Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis

Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis

An active lifestyle has many benefits for adults living with multiple sclerosis (MS).

The rate of MS in Canada is among the highest in the world.  Evidence indicates that engaging in exercise has the potential to improve and/or maintain functional ability, aerobic fitness, strength, fatigue and depression among people with MS. Unfortunately, many people with MS are physically inactive.

These 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 about exercise available for individuals with MS as well as healthcare professionals, and provide a foundation for program and policy development.

The Guidelines are the first rigorously developed guidelines for prescribing and developing exercise programs for adults living with multiple sclerosis (MS).

The new Guidelines are evidence-based. They are based on systematic reviews of the best available evidence. They were developed by experts and reviewed by health and fitness professionals and Canadians living with MS.


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 irrespective of gender, race, ethnicity or socio-economic status. People living with multiple sclerosis, their families, health care professionals and organizations that promote exercise or serve adults with multiple sclerosis may use these guidelines as a tool for making exercise recommendations or developing exercise programs.

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 multiple sclerosis 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 multiple sclerosis 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, 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.


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,
  • AND
  • 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.

Here is what is Recommended

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 sessions
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 aerobic and strength training exercise that may bring benefits

  • Elastic resistance bands
  • Aquatic exercise
  • Calisthenics
Download the Guidelines

MS Get Fit Toolkit

A Resource to Help Adults Living with multiple sclerosis (MS) meet the Canadian Physical Activity Guidelines. 



MS Get Fit Toolkit
Toolkit (4-page PDF) - describes the Guidelines and outlines how a person with MS can include safe, appropriate and effective exercise in their daily routine.
Download the Toolkit

MS Get Fit Toolkit Insert

Insert (2-page PDF) - a guide to assist adults with MS to set goals and prepare an action plan to achieve them.

Download the Insert