Cover Story: Enhanced Wellness – Healthy Strategies for People with MS

By Tom Garry
Edited by Susan Wells Courtney
Reviewed by Barry A. Hendin, MD

Section 1: Preparing a Plan and Avoiding Obstacles

Introduction

Physical wellness and emotional well-being are vitally important for everyone, but particularly for members of the MS community, who strive to minimize symptoms and feel their best. This can be especially difficult when certain symptoms interfere with one’s routine or ability to stay active.

However, individuals with MS may be better equipped to improve their wellness and well-being by following the healthy strategies for pursuing those benefits listed throughout this cover story.

Creating a personalized plan that focuses on areas such as exercise, diet, and sleep, along with other activities, can result in long-term physical and emotional wellness – and this is something we should all strive to achieve!

Editor’s note: Individuals should not make any changes to their exercise routine, diet, or other daily activities without consulting their medical professional.

The importance of “why” versus “what” when taking on something new

Researchers report that roughly 80% of New Year’s resolutions are abandoned by mid-February. That statistic doesn’t surprise Robert Motl, PhD, an expert on exercise in MS who serves as Professor in the Departments of Kinesiology and Nutrition and Rehabilitation Services at the University of Illinois Chicago.

Dr. Motl explains that sustaining change requires identifying what drives you – and will keep driving you when the going gets tough.

“For example, when people with MS decide that they want to get more physically active, the first thing to think about isn’t which exercises they will do. Instead, they really should think long and hard about their ‘why.’ In other words, what are they hoping to accomplish or improve? They need to know their ‘why’ because not only will that give them motivation to start exercising, it will also give them something far more valuable: determination.

“The ‘why’ has to be something very salient, very meaningful to them because, invariably, exercise becomes hard. Sometimes it hurts or leaves us sore. Sometimes we’re tired afterwards. Sometimes we have other things that we want to do, but if you have the determination that comes from knowing your ‘why,’ this will help you to continue working toward your goal,” he says.

To define your “why” and record it for subsequent reference, please see “Mapping Your Path to Enhanced Wellness – A Self-Assessment and Personalized Planning Tool for People with MS” in Appendix #3.

Make a plan that works for you

Neurology professors use an adage to caution their residents against making generalizations about multiple sclerosis: “When you’ve met one person with MS, you’ve met one person with MS.”

The varied nature of the condition precludes one-size-fits-all approaches – but it also enables you to create a wellness plan tailored to your particular needs and goals. Again, the self-assessment tool in Appendix #3 can help. Dr. Motl recommends that the plan includes attention to what he calls the “trifecta” of good health – exercise, diet, and sleep. “Putting those three things together is key,” he says.

Stephanie L. Silveira, PhD, adds that in pursuing your goals, it’s important to consider not only your specific abilities and challenges but also your personal preferences. “With exercise, for example, find something that is both good for you and that you enjoy doing, which will make you more likely to do it consistently,” says Dr. Silveira, who serves as Assistant Professor in the Department of Management, Policy and Community Health at the UTHealth Houston School of Public Health in Houston, Texas.

Dr. Motl notes that it’s also essential to make an honest assessment of your current health status when setting your wellness goals and deciding how you will pursue them. “If you haven’t been very active recently, be realistic about where you are and if possible, start by walking for five minutes, and do that for a week or two. You won’t be as tired, stiff, or sore, and over time you can build on that success and steadily increase how long and how far you walk,” he says. For those with limited mobility, the main idea is to start slowly with whatever activity you are able to do, and then gradually increase the duration.

Identify and anticipate barriers, while allowing yourself time to take a break when needed

Good plans allow for the obstacles that can derail them.

Time tops the list of potential pitfalls to be considered. For example, let’s say that you want to exercise for 30 minutes four-times weekly. That’s great, but can you identify those four, half-hour slots that will always be available for you each week? And if you want to cut back on having take-out food for dinner in favor of making healthier meals at home, how does the prep time required work with the other demands on your evening schedule?

Dr. Silveira notes that people with MS often face another time-related obstacle: decreasing energy levels as the day goes by. “Fatigue is one of the most common symptoms of multiple sclerosis, and if it is a major factor in your life, you need to take it into account as you make plans for exercise, meal prep, or other activities,” she says.

