Maintaining Strength and Independence with Multiple Sclerosis
IN SHORT
Multiple sclerosis (MS) can affect leg strength, balance, walking, and independence. Although MS disrupts communication between the brain and muscles, progressive strength training can help build and maintain muscle strength, improve mobility, and support everyday activities. An individualized exercise program can help improve physical function and make walking, standing, and transfers easier. Because MS symptoms can change over time, strength training should be adjusted to a person's abilities and energy levels.
A diagnosis of Multiple Sclerosis (MS) brings uncertainty, but it does not mean giving up independence or mobility. While MS is a progressive neurological disease, the right strength training program can help preserve muscle strength, maintain mobility, and support quality of life.
Research shows that progressive strength training can improve muscle strength and may also support walking ability, balance, and overall physical function. For many people, maintaining leg strength is an important part of supporting independence and continuing to participate in everyday life.
This article explains how multiple sclerosis causes leg weakness, how progressive resistance training can help, and why ongoing exercise plays an important role in maintaining mobility.
How Multiple Sclerosis Affects Each Person Differently
Multiple Sclerosis is an autoimmune disease in which the immune system attacks myelin, the protective covering around nerve fibers in the brain and spinal cord. As this insulation becomes damaged, communication between the brain and muscles becomes slower or interrupted - similar to a frayed electrical wire struggling to carry a signal.
This disruption affects movement, balance, coordination, sensation, and muscle control.
Common symptoms include muscle weakness, especially in the legs; difficulty walking and reduced mobility; poor balance and coordination; fatigue that interferes with daily activities; muscle stiffness (spasticity) and spasms; and numbness, tingling, or cognitive changes that affect sensation and concentration.
Multiple Sclerosis is not the same for every person. Some individuals have relapsing forms of MS, where symptoms flare up and then improve, while others have progressive forms, where symptoms gradually worsen over time.
The severity of symptoms also varies considerably. Some people remain active with relatively mild limitations for many years, while others experience more significant weakness, balance problems, or mobility challenges.
Because MS affects everyone differently - and symptoms can change over time - exercise programs should evolve with the individual. Exercises, resistance, and intensity should be adjusted to match each person's current strength, mobility, fatigue, symptoms, and personal goals.
How Multiple Sclerosis Causes Leg Weakness
Multiple Sclerosis primarily affects the brain, spinal cord, and the nerves that control your muscles. As the immune system damages the myelin surrounding nerve fibers, messages from the brain no longer reach the muscles as efficiently. The result can include muscle weakness, stiffness, spasms, poor coordination, and fatigue.
Although MS changes how muscles function, it does not eliminate the muscles' ability to adapt to strength training. Healthy muscle tissue can still respond to progressive resistance exercise.
Much of the leg weakness experienced with MS develops from a combination of impaired nerve signaling, reduced muscle activation, spasticity and muscle spasms, fatigue that makes it difficult to stay physically active, and muscle deconditioning as reduced activity causes muscles to lose strength and endurance.
Without ongoing strengthening, these changes can create a cycle:
Impaired nerve signaling → Less activity → Muscle weakness and deconditioning → Greater fatigue → Reduced mobility and independence
The encouraging news is that progressive resistance exercise can help preserve and improve muscle strength, even when nerve signaling is impaired. While strength training cannot repair damaged myelin, it can help people make the most of their remaining muscle function and support movement during everyday activities.
Research reviews have found that resistance training can improve muscle strength in people with MS, with some studies also showing improvements in functional mobility and walking performance.
Benefits of Leg Strength Training for Multiple Sclerosis
Progressive resistance exercise can help people living with MS build strength and support everyday function. Benefits vary depending on symptoms, mobility, and the individual's exercise program.
1. Improves Walking and Everyday Mobility
Stronger leg muscles can make daily activities such as walking, climbing stairs, standing from a chair, and getting in and out of bed easier. Building strength may help individuals with MS continue performing everyday tasks with greater confidence.
2. Supports Balance and May Help Reduce Fall Risk
Muscle weakness and impaired balance can increase the risk of falls. Strengthening the hips, thighs, calves, and core can support stability and help with everyday movement. Balance-specific exercises may also be needed to address the changes MS can cause in coordination and postural control.
3. May Help with Fatigue
Fatigue is one of the most common symptoms of MS. As muscles become stronger, some everyday tasks may require less effort. However, fatigue varies from person to person, and strength training does not improve it for everyone. Exercise should be adjusted to avoid excessive fatigue.
4. Supports Muscle Function and Movement
Progressive resistance training helps strengthen muscles that may be difficult to activate fully because of impaired nerve signaling. This can support more effective movement and greater confidence with everyday activities.
5. Helps Maintain Comfortable Movement
Muscle stiffness and spasms can make movement more difficult. An individualized program that combines appropriate strengthening with mobility and flexibility exercises may help support more comfortable movement. The effects on spasticity vary, so exercise should be tailored to the person's symptoms.
6. Supports Long-Term Independence
Maintaining leg strength can help people continue walking, transferring, and participating in family and community activities. Ongoing exercise can support independence as physical needs change.
Why Strength Training Is Different from General Exercise
For people living with Multiple Sclerosis, all movement can be beneficial, but not all exercise produces the same results.
Walking, stretching, yoga, cycling, and aerobic exercise can improve cardiovascular health, flexibility, and overall well-being. However, these activities may not provide enough resistance to maintain or rebuild leg strength.
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Progressive strength training is different because it intentionally challenges the muscles to become stronger. Even when nerve signaling is impaired by MS, healthy muscle tissue can still respond to appropriately prescribed resistance exercise.
