Development of evidence-informed physical activity guidelines for adults with MS

Historically, people living with MS were advised against engaging in physical activity. This advice was based on the fact that exercise could result in a worsening of neurological symptoms including fatigue, mobility and vision problems. Current research has provided evidence to support that exercise is in fact beneficial and safe for people living with MS and it is now considered to be an important aspect of the overall management of the disease. That being said, there is still a large percentage of people living with MS who are inactive. Research suggests that up to 78 per cent of people with MS do not engage in physical activity as compared with the general population, of whom 38 per cent are inactive. Clearly there was a need for evidence-based information about appropriate physical activity for people living with MS and their health care teams. Recognizing this need, a research team developed the Canadian Physical Activity Guidelines for Adults with MS.


Development Process of the Canadian Physical Activity Guidelines for Adults with MS

The Guidelines project team was lead by Drs. Amy Latimer-Cheung of Queen’s University and Kathleen Martin Ginis of McMaster University, both with extensive expertise in the development of physical activity guidelines in adults with mobility limitations.

The Guidelines were developed using a rigorous process that is considered the international standard for guideline development. First, researchers conducted a systematic review of relevant literature related to MS and exercise. The review included 54 studies that reported on one or more of the following key outcomes: physical capability, muscular strength, mobility, fatigue and health related quality of life (HRQOL). The review included people between the ages of 18 and 65 with relapsing-remitting MS and progressive MS. The disability range of the adults included in the review was EDSS 0 to 7.

A consensus panel met to review the research evidence. This panel included researchers with expertise specifically related to exercise and MS along with key stakeholders including health care professionals and service providers, including the MS Society of Canada. The consensus panel discussed the reviewed evidence and developed a guideline based on the evidence and it was then circulated to over 300 health and fitness professionals and people living with MS for feedback.


The Canadian Physical Activity Guidelines for Adults with MS

Based on the team’s findings and stakeholder feedback, the research team concluded that to achieve important fitness benefits, adults living with MS with mild to moderate disability (EDSS 0-7) need at least 30 minutes of moderate intensity aerobic activity twice per week and strength training activities twice per week. In addition, meeting the guidelines may also reduce fatigue, improve mobility and enhance health-related quality of life.



The Canadian Physical Activity Guidelines for Adults with MS were developed to provide a basis for exercise prescription, target goals for promoting physical activity and to serve as a benchmark for monitoring activity levels among individuals with MS.

The Guidelines also provide a reference to appropriate physical activity levels, including the minimum frequency, intensity, duration and type of physical activity necessary for improved fitness among adults with MS. In addition to the Guidelines, the Get Fit Toolkit was created to outline how a person with MS can include safe, appropriate and effective physical activity into their weekly routine.


The development of the Canadian Physical Activity Guidelines for Adults with MS was funded by a grant from the Canadian Institutes of Health Research and the Public Health Agency of Canada.

Development of Evidence-Informed Physical Activity Guidelines for Adults with Multiple Sclerosis. Latimer-Cheung AE, Martin Ginis KA, Hicks AL, Motl RW, Pilutti LA, Duggan M, Wheeler G, Persad R, Smith KM. Arch Phys Med Rehabil. 2013 Sep;94(9):1829-1836.e7. doi: 10.1016/j.apmr.2013.05.015. Epub 2013 Jun 11.