In keeping with the adage, “The morning wins the day,” Dr. Silveira says that one simple approach is to schedule your exercise not long after rising, before other tasks deplete your energy – and perhaps hijack your time.

Dr. Motl explains that some of the biggest barriers people face involve their own perceptions or attitudes, including perfectionism and an “all-or-nothing” mentality.

“Let’s say that you have established a good exercise routine and are really seeing its benefits, but you come down with a cold that is leaving you congested and run down. You can either take a break from exercising and feel better in a few days, or try to push through and maybe require a week or more to recuperate.”

In such situations, he adds, “You need to give yourself the grace and the latitude to back off for a couple of days. Most people with MS are very good at knowing themselves and knowing when something is not right.

“It’s important to pay attention to that sense and to give yourself the rest you need. You can’t feel guilty about taking a couple of days off because your body needs it, but at the same time, you need to have a plan for how you will get going again when you feel better.”

The manifestations of MS are so numerous and nuanced that two people of the same age and gender, with the same form of the condition, and even the same predominant symptoms or Expanded Disability Status Scale (EDSS) score, can have markedly different challenges and abilities. For that reason, Dr. Silveira points out that it is important to keep the focus on what you are doing and to not be discouraged by the perception that someone else may be seeing greater or quicker results.

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Section 2: Involving Both Your Healthcare Team and Those Around You

Partner with your provider

With your “why” defined and your “what” sketched out, the next step is to make sure that your plan is just what the doctor ordered – or at least what the doctor approves.

“Any time you’re considering making a major change that will affect your health, it’s important to touch base with your neurologist and, as appropriate, other members of your healthcare team, to tell them what you have in mind and to get their guidance,” Dr. Silveira says.

She notes that clinicians can provide important insights on topics such as tweaking exercise regimens to avoid over-exerting muscles, how planned dietary changes could affect other conditions you may have, and potential drug-to-drug interactions between over-the-counter supplements and disease-modifying therapies or medications you are taking to treat MS symptoms.

“Consulting your MS provider doesn’t need to entail scheduling an in-person visit just for this purpose, much less waiting for your next regular visit several months down the road. In most cases, you can use the practice’s patient portal to outline your plan and get the clinician’s feedback within a couple of days. Alternatively, there’s always the ‘old school option’ of contacting the office to leave a message requesting that the provider call you back,” she adds.

MSAA’s Chief Medical Officer Dr. Barry Hendin is a neurologist and MS specialist with the Arizona Integrated Neurology MS Center, in Phoenix. Dr. Hendin notes that neurologists welcome and want the opportunity to weigh in on exercise, diet, and other lifestyle changes from the outset – at a time when they can provide expert guidance in advance on effective approaches and flag potentially problematic plans.

Dr. Hendin explains, “We’re able to provide patients with a view of the big picture. For example, it’s not uncommon for someone with MS to also have one or more chronic conditions, such as diabetes or high blood pressure. The impact that planned changes will have on those other diagnoses has to be considered. However, the good news is that in the great majority of cases, increasing physical activity, improving diet, reducing stress, and taking other steps that are beneficial in terms of MS, also are going to be helpful in managing any additional conditions.”

Involve those around you and look to them for support

The people around us can help – or hinder – our plans to make healthy changes. Dr. Silveira says that ensuring that those people facilitate rather than frustrate our efforts can come down to what she calls “one of the hardest things for all of us to do: engaging in an honest conversation.

“Perhaps someone else in the house handles the grocery shopping and meal preparation and favors foods that you now want to avoid. If you’re asking them to make changes that will have an impact on them and others, as well as you, it’s important to explain not only what you want to change, but why. You might say something such as, ‘I’ve noticed that when I eat a lot of ultra-processed foods, I have less energy the next day. Maybe you could pick up a pack of small carrots that I could munch on instead of crackers or cookies,’” she says.

Sleep environment is imperative for everyone, but it is an area where alignment between spouses or partners is particularly important. “The other person may want to keep the phone on the nightstand, but if it buzzes or lights up each time a notification arrives, that can interfere with your ability to get to sleep and stay asleep,” Dr. Silveira says.

