Fatigue and exercise

Do you exercise regularly? #MSBlog #MSResearch

“This study compares MSers to unfit healthy controls and finds MSers have reduced exercise capacity and higher ratings of perceived exertion during recovery. Are you surprised?”

“It is difficult to interpret this study because of its design; study subjects were exercised to voluntary exhaustion, after which feelings of leg fatigue were higher throughout the recovery period in MSers than in healthy controls. Recovery with regard to all other physiological and self-report measures were the same. Does this mean that MSers have an altered percept of fatigue? In other words do MSers perceive fatigue more than health controls? This may be the case. If you have chronic fatigues and most things exhaust you it may alter the way the brain interprets sensory information from the body as being greater than it is hence a greater level of perceived fatigue for the same physiological stressor. Tim Noakes a sport scientist at Cape Town University, who studies elite athletes, has shown that elite athletes have reduced levels of perceived fatigue for the same level of exertion, which is why they can push themselves to the limit. He also believes you can train yourself to increase your perception threshold with regard to fatigue. This clearly happens spontaneously when you train and get fit you notice that your perceived levels of fatigue are reduced. In addition,  to this your brain gets very adept at producing endorphins, small peptides, that make you feel good. So the solution to this problem of physical fatigue is a graded exercise programme to condition your musculoskeletal, cardiovascular and cognitive systems.”

“We have posted many times on the health benefits of exercise and how important it is for maintaining brain health and reserve. Even if you are quite disabled in terms of mobility there are exercise programmes you can engage in be they water or upper limb based. Developing a routine that you stick to is in itself therapeutic; being self-disciplined helps. I know some of you will say that you are too tired to exercise. However, it is a vicious cycle, the more deconditioned or unfit you become the more physically fatigued you become and it is downhill from there. You have to break the cycle. I have little doubt that MSers in my care who exercise regularly do better than MSers who don’t. This may be a chicken or egg argument, but outside of MS in the general population the health benefits of exercise are beyond doubt.”

“As I am writing this post sitting in a Hotel room in New Jersey, at 4.30 am in the morning, I am getting the urge to go for a run. The good news is that fitness centre in the hotel is open 24 hours a day. Let’s hope my groin and hip injury from last year’s marathon will allow me to get beyond 30 minutes on the treadmill. The injury was not acquired in vain; I raised a significant amount of money for the MS Society doing the marathon.”

Epub: Dawes et al. Delayed Recovery of Leg Fatigue Symptoms Following a Maximal Exercise Session in People WithMultiple Sclerosis. Neurorehabil Neural Repair. 2013 Sep 11. 

BACKGROUND: Fatigue is a chronic symptom for MSers.

OBJECTIVE: Symptoms of fatigue were investigated during and following a single exercise session.

METHODS: In all, 58 MSers and 15 healthy, low-active controls performed a cycle ergometer incremental exercise test to voluntary exhaustion. Physiological intensity (expired air and heart rate), perceived breathlessness, and leg fatigue (Rating of Perceived Exertion [RPE] CR-10 Scale) were measured during and for 10 minutes following exercise.

MEASURES: Baseline disability (Barthel Index), activity (Physical Activity Scale for the Elderly), vitality (Subjective Vitality Scale), and general fatigue (Fatigue Severity Scale [FSS]) were recorded.

RESULTS: MSers had reduced exercise capacity (P = .00 to .01), but sensations of breathlessness and leg fatigue were the same at voluntary exercise termination in both groups (P = .09). MSers with fatigue (FSS ≥ 4) exhibited reduced exercise capacity (P = .03 to .05) but reached the same physiological intensity, breathlessness, and leg fatigue symptoms at test termination as non-fatigued peers (P = .16 to .59). During recovery, there was no difference in observed means between groups, except for leg RPE, which was higher in the MS group (P = .047) and higher at 3 and 5 minutes after exercise in the fatigued MS group (P = .02). Physiological markers and breathlessness recovered at the same rate in both groups (P = .33 to .67).

CONCLUSION: Monitoring leg fatigue symptoms during and through recovery from physical activities may help guide participation in physical activities for MSers, particularly in people managing high levels of fatigue.

Other posts on exercise:

