When Can I Start Exercising After a Neurological Diagnosis?
Whether starting for the first time after your diagnosis or getting back to the activities you love, exercise is essential—and it can be fun!
After a neurological diagnosis, it can feel overwhelming to start exercising again. You may worry about falling, fatigue, or whether physical activity could make symptoms worse. With the right guidance, exercise can be safe, beneficial, and even enjoyable. Whether you are easing back into activity or starting for the first time, there are ways to find an exercise plan that fits your diagnosis, abilities, and goals.
Michael Jaffee, MD, FAAN, FANA, a neurologist at the University of Florida Brain Injury, Rehabilitation, and Neuroresilience Center, explains that in medical school, he learned people with neurological conditions should avoid all physical activity. “We [now] know that exercise can enhance and promote recovery of neurological conditions,” he says, “So then the question becomes, ‘What kind of exercise should you do and how?’ Some people really enjoy [it], some don’t,” says Dr. Jaffee. “For those who don’t, we try to find creative things, fun things, things that involve a social component. That’s a lot more appealing than, ‘Just go take a walk around the block.’”
“A large majority of the people we see recognize the importance of exercise,” says Robynne Braun, MD, director of the Brain Rehab and Recovery Lab at the University of Maryland Medical Center. “Some are willing to do what it takes to get back, but others are a little more hesitant, often because they’re afraid they might fall.”
Part of Dr. Braun’s job is to relieve those worries and suggest to patients that they might be capable of doing more than they think. Some people with neurological conditions have gone way beyond what doctors thought was possible:
Jac Folkert, a 55-year-old Los Angeles resident, is one example of this. In the twenty years since her multiple sclerosis diagnosis, she has completed 40 marathons—including 18 finishes at the competitive Boston Marathon—and over 25 ultramarathons, which is any race longer than the traditional 26.2-mile marathon. Folkert, a runner since high school, has done it with the support of her neurologist. “[My doctor] says, ‘Whatever you’re doing, continue doing exactly that,’” she shares with a chuckle.
It is very common for people with neurological disorders to want to get back to the activities they enjoy, especially if they were active before their diagnosis. And if you didn’t exercise before your diagnosis, you can get started now.
Talk to your doctor to learn the best way to start exercising again. The goal is to return to activity as soon as possible, but only when it can be done safely. “Exercise is a vital part of any treatment plan,” says Michelle Fabian, MD, FAAN, MEHP, an associate professor of neurology at Mount Sinai Hospital. “But, it’s important that you’re out of the acute phase of your illness first.”
Your neurologist is a trusted person to make the assessment of if you are ready to begin an exercise program.
Physical Therapy May Be a Good Option
“If I was diagnosed with a neurological illness, the first thing I’d do is seek out a physical therapist with expertise in that disease,” says Fay Horak, PhD, PT, a professor of neurology at Oregon Health & Science University.
The controlled, supervised environment of a physical therapy (PT) facility can help you overcome fearful feelings about pain, fatigue, or falling. “I think PT is great for building confidence,” says Dr. Fabian. “It’s the first step for a lot of my patients.”
Beyond that, you may want to consider a certified, one-on-one trainer. “The PT is not there to meet with you every week for the rest of your life,” says Dr. Horak. “A certified personal trainer can help shape and guide your program, going forward.”
What Is the Best Exercise to Do After a Neurological Diagnosis?
There is no perfect exercise for everybody. However, there is one that is right for you. “I think there is an exercise type that can fit almost any type of diagnosis, and any lifestyle and risk factor,” says Dr. Braun.
Finding the one that’s right for you means trying a few different activities. “Research shows that virtually all forms of exercise support brain health,” says Dr. Fabian.
For beginners, it’s best to start slowly and build gradually. Four years ago, New York City resident, Sally Koslow, began taking Pilates and dance-exercise classes at a local gym. “It was intimidating at first,” says Koslow, who was diagnosed with Parkinson’s disease in 2018. She explains that she struggled with balance more than most of the women in the class. But she didn’t give up. She now takes four classes a week consistently and no longer compares herself to others. “I just focus on what I can do and do it the best I can,” she says.
How to Return to the Exercise You Love
You might be able to get back to your favorite sports and activities, but you’ll have to be patient and flexible. “I work with a lot of athletes, and they just want to start back at the same intensity they had before their injury or illness,” says Dr. Jaffee. “I have to remind them that it took time to build up to that level of fitness, and it will probably take some time to build up to that again.”
With time and effort, most people will see improvement. “I have patients that run marathons and climb mountains,” says Dr. Fabian. While they need to learn what their body is capable of after diagnosis, she says that most people can return to exercise in some way.
Work Toward the Guidelines at Your Own Pace
Experts recommend moderate-intensity aerobic activity for a minimum of 30 minutes, five days per week. They also recommend vigorous-intensity aerobic activity for a minimum of 20 minutes, three days per week, and resistance training to increase muscular strength and endurance at least two days per week. Additionally, for older adults, regular balance training is suggested.
That may sound like a lot, especially if you are just beginning. Your neurologist can help you modify the amount of exercise to be right for you. As you plan your exercise program—whether it’s walking or water aerobics; bicycling or balance classes—you should start “slow and low.” This means keeping a slow pace with low intensity and low impact.
Get Fit, Find Community
Certified fitness instructor Leigh Anne Bolling Richards has been directing the Rock Steady Boxing classes since 2017. Four days a week, she leads a class of about 17 people with Parkinson’s disease through a workout that is less about traditional boxing than it is about movements designed to address Parkinson’s disease symptoms like imbalance and stiffness.
The class offers more than the benefits of physical exercise: it offers the benefits of human connection. “We’ve really become like family,” says Richards. Once per week, members share updates with each other about their health, their frustrations—and their achievements. The group has seen many successes: Richards says she has one participant who was using a walker when he started but no longer needs it.
“I’ve had people with Parkinson’s tell me, ‘I’m not ready to come to your class, because I’m not ready to see what my future is,” says Richards. “I tell them, ‘You should come because you’ll see it might be brighter than you thought.’”
There are many options for group exercise beyond boxing. Consider joining a running or walking club to make exercise more fun and help build social connections. Exercising in a group will hold you accountable to your goals and motivate you to work harder. Talk to your insurance company about reimbursement for gym memberships, group classes, or both.
Getting back to exercise after a neurological diagnosis may take time. Start slowly, listen to your body, and work with experts to help you regain strength, confidence, and independence. Over time, exercise can become not just part of your treatment, but a source of connection, enjoyment, and hope for what’s still possible.
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