Resistance Training for Muscle Weakness in Multiple Sclerosis (MS)

This brief outlines the evidence and provides a practical guide for implementing resistance training to combat muscle weakness in patients with Multiple Sclerosis. It covers the significant strength and functional gains your patients can achieve, backed by recent systematic reviews and randomized controlled trials.

Research: June 2025

This infographic from the Physiotherapy Evidence Database (PEDro) summarizes the findings of a systematic review on resistance training for improving walking speed in people with MS.

Key Findings

1Resistance training significantly improves muscle strength in people with MS.
2Gait and functional mobility can be improved, especially when resistance training is combined with motor control exercises.
3Resistance training can help reduce fatigue, a common and debilitating symptom of MS.
4Improvements in quality of life have been reported, although more research is needed in this area.

It's a common misconception that resistance training is unsafe or too strenuous for people with MS. The opposite is true. A growing body of evidence shows that a well-designed resistance training program is one of the most effective things you can do to improve your patient's muscle strength, function, and quality of life. A 2024 systematic review and meta-analysis in the Journal of Clinical Medicine, which included 12 studies, found that resistance training resulted in significant improvements in muscle strength. The analysis showed a medium-to-large effect size, which is quite impressive. The typical protocol involves 2-3 sessions per week, focusing on major muscle groups with 2-3 sets of 1-2 multi-joint exercises. For strength, the intensity should be around 70-85% of your patient's one-repetition maximum (1RM). For power, a lower intensity of 40-60% 1RM with faster concentric movements is recommended. It's crucial to individualize the program based on the patient's specific presentation and tolerance, paying close attention to fatigue levels. The evidence also points to modest but significant improvements in gait, especially when resistance training is combined with other exercises that challenge motor control. So, don't be afraid to push your patients a little, the benefits are well worth it.

Clinician's Note

What I've found works best is to start slow and build confidence. Many patients with MS are hesitant to lift weights because they're afraid of getting hurt or making their fatigue worse. I usually start with bodyweight exercises or very light resistance bands to teach proper form and show them they can do it. I also make sure to schedule training sessions on days when they typically have more energy. It's all about finding that sweet spot where you're challenging them enough to make progress but not so much that you're causing a flare-up. And remember to celebrate the small wins. For someone with MS, being able to lift a slightly heavier weight or do one more repetition is a huge accomplishment.

Clinic Action Plan

1. Patient Selection: Patients with mild to moderate disability (EDSS ≤ 6.5) who are not in an active exacerbation are ideal candidates. 2. Initial Assessment: Establish a baseline with a 5-repetition maximum (5-RM) test for key muscle groups (e.g., leg press, chest press). Also, assess functional measures like the Timed 25-Foot Walk and the 5-Time Sit-to-Stand. 3. Initial Protocol: Start with 2 sessions per week on non-consecutive days. Prescribe 2 sets of 10-15 repetitions at an intensity of 60-70% of their 1RM. Focus on large, multi-joint exercises like squats, rows, and overhead presses. 4. Progression: When the patient can comfortably complete 2 sets of 15 repetitions, increase the weight by 5-10%. You can also progress by increasing the number of sets or the frequency of sessions. 5. Red Flags: Watch for signs of overexertion, such as excessive fatigue, increased spasticity, or pain that lasts for more than a few hours post-exercise. If these occur, reduce the intensity or volume of the next session.

Common Mistakes to Avoid

•Prescribing a generic, one-size-fits-all program.
•Not properly educating the patient on the difference between muscle fatigue and MS-related fatigue.
•Focusing only on strength and neglecting power and motor control.
•Not modifying the program based on the patient's day-to-day symptoms.

Frequently Asked Questions

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