Prehabilitation for MS: A Proactive Approach

When it comes to managing health—especially with chronic conditions like multiple sclerosis (MS)—timing matters. Two essential approaches to care are prehabilitation (prehab) and rehabilitation (rehab). While they may sound similar, they play very different roles in your health journey.

Prehab vs. Rehab: What’s the Difference?

Prehabilitation refers to proactive interventions that happen before there’s a major decline in function. The goal is to maintain wellness, prevent disability, and support long-term health.

Rehabilitation, on the other hand, is reactive—used after functional impairment or a worsening of symptoms. Its purpose is to help you recover and adapt to changes.

Why Prehab Matters

Prehabilitation focuses on preserving function, building resilience, and delaying or even preventing disability. Through education, exercise, and wellness strategies, prehab helps you stay ahead of the game—especially in the context of MS.

In contrast, rehab works to restore function once issues have already emerged. It uses task-specific exercises and compensatory strategies to regain independence and improve quality of life.

The Role of Prehab in MS Care

1. Preserve Physical Function

Prehab helps maintain strength, flexibility, endurance, and balance before noticeable decline occurs. By building “reserve capacity,” it gives your body a buffer to better handle future relapses or disease progression.

2. Delay or Prevent Disability

Early intervention reduces the risk of complications like deconditioning, falls, or joint stiffness. Even mild impairments, if addressed early, can prevent larger losses down the road.

3. Promote Neuroplasticity and Resilience

Your brain can adapt—even with MS! This ability, called neuroplasticity, is enhanced by movement. The right kinds of exercise challenge your body and brain to work together, improving balance, strength, and coordination. This keeps you active and independent longer.

4. Educate and Empower

Prehab teaches you how to monitor fatigue, manage symptoms like overheating, and pace yourself. It gives you tools to take charge of your exercise and wellness.

5. Support Mental Health and Cognitive Function

Exercise benefits more than your body. It boosts mood, reduces anxiety, and helps with thinking and memory. Plus, it fosters connection and purpose—especially important after a new diagnosis.

6. Establish Baselines for Future Comparison

Functional assessments—like gait, strength, and fatigue scores—set a benchmark. That way, you (and your care team) can catch subtle declines early.

7. Tailor Long-Term Wellness Programs

A prehab program helps personalize your exercise plan based on your goals, values, and current health. It can also encourage lifestyle changes in diet, sleep, and stress management that support brain and body health.

Exercise Guidelines for People with MS

You don’t have to wait for symptoms to start. Movement is medicine—especially when it’s regular and tailored to your needs.

Aerobic Exercise (for Heart & Lung Health)

• Frequency: 2–3 times/week
• Duration: 10–30 minutes/session
• Intensity: Moderate (breathing faster but still able to talk; 11–13 on a 20-point effort scale)

Resistance Training (for Strength)

• Frequency: 2–3 times/week
• Sets/Reps: 1–3 sets of 8–15 reps targeting major muscles (legs, arms, back, core)

Flexibility (for Stretching)

• Frequency: 2–3 times/week
• Duration: Hold each stretch for 30–60 seconds, repeat 3–4 times
• Focus Areas: Hamstrings, calves, shoulders

Neuromotor Training (for Balance & Coordination)

• Frequency: 3–6 days/week
• Duration: 20–60 minutes/session
• Focus: Activities that improve balance and body control—key for fall prevention

Reference:  Kalb R, Brown TR, Coote S, Costello K, Dalgas U, Garmon E, Giesser B, Halper J, Karpatkin H, Keller J, Ng AV, Pilutti LA, Rohrig A, Van Asch P, Zackowski K, Motl RW. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler. 2020 Oct;26(12):1459-1469. doi: 10.1177/1352458520915629. Epub 2020 Apr 23. PMID: 32323606; PMCID: PMC7575303. 

Examples of Prehab Exercises

• Aerobic: Walking, cycling (stationary or outdoor), swimming, rowing, or using an arm or leg ergometer
  • Exercises for Endurance- Can Do MS
• Neuromotor: Pilates, dance, Tai Chi, virtual reality games, horseback riding (hippotherapy), or specific balance exercises
  • Exercises for Balance- Can Do MS
• Flexibility: Stretching exercises or gentle yoga
  • Exercises for Flexibility – Can Do MS
• Resistance: Lifting weights, resistance bands, or doing bodyweight exercises like squats or pushup
  • Exercises for Strength – Can Do MS

REMINDER: Everyone is different. A physical therapist can help create a program that fits your needs and energy levels.

How to Build a Prehab Program

• Set a personal goal. Start with something that matters to you.
  • “I want to keep walking my dog every day.”
  • “I want to have more energy in the afternoons.”
  • “I want to stay steady on my feet.”

• Switch it up and make it fun

• Rotate activities to avoid boredom and overuse.
• Include hobbies like dancing, swimming, hiking, or group fitness classes.
• Consider virtual reality games, Pilates, or horseback riding if you enjoy them!

• Track your progress

• Keep a journal or use an app to note how you feel after workouts.
• Adjust based on fatigue, heat sensitivity, or stress.
• Celebrate small wins!

• Work with a physical therapist

• A neuro PT can help design a plan just for you.
• They will focus on your current strengths and prepare you for possible changes down the road.

Consider a virtual exercise program offered by Can Do MS.

• MS Moves ® is an expert-led exercise program designed to boost your fitness and function for everyday life. You’ll receive a customizable, multi-month workout plan, expert support from our Can Do Coaches, and regular Zoom meetups for guidance, motivation, and community connection. Follow along at your own pace, then join our MS Moves meetup where coaches demo exercises, offer modifications, and answer your questions live.

The Power of Starting Early

Whether or not you have symptoms, getting started early matters.

• Starting care early helps protect your brain and body. Early treatment (including medication, exercise, and lifestyle changes) can slow down disease progression. It helps you build strength before any symptoms may get in the way. 
• Learn tools to stay ahead. A physical or occupational therapist can teach you how to manage energy, avoid fatigue, and move better—even before problems start.
• Support your long-term independence. The earlier you start building healthy habits, the more likely you are to stay mobile, independent and active over time.
• It gives you a strong care team and plan. Having a neurologist, rehab team, and support system in place makes it easier to respond quickly if symptoms ever do appear or worsen.

Prehab isn’t just about exercise—it’s about empowerment. It helps you stay strong, independent, and ready for whatever comes your way.