Exercise and physical activity are crucial for people with multiple sclerosis (MS). Studies suggest staying active may improve MS symptoms, such as fatigue, spasticity, depression, weakness and balance problems, and cognitive impairment. Additionally, exercise is good for heart, lung, and bone health and may mitigate the effects of co-existing conditions such as obesity, diabetes, cognitive decline, high cholesterol, and hypertension.

The challenge during the COVID-19 pandemic is to continue to exercise despite not being able to go to the gym, park, community center, or specialized classes. Fortunately, the internet offers an abundance of exercise classes. In fact, exercising at home may prove more convenient and cost-effective than going to the gym. It may also provide access to some of the foremost experts in MS-based exercise. Consider these strategies for jumpstarting an exercise program at home.

1. Schedule time. Set aside 20 to 60 minutes of some type of aerobic activity—something that moves major muscle groups and increases your heart rate—each day. You can divide the time into shorter periods, initially, with the goal of increasing duration and endurance. Unstructured activity can include walking, running, bicycling, climbing stairs, dancing, walking the dog, playing with your kids, or housecleaning. If you have limited mobility, try standing (if feasible or practical), manually propelling a wheelchair, or chair exercises. Exercise time is fluid and depends on how you feel on any given day. Less than 20 minutes is not “bad,” and more than 60 minutes is not “perfect.”
2. Supplement with mind-body exercise. Exercises that combine mindful awareness, therapeutic movement, coordinative exercise, restorative postures, and/or a focus on breath control include yoga, tai chi, Pilates, qigong, and some forms of dance. These types of exercise can relieve muscle tightness, improve flexibility, manage stress, and help improve cognitive and psychological well-being. Add this to your routine—aiming for two to three times a week— either instead of, or in addition to, higher-intensity exercise.
3. Add strength-training. Lifting weights helps build or maintain muscle strength and bone health. It’s also good for brain health and can improve function. If you don’t have a set of weights or machines at home, use homemade weights like large cans of food or full water jugs, bags, or backpacks. Many companies are now offering deals on home exercise equipment such as resistance bands, dumbbells, and kettlebells. For a low- or no-equipment option, do chair squats or wall-supported push-ups. Shoot for two to three times a week and try combining resistance training with aerobic exercise in the same workout (10 to 30 minutes of aerobic and 10 to 30 minutes of resistance training).
4. Learn a new skill. Try an exercise like dance or martial arts that requires you to master a new movement, pay more attention, or coordinate your body in sequences. Even practicing movements such as a tennis or golf swing, boxing punches, or agility drills adds novelty, makes cognitive demands, and incorporates unique physical skills. Integrate this into your current routine or dedicate a specific time, for example 30 minutes of dance on a Thursday.
5. Keep your cool. If you are sensitive to heat—many people with MS are—turn on a fan during your workout or keep a cold wet towel or some ice chips handy to keep from overheating.
6. Listen to your body. If your physical and cognitive abilities fluctuate, adjust your workouts accordingly. Do higher-intensity workouts when you feel at your peak and choose restorative activities when you don’t. If you feel sluggish, in pain, or unmotivated, gently ask yourself if you could do a minimal amount of exercise and stick with that for the day. And remember that incorporating daily exercise is a lifelong pursuit.
7. Check out these resources. For ideas, instruction, and inspiration, consider these online programs: MS Gym, Above MS, ChairFit with Nancy, Evergreen Health, Online Strength Training for MS, and Multiple Sclerosis Trust.
   
   Dr. Giesser is professor emeritus of clinical neurology at the David Geffen School of Medicine at UCLA in California, a staff physician at Pacific Neuroscience Institute, and a member of the Brain & Life editorial board.

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