15 Jul 2013
Objective: The primary aim was to investigate the comparative effects of massage therapy and exercise therapy on patients with multiple sclerosis. The secondary aim was to investigate whether combination of both massage 
09 Jul 2013
BACKGROUND: Despite the commonly known benefits of exercise and physical activity evidence shows that persons Multiple Sclerosis (MS) are relatively inactive yet physical activity may be even more important in a 
31 May 2013
BACKGROUND: Multiple Sclerosis (MS) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated. The objective of this study is to understand the effect of 
19 May 2013
STUDY SELECTION: The review was limited to English language studies (published prior to December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, 
04 Apr 2013
Interventions:Exercise group completed a 12-week group exercise programme under the physical therapists’ supervision. Control group was included in the waiting list.Main measures:The primary outcome measures were the 
08 Nov 2012
Epub: Garrett M et al. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial Mult Sclerosis [Epub Nov] doi: 10.1177/1352458512461966. Background: 
31 Dec 2012
Research: Effect of Natalizumab on T cells · Exercise for MS · Research Day 31 · Unrelated Blogger Comments New Years Eve · Research: clearing up myelin debris · Research Gender differences in MS · Research: Genetic 
27 Nov 2012
Methods: 32 MSers with cognitive fatigue according to the Fatigue Scale for Motor and Cognitive Functions (FSMC ≥ 22) performed attention tests (alertness, selective, and divided attention subtests from the TAP test battery 
14 Jul 2011
“Good news for physically active MS’ers. Exercise also release endorphins within the brain that are part of the brain’s reward system and make you feel pleasant. Interestingly, this is one of the ways low dose naltrexone is 
11 Apr 2011
Exercise therapy may have a positive effect on MS-related fatigue, however, the findings of a systematic review show the impact of exercise can be highly variable. “I think the problem with in the field of fatigue is that we still 
31 Jan 2013
The secondary objective was to estimate the extent to which women and men with MS present different perceived-health, depressive symptoms, and current exercise routines or preferences. Methods: This was a cross 
07 Jun 2012
Purpose: The evidence base to support therapeutic exercise for MSers is improving; however few studies have considered the MSers’ perspective. This study aimed to explore the experiences and views of people moderately 
26 Nov 2012
OBJECTIVE: The purpose of this study was to test the hypotheses that (a) a relationship between exercise-induced changes in core-temperature and changes in symptom intensity exists, and (b) that resistance exercise, as a 
15 Jun 2012
Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS). Methods: A multi-centre, randomised, controlled 
18 Aug 2013
Improved diet, exercise and stopping smoking if you smoke. All the things that have been shown to reduce your cardiovascular risk will also work in MS. Why? MS reduces your brain reserve therefore any other insult will result 
01 Jun 2012
RESULTS: Findings are based on 21 patients (10 from exercise and 11 controls) who had data available on outcomes. There was no significant difference between the two groups at the baseline. MSers in the aquatic exercise 
04 Sep 2012
BACKGROUND: The influences of exercising on cytokine response, fatigue and cardiorespiratory values are important aspects of rehabilitation in MSers. Exercise performed within these programs is often practised in water 
26 Aug 2013
The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, 
24 Feb 2013
I can’t work out if I’m better or worse for doing exercise. Suspect more mobile. Trying yoga again after 3 year gap. Shocked at how much worse I am but now I’m more homebound it’s something ironically there’s more time 
28 Aug 2013
The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was 
26 Sep 2012
“This study indicates that physical exercise prior to MS-onset is a predictor of slower disease progression once you have the disease. Chicken or egg? Physical activity is associated with a lot of other factors that could explain 
20 Jul 2012
“This is good news; MSers behave in the same way as normal subjects when it comes to energy expenditure from exercise or physical activity. This is not surprising as there is no evidence that MSers peripheral energy usage 
12 Sep 2013
You may find the research priorities interesting, or not! My one criticism is the priorities make no mention of cause or causation; the whole exercise seems to have be done within the current paradigm or “autoimmune dogma”.
28 Dec 2011
“The creativity of the research community never ceases to amaze me. I have seen similar work done using software and hardware available on the Wii, PSP3 and XBox360. The message is exercise, particularly if it challenges 
27 Apr 2013
The impact of disability on your ability to exercise. #MSBlog #MSResearch. Epub: Motl et al. Longitudinal Change in Physical Activity and Its Correlates in Relapsing-Remitting Multiple Sclerosis. Phys Ther. 2013 Apr.
22 Dec 2010
Walking impairment in patients with multiple sclerosis: exercise training as a treatment option; “exercise training and physical activity might hold significant potential for the management of progressive mobility disability in MS.
28 Jul 2011
The commonest example is exercise-induced fatigue. For example you may find that as you walk or exercise it becomes more difficult; your leg begins to drag, your vision may blur or your thought processes seem to slow.
24 Jul 2013
Intervention:Prescribing a home-exercise program and following up with customized pamphlets, which are matched to participants’ stage of readiness to change physical activity behavior and physical activity barriers (e.g. 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • In my case, fatigue is sometimes in the mind, mostly in the legs and body.
    I know it can be in my mind because if I have a job to do which I know will tire me, I get fatigued just contemplating the job. In some cases the job is avoided altogether because of the expected anguish afterwards. – How bad is that!!!
    When I do get engrossed in a job, I always want to finish it, but get slower and slower as time progresses. By the end of the job I am then too tired to do anything for a few hours. So is there a "Pavlov's dog" feedback mechanism that affects the mind before the body???

    • Pavlov's dog is a good analogy; it is called anticipatory fatigue. This happens a lot. This is why you need to plan your tasks and if they are too tiring to break them up into more manageable components.

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