Table 1.

The current exercise guidelines for people with mild to moderate MS, reproduced by kind permission from the Canadian MS Society. © 2013. Canadian Society for Exercise Physiology. * modifications courtesy of Kim et al., 2019 [73].

	General Aerobic Activity	Advanced Aerobic Activity *	Strength Training
How often?	2/3 times per week	5 times per week	2/3 times per week
How much?	Gradually increase your activity towards being able to complete 30 min of aerobic activity during each workout session	Increase your activity towards being able to complete 40 min of aerobic activity during each workout session	Repetitions are the number of times you lift and lower a weight Try to do 10–15 repetitions of each exercise. This counts as 1 set Gradually work up to doing 2 sets of 10–15 repetitions of each exercise
How hard?	The activities should be performed at a moderate intensity. Moderate intensity physical activity is usually between 11 and 13 on the 20-point RPE scale, and it causes your heart rate to go up. Another rule of thumb, if you are doing moderate-intensity activity you can talk, but not sing a song, during the activity An alternative way of measuring moderate intensity of exercise is 40–60% VO2peak or HRpeak	The activities should be performed at a moderate to vigorous intensity. Intensity of exercise can approach 15 on the 20-point RPE scale. Another rule of thumb, if you are doing vigorous-intensity activity you can only say a few words while doing your activity. An alternative way of measuring moderate intensity of exercise is 70–80% VO2peak or HRpeak	Choose a resistance (using free weights, cable pulleys, bands etc) heavy enough that you can barely, but safely, finish 10–15 repetitions of each exercise You should rest for 1–2 min between each set and exercise, or alternate with a different resistance exercise (e.g., upper body then lower body)
How to?	Options should be feasible and sustainable, and might include
	Some options for general aerobic activities include Upper body exercise: arm cycling, seated shadow boxing Lower body exercise: walking, leg cycling Combined upper and lower body exercises: elliptical trainer	Some options for advanced aerobic activities include Same as the general guidelines Running Road cycling	Strength training activities Weight machines Free weights Cable pulleys
	Other types of exercise that may bring benefits Elastic resistance bands Aquatic exercise Calisthetics
Special considerations	Progressions should start with either duration or frequency and finally progress intensity per tolerability of the person Rest your muscles 2 to 4 min in between sets and muscle groups. Rest your muscles for at least 1 day between strength training sessions Aerobic and resistance training can be performed on the same day as aerobic exercise training, depending on tolerability MS Specific symptoms (i.e., fatigue and heat sensitivity) should be identified and discussed before prescribing exercise routine.