She adds that room temperature and light levels should also be discussed, explaining the reasons for such changes during these discussions.

Enlisting the support of loved ones and friends, however, isn’t all a matter of explanation and negotiation. Your pursuit of enhanced wellness also provides an opportunity to enjoy more time with the people in your life – have a friend be your walking buddy or plan the week’s meals with a spouse or partner over a cup of coffee. Besides, as Dr. Silveira notes, the steps that you are taking to enjoy better health – such as exercising more or eating more fruits and vegetables – offer benefits to those who adopt them with you.

Also, introduce your health insurance plan to your wellness plan. That is, contact your insurer or managed care organization and see if they will cover one-time or ongoing consultation with a dietitian, exercise physiologist, physical therapist, or social worker. Similarly, some plans will provide partial reimbursement for gym memberships or have other features to support members’ well-being.

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Section 3: Exercise, Diet, Sleeping Well, and Caring for Your Mind and Spirit, Are Just What the Doctor Ordered!

Putting your wellness plan in motion – literally

MS is a whole-person condition, and Dr. Motl wants people with MS to appreciate that physical activity offers whole-person benefits. He says, “Exercise is a very powerful behavior that targets and influences nearly every physiological system in the human body. Because of that, exercise exerts many life-changing benefits for people with multiple sclerosis.

“If we start with the most obvious thing, exercise improves aerobic fitness and muscle strength, both of which are reduced in people with MS. Improvements in those two aspects of health enable people to do so much more in their lives. If you have more muscle strength, it can be easier to go up and down stairs, get in and out of a car, and carry your groceries into your house. If you have greater aerobic capacity, you have greater endurance for every single thing you do in daily life.”

The exercise physiologist explains that exercise has a sort of positive domino effect for people with MS. “As you become more aerobically fit and have greater muscle strength, that translates into reductions in fatigue. Reduced fatigue translates into improvement in depression, exercise capacity, daily physical activity, and cognition. As a result, the benefits of exercise ultimately extend all the way to quality of life. People with MS who exercise regularly have been shown to have better self-perceived quality of life than those who don’t engage in exercise,” he says.

Dr. Motl emphasizes that people with MS can – and should – draw upon evidence-based guidance when embarking on an exercise program.

He explains that the non-profit organization MS Canada has published guidelines grounded in the scientific literature.¹ Dr. Motl adds that those guidelines recommend that adults with MS who are aged 18-64 years old and who have a mild to moderate degree of disability need at least:

• 30 minutes of moderate-intensity aerobic activity two times a week
• Strength training exercises for major muscle groups two times per week

“The Canadian guidelines emphasize gradually increasing your level of physical activity and recommend resting your muscles for at least one day between strength training workouts. However, per the guidelines, aerobic and strength training can be done on the same day,” he notes, adding that the guidelines provide examples of appropriate activities.

But what about people with MS who have a greater degree of disability? An international panel of experts in exercise and MS provided recommendations informed by both the evidence and panelists’ professional opinions.²

These recommendations offer guidance across the MS disease course, with key messages and strategies for people with various Expanded Disability Status Scale (EDSS) scores. For example, for people with an EDSS score of 8.0 to 8.5, which reflects increasing difficulty performing activities of daily living and the need to use a wheelchair, the recommendations detail breathing exercises, stretches to support flexibility, core-strengthening exercises, and other activities.

“The point is that while you have to be mindful of your abilities and limitations and follow your MS provider’s guidance, there is always something you can do,” says Dr. Motl, who served on the expert panel. He adds that there is always a place you can exercise.

“Some people like to go to the gym because they find it motivating and they like the social interaction, but it’s perfectly okay to exercise at home. You can get some resistance bands or hand weights for strength training. You can do squats or chair stands – an exercise that involves slowly standing up from a chair and slowly sitting back down – and build a lot of strength in your quadricep muscles without any special equipment. And when possible, walking outside is another good option” he says. For individuals with limited mobility or strength, gentle exercises while sitting or even in a reclined position can be of great benefit.

