Multiple Sclerosis Physiotherapy Resource Centre: Exercise, Fatigue, Balance & Walking

Multiple Sclerosis can affect movement in very different ways. One person may mainly notice fatigue. Another may struggle with balance, leg weakness, foot clearance, stiffness or confidence when walking. Others remain highly active and want to preserve strength and fitness for as long as possible.

Physiotherapy is therefore not one fixed programme. A useful MS rehabilitation plan is built around the person's current symptoms, function, goals, fatigue and safety.

Why exercise matters in MS

Current NICE guidance encourages people with MS to exercise and notes that regular exercise can be beneficial. For people with fatigue or mobility problems, aerobic exercise, progressive resistance work and balance exercise may all have a role when they are appropriate for the individual.

The important point is progression rather than simply doing more. Exercise may need to be shorter, supported, seated, split across the day or reduced during periods of increased fatigue.

Strength and preventing deconditioning

Reduced activity can lead to secondary loss of strength and fitness. Rehabilitation may therefore include targeted work for the hips, knees, ankles, trunk and upper body, alongside functional tasks such as sit-to-stand, stepping, transfers and walking.

Balance and falls prevention

Balance rehabilitation can range from supported weight shifts and seated reaching to standing balance, stepping, obstacle work, head turns and higher-level dynamic tasks. The level needs to match the person's current ability and falls risk.

Walking, gait and foot clearance

Walking difficulties may relate to weakness, fatigue, balance, stiffness, coordination or reduced foot clearance. Physiotherapy may work on strength, stepping control, gait practice, pacing, suitable walking aids and, where appropriate, referral for orthotic or specialist assessment.

Fatigue changes how rehabilitation is prescribed

Fatigue is not a reason to abandon exercise, but it can change the dose. Rest breaks, shorter sets, prioritising the most useful exercises and avoiding unnecessary repetition can make rehabilitation more sustainable.

Different ability levels need different exercises

Someone who is mainly bed-based needs a very different programme from someone training in a gym. Useful rehabilitation can include bed mobility and active-assisted movement, seated strength and balance, supported standing, walking practice, resistance training, cardiovascular exercise and higher-level agility work.

When to seek individual advice

MS affects people differently. New or worsening neurological symptoms, a suspected relapse, significant changes in walking or balance, repeated falls, or concerns about medication or treatment should be discussed with your MS nurse, neurologist, GP or appropriate healthcare professional. Exercise advice should be adapted to your individual symptoms and safety needs.

A structured MS physiotherapy resource

For a much larger exercise library and practical self-management guidance, see The Complete Multiple Sclerosis Physiotherapy & Rehabilitation Guide. It is a 353-page digital guide with 91 exercises ranging from bed-based and seated rehabilitation through to standing, balance, walking, strength, gym and higher-level exercise.

The guide is designed to complement, not replace, individual medical and physiotherapy care.