises to my right leg as well, but my therapist was very reluctant in giving me the strength training. I only received the back exercises. His reasoning for not doing the strength training was he didn't want to cause further weakness in my leg. Please understand that I''ve had strength training before in my legs after experiencing an exacerbation and I did fine. My baseline is walking with a cane and sometimes if I know there will be a lot of walking involved I will take my four wheel walker. My question to you is shouldn't part of the strength training be up to me as well? Also, why is it a problem for some therapist and not a problem for other therapist?
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    Bobo  Jul 21, 2013 12:44 PM
    I think we have to find the physical exercise that works for us. A good place to combat the heat but get exercise and stretching may be at your local YMCA, if it's a lap-swimming pool. Ours keeps the temperature between 84 and 82, and there are aerobic exercise pool classes every day. Great stretching and workout without the strain on joints and efforts to stay balanced.
    I worked with a personal trainer who developed strength training programs tailored to my abilities. Most involve hand weights and balance training, and I feel stronger and more stable IF I get myself to the Y on a regular basis. I don't use the machines, as trainer said they would do little to improve core strength, the key to balance.
    Both my GP and neurologist want me to stick with the exercising, only watching that I don't exercise to the point of heat fatigue. Our Y is air-conditioned. Maybe check into your local Y programming, of course with your doctors' approval.