The exercise physiologist notes that other important considerations, regardless of activity or setting, include:

• Staying adequately hydrated
• Exercising at a level of intensity that will yield benefits without over-exertion or injury
• Wearing appropriate clothing and shoes to be able to move freely, avoid overheating, and maintain a firm footing
• Potentially recruiting an exercise partner

He adds that the recommendations he helped shape also endorse early evaluation by a physical therapist, occupational therapist, or exercise or sports medicine physician experienced in MS to formulate an individualized plan. Similarly, he stresses that – per those recommendations – people with very limited physical mobility should have a trained assistant help them with exercise.

Making smart dietary choices goes a long way

We’ve all heard, “You are what you eat,” and to a certain extent, this is true! While we have several healthy alternatives, many of us are still tempted to indulge in those tasty but less healthy foods. As a result, weight problems are common, and in terms of MS, research has shown that obesity:

• Increases the risk of developing MS³
• Is common in MS, affecting 42.4% of 942 people recently diagnosed with the disease⁴
• Is associated with worse outcomes, including greater disease activity, faster disease progression, and reduced cognitive function and quality of life⁵

As a result of those and similar findings, nutrition has become a major area of focus for multiple sclerosis researchers. Specifically, they are examining whether particular diets can improve MS symptoms and alter the course of the disease.

Dr. Hendin says that while further research is needed, the Mediterranean diet and the MIND diet appear to offer benefits to people with MS. In an earlier interview with The Motivator, he noted, “Although I don’t endorse any one diet, I tend to like the Mediterranean diet, which emphasizes the vegetables, fruits, fish, nuts, and other foods that I recommend, along with whole grains and olive oil.”

The MIND diet draws on both the Mediterranean diet and another diet plan termed Dietary Approaches to Stop Hypertension, or DASH. Reflecting this combination, MIND is an abbreviation for Mediterranean-DASH Intervention for Neurodegenerative Delay.

Key components of the MIND diet include an emphasis on berries because of their antioxidant properties and on green, leafy vegetables because of their abundant nutrients, as well as a recommendation to eat fish at least once a week. Both the Mediterranean and MIND diets recommend limiting sweets and red meat.

A recent study involving more than 3,700 people with MS found that those who followed the MIND diet for several years had less disability, less fatigue, and a higher quality of life than those who did not follow the diet.⁶ Meanwhile, an analysis of seven studies involving more than 1,100 people with MS found that following the Mediterranean diet was associated with reduced relapse rates and less disability relative to other dietary practices.⁷

Dr. Hendin notes that many other diets and eating plans have been proposed by their supporters for people with MS. However, no specific diet is definitively recommended for MS. He says that while research continues to explore the impact of those approaches, following a few simple rules makes sense:

• Avoid processed foods as much as possible.
• Eat plenty of fruits and vegetables.
• Beware of fads, and of centering your diet around any one food.
• Choose healthy foods that taste good to you and mix up your menu throughout the week.

Dr. Silveira notes that your diet, like your exercise regimen, needs to work within the context of your larger life. If your schedule or your energy level doesn’t allow you to make dinner seven nights a week, make dinner when you can, and pick up salads rather than a pizza on a night when you can’t make dinner.

Dr. Motl warns against another mindset that can be self-defeating: “Just because you’re exercising, it doesn’t mean you can eat anything you want. You want physical activity and good nutrition to work together to make your body better,” he says.

Have a sound strategy for sound sleep

Both Dr. Motl and Dr. Silveira emphasize that the importance of a balanced approach extends beyond the mix of exercises you perform and the variety of foods you eat. They explain that it also means pairing physical activity with adequate sleep.

“When you’re working your body harder, it needs more rest and recovery. I know it can be hard to get a good night’s sleep, but when you’re increasing your physical activity and making healthy dietary changes, enhancing sleep rounds out the trifecta,” Dr. Motl says.

