Advices on Exercise

Advice on Exercise

Arm and shoulder exercises

Advice for performing shoulder strengthening exercises.

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Adductor muscle exercises

Adductor muscle exercises

Advice for performing hip adductor or internal thigh muscle self-stretching exercises.

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Jesus Conesa, Madrid Multiple Sclerosis Association

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  1. 1. Planning

    Develop a plan of action with the appropriate healthcare professional, taking into consideration rehabilitation and physical therapy exercises. He/she will help you discover your body's potential and its limitations. Ask your healthcare professional to show you how to perform the exercises correctly and which ones will benefit you the most.

  2. 2. Consistency

    Staying in shape in multiple sclerosis is like a long-distance race. It is essential to be consistent: it is always better to do even a little exercise, as long as it is performed consistently.

  3. 3. Moderation

    Gentle and constant physical activity is essential for minimizing the complications that are sometimes associated with some of the symptoms of multiple sclerosis, as well as for maintaining and even improving the functions affected by the disease. Moderation includes listening to your body: listen to what your body is telling you and rest when you feel tired.

  4. 4. Appropriate environment

    Do the exercises in a cool, comfortable and quiet location.

  5. 5. General advice

    - Wear loose clothing and shoes that do not limit your movement.

    - Make sure that the room temperature is comfortable. In winter, make sure that the heat is not too high in the room in which you do your exercises. In summer, use a fan or air conditioner or keep a window open. If the heat really bothers you, you can take a cold bath (50-60ºF) for 10 minutes (begin with warm water and slowly add cold water) before exercising.

    - If one side of your body is weaker than the other, take advantage of this strength by using the stronger side to move the weaker side. Your doctor or physical therapist can help you.

    - Breathe rhythmically and relax the facial muscles during each movement. People tend to make faces or hold their breath while they are performing new movements.

    - Avoid overexertion. Include rest periods and drink cool water to avoid overheating and dehydration.

    - Find the best time of the day to do your exercises. Some people prefer to do their exercises in the morning, while others feel it is better to divide them into two sessions, one in the morning and one in the afternoon.

    - Be aware of your limits and potential. Schedule regular and timely rest periods, so that your body gets used to a "pattern of activity."


  1. Spasticity recommendations

    • By performing specific exercises for muscular rigidity (spasticity), you will improve the muscle balance of not only the spastic muscles themselves, but of those muscles that are constrained by them, thereby improving your muscle dynamics and also coordination.
    • It is important to keep in mind that before performing the stretching exercises, you will need to prepare the muscle by slowly imitating the stretch and breaking down the resistance little by little (gear effect).
    • Avoid positions that cause or worsen your spasticity.
    • Go slowly. The movements must be performed slowly, giving the muscles enough time to stretch and relax. Sudden movements can increase spasticity and moving a spastic muscle into a new position can also worsen spasticity. If this happens, let the muscles rest for a a few minutes.
    • Do not force any part of your body. Make progress with your movements with as little pain as possible. You should know how to distinguish between pain and the feel of the stretching itself. If you feel pain, do not continue and consult your physical therapist before repeating the movement.
    • While you are exercising, try to keep your head straight.
    • If you are taking antispasticity medication, perform the exercises approximately one hour after taking it.

Loss of mobility

  1. Exercises for loss of mobility

    • Regarding the exercises to minimize loss of mobility, it is important to perform them slowly and in front of a mirror. These exercises are based on stretching and strengthening, as well as correcting your posture.
    • Some patients perform exercises that focus on using breathing techniques such as yoga, Tai Chi and Pilates, which help with mobility. Walking and aerobic exercise can also help.
    • To address difficult situations, like climbing stairs, you can exercise alternate muscles, like the glutes, as long as you have the proper support.

Recommended bibliography

1. Apuntes de Neurología 2005. Universidad de Ciencias de la Salud de Ponferrada.

2. Adler, S. Facilitación Neuromuscular Propiaceptiva en la Práctica, 2002. Second Edition . Publisher: Editorial Panamericana.

3. Bob Anderson. Estirandóse, 2002. Third Edition. Publisher: RBA Libros, S. A.

4. Calero M. Actuación del Fisioterapeuta en Esclerosis Múltiple. First Edition 2002. Publisher: Formación Álcala.

5. Lucera, María.”Propiocepción. Ejercicios con Balón”,1997. Publisher: Bellaterra.

6. Downie P. A. Cash. Neurología para fisioterapeutas, 1989. Fourth Edition. Publisher:  Editorial Panamericana.

7. Pellicer AM. Tratamiento fisioterápico en neurología. Primera Parte. 2007. Publisher: Colección Práctico Profesional.

8. Paeth, B. Experiencias en el Concepto Bobath. Fundamentos, Tratamientos y Casos, 2006. Publisher: Editorial Panamericana.

9. Pellicer. AM. Tratamiento fisioterápico en neurología. Segunda Parte. 2007. Publisher: Colección Práctico Profesional.

10. Sermef. Evaluación Clínica y tratamiento de la espasticidad, 2009. Publisher:  Editorial Panamericana.

11. Stokes, M. Fisioterapia en la rehabilitacion neurológica, 2006. Publisher: Elsevier, 2º Edición.

12. Ayán Pérez, CL. (2006): Esclerosis Múltiple y Ejercicio Físico. Wanceulen Editorial Deportiva.

13. De Souza Teixeira F, 2009. Entrenamiento en poblaciones especiales: esclerosis múltiple y entrenamiento físico., Revista Digital. Buenos Aires, Nº 128, enero. Available at:

14. Ejercicios prácticos de estiramiento para las personas con esclerosis múltiple. National Multiple Sclerosis Society. Available at:

15. Ejercicios para las personas con esclerosis múltiple. Federación española para la lucha contra la esclerosis múltiple (FELEM). Available at:

16. Fernández Fernández O, Fernández Sánchez VE, 2003. Esclerosis Múltiple: Concepto. Etiopatogenia. Fisiopatología. Manifestaciones Clínicas. Diagnóstico. Historia natural. Pronóstico. Servicio de Neurología. Hospital Regional Universitario Carlos Haya. Málaga.

17. Neiger H, 1998. Estiramientos analíticos manuales. Publisher:  Editorial Panamericana, Buenos Aires.

18. White L, Dressendorfer R (Sports Medicine, 2004): Exercise and Multiple Sclerosis. Department of Applied Physiology and Kinesiology, Center for Exercise Science, Applied Human Physiology Laboratory, University of Florida, Gainesville, Florida, USA.