Unlike activities that primarily improve endurance or flexibility, strength training targets the muscles responsible for everyday movement. By gradually adjusting resistance over time, these muscles can continue adapting, helping people preserve mobility, perform daily activities, and maintain independence.
The goal isn't simply to exercise - it's to build and maintain the strength needed to continue doing the activities that matter most.
Research also suggests that combining strength training with balance or motor-control exercises may be useful for addressing different aspects of mobility.
Adapting Exercise to the Changing Nature of MS
One of the unique challenges of Multiple Sclerosis is that symptoms can fluctuate from day to day. A person may feel stronger and have more energy one day but experience increased fatigue, weakness, muscle stiffness, or balance difficulties the next.
That doesn't mean exercise should stop - it means the program should adjust.
On stronger days, resistance and functional challenges may be increased when appropriate. On more challenging days, the focus may shift toward maintaining strength, improving movement quality, and preserving mobility without causing excessive fatigue.
Continuing to move safely - even during more difficult periods - can help reduce the muscle loss and deconditioning that may occur when activity declines.
The goal isn't to push through symptoms. It's to provide the appropriate level of challenge so muscles continue receiving the stimulus they need to stay as strong and functional as possible.
Exercise plans should account for individual symptoms, heat sensitivity, fatigue, balance, and any changes in health. A physical therapist or other qualified healthcare professional can help determine appropriate modifications.
Why Ongoing Exercise Matters
Many people with Multiple Sclerosis receive physical therapy after a relapse, hospitalization, or decline in mobility or function. Therapy can help restore strength, improve walking, and rebuild confidence during recovery.
Because MS can cause changing levels of leg weakness, fatigue, muscle stiffness, and balance difficulties, maintaining strength is an ongoing challenge. When structured exercise ends, reduced activity can lead to further muscle weakness, making standing, walking, and transfers more difficult.
Maintaining leg strength isn't about stopping the progression of MS - it's about helping your muscles remain as strong and functional as possible despite the neurological changes caused by the disease.
Ongoing, individualized strength training can help preserve mobility and independence as symptoms and physical needs change.
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How Tandem Strength & Balance Helps Individuals Living with Multiple Sclerosis
At Tandem Strength & Balance®, we provide private-pay, in-home physical therapy for individuals who want to continue building and maintaining strength after Medicare or insurance-covered therapy ends.
Because MS affects everyone differently, each exercise program is tailored to the individual's strength, mobility, fatigue, balance, and changing symptoms. Every session is adjusted to how the person is functioning that day.
We focus on progressively strengthening the muscles needed for standing, walking, transfers, and everyday activities. By exercising in the home, we can work on the movements that matter most in a person's daily life.
Our goal is to help individuals with MS maintain strength, preserve mobility, and remain as independent as possible as their needs change.
Why Families Choose Tandem Strength & Balance
Living with MS often means adapting to changing physical abilities. TandemSB provides ongoing, individualized in-home physical therapy designed to support strength and independence beyond a short episode of care.
Families choose TandemSB for ongoing private-pay physical therapy after insurance-covered visits end, one-on-one in-home care with the same physical therapist whenever possible, progressive strength training focused on the muscles needed for everyday movement, personalized exercise programs that adapt to changes in fatigue, muscle stiffness, balance, and strength, and consistent support through periods of stability, recovery, and changing abilities.
Our focus is helping individuals with MS stay as strong, mobile, and independent as possible.
Common Questions About Exercise and Multiple Sclerosis
Can strength training make Multiple Sclerosis worse?
Appropriately prescribed strength training is generally considered safe for many people with MS and can improve muscle strength. Exercise should be individualized based on symptoms, fatigue, mobility, and overall function.
Can people with MS build leg strength?
Yes. Although MS disrupts the nerve signals that activate muscles, muscle tissue can still become stronger with progressive resistance training. Building strength can help support movement and everyday function.
Is walking enough exercise for someone with MS?
Walking is beneficial for cardiovascular health and endurance, but it may not provide enough resistance to build or maintain muscle strength. A combination of aerobic activity, progressive strength training, and balance exercises may address different physical needs.
Why is ongoing exercise important if my MS symptoms come and go?
Many people with MS experience periods when symptoms improve, followed by times when weakness, fatigue, or balance problems become more noticeable. Continuing an appropriately adjusted strength training program can help maintain muscle strength and support function as symptoms change.
How do you exercise safely during an MS flare-up or on days when symptoms are worse?
Exercise may need to be modified during a flare-up or when symptoms worsen. At Tandem Strength & Balance, every session begins with an assessment of how you're functioning that day. We adjust exercises, resistance, and intensity based on your strength, fatigue, balance, and muscle stiffness. New or worsening symptoms should be discussed with your healthcare provider before continuing exercise.
Research and Further Reading
These research reviews provide additional information about strength training and exercise for people living with multiple sclerosis.
1. Multiple Sclerosis and Progressive Resistance Training: A Systematic Review - Reviews evidence on muscle strength and other outcomes.
2. Effects and Optimal Dosage of Resistance Training in People with MS: A Systematic Review and Meta-Analysis - Examines strength, functional capacity, balance, and fatigue.
3. Home- and Community-Based Strength Training in Multiple Sclerosis: A Systematic Review and Meta-Analysis - Examines how strength training at home or in the community may affect strength, walking, mobility, and balance.
Get Strong. Stay Strong. Maintaining leg strength is an ongoing part of supporting mobility and independence while living with Multiple Sclerosis.