However, multiple sclerosis can pose as many challenges to sound sleep as it does to regular exercise. A recent analysis of 44 studies involving more than 7,000 people with MS found that 49.5% reported sleep disorders, including insomnia, obstructive sleep apnea, and restless leg syndrome.⁸

Dr. Silveira recommends a multi-faceted approach to addressing those challenges. She notes that while the approach is pertinent to all people, many of the steps are particularly important to those with MS because of the condition’s symptoms. Those steps include:

• Being physically active during the day
• Spending at least some time each day outdoors in the natural light
• Transitioning away from screens – on your phone, laptop, or television – an hour or more before bed
• Stopping fluid intake a few hours before bed to reduce the need to use the bathroom overnight
• Limiting caffeine intake throughout the day, both to help get to sleep and to not have sleep interrupted due to a full bladder

As noted earlier in this article, creating the right sleep environment is also key, according to Dr. Silveira, noting that this means resting in a dark room. “I know we’re all tethered to our mobile phones, but it’s important to put the phone some place where it won’t wake you every time a notification arrives,” she explains, adding that a comfortable room temperature is also important given the heat sensitivity that many people with MS experience.

A breathing exercise or brief meditation can help, as can playing calming music or “white noise” (think ocean waves or soft rain). “Choose the options that work for you, but the idea is to have a routine that sets you up for a good night’s sleep,” Dr. Silveira says.

Contrary to what you might assume, the fatigue that is a common hallmark of multiple sclerosis can be an impediment to good sleep, the exercise physiologist notes. Dr. Silveira explains that napping during the day to allay fatigue can leave one awake at night. “By all means, if you need to rest in the late morning or the afternoon because fatigue has sapped your energy, do so, but try to keep naps to 20 to 45 minutes, and if possible, avoid napping after 4 pm.”

Restless leg syndrome (RLS) is another frequent interference to getting a good night’s sleep for people with MS, she adds. “We don’t tend to think of RLS as a sleep disorder, but it actually is because it occurs much more frequently during sleep than when people are awake,” Dr. Silveira says. Further, research has shown that RLS is two-to-four-times more common in people with MS than in the general population,^{9, 10} with studies reporting that at least 21% to 30% of people with MS are affected by the syndrome.^{8, 11}

Talking with your MS clinician or primary care provider about tactics for dealing with RLS is important, says Dr. Silveira. While the spasticity that is a hallmark of MS is distinct from RLS, it can have a similar negative impact on sleep and also warrants discussion with a neurologist or other MS specialist, she notes. “If your provider has prescribed a muscle relaxant such as baclofen, he or she may have some helpful strategies in terms of doses or the timing of when you take the medicine,” she explains.

Dr. Silveira emphasizes that it is also important to talk with your clinician if you are considering taking any over-the-counter sleep aid, supplement, or herbal preparation. “You want to get professional input on the safety and efficacy of the product. You also want to see if there are better, non-medication alternatives to dealing with your sleep challenges,” she says.

Care for your mind and spirit, as well as your body

Researchers report that more than one-quarter of people with MS suffer from depression and that more than one-third will experience anxiety at some point in the course of the disease.¹²

Given the high prevalence of those disorders, and the toll that MS takes on people living with the disease, efforts to enhance wellness need to incorporate attention to mental and emotional health as well as physical status.

For some, that may mean seeing a mental health professional for assessment and for any indicated counseling or medication. In other cases, attending to emotional well-being may primarily be a matter of practicing stress-reduction techniques or yoga, meditation or prayer, mindfulness exercises, or cultivating a positive mindset.

A growing body of small but promising studies shows that many of those approaches can yield documented benefits. One study involving 61 people with MS found that participating in four weeks of mindfulness-based training helped participants regulate their emotions, worry less, and improve working memory as well as cognitive processing speed.^{13, 14}

In another study that enrolled 23 people with MS, completing an eight-week mindfulness program was associated with reduced anxiety, depression, fatigue, and loneliness. Further, 13 study participants who had magnetic resonance imaging (MRI) scans before and after the program had an increase in brain tissue volume, which is a significant finding.¹⁵

Dr. Silveira notes that in addition to practices to enhance emotional well-being, and when warranted, working with a mental health professional, it’s important to have adequate social interaction. “Loneliness is a real problem for so many people today, and MS can be isolating for a host of reasons, from challenges with mobility and transportation to a sense that others can’t understand what you’re experiencing,” she explains.

In-person or virtual MS support groups are a great means of interacting with others who can relate to what you’re going through, but Dr. Silveira says that it is also beneficial to engage with people in other settings and for other reasons.

“People should be involved in activities that bring them joy,” she says, noting that this could involve a favorite hobby or activity, spending time with a community organization or faith-based group, a monthly lunch reunion with former co-workers, or just picking up the phone and chatting with someone you haven’t talked to recently.

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References

1. MS Canada. The Guidelines. Available at https://mscanada.ca/the-guidelines. Accessed March 9, 2026.

2. Kalb R, Brown TR, Coote S, et al. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler. 2020;26(12):1459-1469. These recommendations may be accessed at https://pubmed.ncbi.nlm.nih.gov/32323606/

3. Mohammadi M, Mohammadi A, Habibzadeh A, et al. Abnormal body mass index is associated with risk of multiple sclerosis: A systematic review and meta-analysis. Obesity Res Clin Pract. 2024;18(5):311-321.

4. Conway DS, Taljan K, Harris KA, et al. Body mass index trends over four years in persons with multiple sclerosis. Mult Scler Related Disord. 2025;93:106218.

5. Wu J, Alfredsson L, Olsson T, et al. Obesity affects disease activity and progression, cognitive functioning and quality of life in people with multiple sclerosis. Neurology Neuroimmunol Neuroinflamm. 2025;2(1):e200334.

6. Yu N. Simpson-Yap S, Coe S, et al. Adherence to the MIND diet is associated with reduced disability and fatigue and improved quality of life in people with multiple sclerosis: a 6-year longitudinal analysis from the UK MS Register. European Committee for Treatment and Research in MS (ECTRIMS) 41st Congress. Barcelona, Spain, September 24-26, 2025. Poster P431.

7. Kong J, Kong J, Wen S, Yang K, Tang J. Efficacy of the Mediterranean diet in the treatment of multiple sclerosis (RRMS): A systematic review and meta-analysis. Mult Scler Relat Disord. 2025;104.

8. Ketata I, Tabib F, Ellouze E. Prevalence of sleep disorders in multiple sclerosis: a systematic review and meta-analysis. European Congress for Treatment and Research in Multiple Sclerosis (ECTRIMS) 41st Congress. Barcelona, Spain, September 24-26, 2025. Abstract 3033/P121.

9. Aladro Y, de Tejada C A-S, Diaz-Diaz J, et al. Prevalence of restless legs syndrome in patients with multiple sclerosis, as confirmed by sleep disorders specialists. J Neurol. 2026 Jan 25;273(2):96. doi.org/10.1007/s00415-026-13620-8 10.1007/s00415-026-13620-8.

10. Ozdogar AT, Kalron A. Restless legs syndrome in people with multiple sclerosis: An updated systematic review and meta-analyses. Multipl Scler Related Disord. 2021;56: doi.org/10.1016/j.msard.2021.103275.

11. Aljarallah S, Alkhawajah N, Aldosari O, et al. Restless leg syndrome in multiple sclerosis: a case–control study. Front Neurol. 2023;14:1194212. doi.org/10.3389/fneur.2023.1194212.

12. Peres DS, Rodrigues P, Viero FT, et al. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain Behav Immun Health. 2022;24.100484.

13. Schirda B, Duraney E, Lee HK, et al. Mindfulness training for emotion dysregulation in multiple sclerosis: A pilot randomized controlled trial. Rehab Psych. 2020;65(3):206-218.

14. Manglani HR, Shaadee S, Schirda B, et al. Effects of 4-week mindfulness training versus adaptive cognitive training on processing speed and working memory in multiple sclerosis. Neuropsychology. 2020;34(5):591-604.

15. Hemond CC, Deshpande M, Berrios-Morales I, et al. A single-arm, open-label pilot study of neuroimaging, behavioral, and peripheral inflammatory correlates of mindfulness-based stress reduction in multiple sclerosis. Sci Rep. 2024;14:14044 (2024). doi.org/10.1038/s41598-024-62960-w.

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