HIIT FOR MS:
Aerobic & Cardio Advice
Exercise is hugely beneficial in multiple sclerosis, but new research suggests interval training—in particular high-intensity interval training (HIIT) and intense exercise workouts—may improve fatigue and cognition, potentially rewriting your future with this disease. The first detailed how-to guide for MS includes step-by-step instruction and video tips.
Interval training, in particular high-intensity interval training (HIIT), has been all the buzz lately among multiple sclerosis professionals. Respected MS researchers are rededicating efforts to studying the myriad benefits of aerobic exercise. Prominent MS neurologists are saying exercise should be prescribed as a disease modifying treatment. And a number of MS nurses and physical therapists are now—albeit cautiously—recommending HIIT to their patients.
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EXPLORE THIS GUIDE:
My Experience with HIIT and MS
MY EXPERIENCE WITH HIIT AND MS
As a case study, I enter myself. For the past 20 years, starting nearly a decade before I was diagnosed with MS, I’ve been doing some form of interval training. And I’ve done HIIT at least twice a week for years with my condition—indeed, an argument could be made that with my experience and consistency I am the poster child for HIIT and MS. Has it helped? You be the judge.
Decreased fatigue & cog fog. I know exactly what debilitating MS fatigue feels like—I’d never felt so disabled. I know exactly how frustrating cog fog can be—I’d never imagined a single word could be so hard to recall. And I know exactly what a bad day with MS entails—I’d give anything to avoid it. But I have a confession. In the over 5,000 days since my diagnosis, apart from those times when I was sick or relapsing (both always crush me), I can count the number of days I’ve experienced what most MSers say are the most disabling aspects of this disease… on one hand, two max.
Not a cure-all. While I have seemingly 99 problems due to this disease, I essentially have zero fatigue, zero cognitive issues, and zero bad days. Indeed, I’ve never had to cancel a social engagement because of my MS. Now every case of multiple sclerosis is wildly different. And I know MSers who engage in hardcore exercise who have some fatigue issues, including recently retired NHL star Bryan Bickell and my new marathoner friend Cheryl Hile, so it is not a cure-all. My minimal fatigue could be the result of effective treatments, location of lesions, just plain luck, or a combination of all three. I’m fully aware of that. But based on copious scientific research and ample anecdotal evidence from athletic friends with MS, there’s almost certainly more to this story.
Consistency is key. I absolutely can’t promise that with HIIT you will forever banish fatigue, cog fog, or bad days from your MS dictionary, but the potential exists that you can diminish them. How freaking amazing and life-altering would that be? Better still, results from an effective exercise routine can appear in as little as a few weeks (but expect it to take months or potentially longer). One member of ActiveMSers said it took him 3-6 months before he could tolerate hard exercise at all due to his MS, and several years before he was able to master it. These days he cycles thousands of miles a year.
IMPORTANT: Before starting any exercise program, please discuss these plans with your doctor and/or neurologist. Better yet, also consult a physical therapist. And maybe a personal trainer. Interval training is hard. High-intensity interval training is a lot harder. Getting professional advice so you can avoid injury is not just smart, it’s essential.
THE RESEARCH ON CARDIO FOR MS
There are more than 200 published research studies about the benefits of exercise for multiple sclerosis. Since this is an article and not an epic Game of Thrones retelling (uh, not today), we can’t break them all down here, but we can turn our attention to cardio training, specifically interval and HIIT. And there is a difference.
All aerobic exercise is good. It will come as no surprise that virtually all exercise is healthy for MSers—as it is for pretty much all humans, which is why most of us have unused workout equipment at home (Body By Jake Ab Demolisher, anyone?)—but researchers recently have started to focus on aerobic conditioning and its influence on the disease itself. In these specific studies (now approaching two dozen as of 2019), trends have started to come to light.
But intense aerobic exercise is better (for fatigue and cog fog). Interestingly, moderate exercise—brisk walking, water aerobics, spinning on the elliptical—does not appear to modify MS fatigue or cognition much. Sure, you’ll get fitter, and likely feel better, although your MS symptoms might not change. But turn up the intensity and—in randomized studies comparing traditional exercise directly to HIIT—“significant” reductions in fatigue and improvement in cognition become commonplace in the HIIT exercisers.
HIIT could slow progression, but don't ditch the DMTs. There is even evidence that exercise may be neuroprotective, slowing catastrophic regional brain atrophy so common with multiple sclerosis. And in some studies (but not all) HIIT was seen boosting brain-derived neurotrophic factor (BDNF). It’s important to remember, however, that exercise science and MS is far from being settled. As a daily vigorous exerciser for decades, I am walking proof (or rolling proof, as I now use a wheelchair) that while exercise is hugely beneficial, it is not a replacement for FDA-approved disease modifying therapies.
HOLD ON: I Tried Exercise & It Didn’t Work. I’ve heard this before. Unlike many MS diets—where if it didn’t “work,” fellow dieters will tell you that you simply didn’t try a specific diet long enough (or you cheated), and that you need to give it another one or three or five years—with exercise there is growing scientific evidence that harder aerobic conditioning is the true sweet spot for influencing your disease. If your past forays into exercise didn’t get your heart deep into the cardio zone, I urge you to give it another try. Even for just a few weeks. Please try if you can.
WHY INTERVAL TRAINING FOR MS SPECIFICALLY?
Interval training and HIIT appear to be perfectly suited to MS. Why? Intervals help exercisers largely avoid the sustained deleterious effects on core temperature, walking, gait, cognition, mood, or enjoyment that often accompanies traditional longer-form exercise. That’s a huge deal, particularly for the mobility impaired. So let’s break down some specific MS benefits briefly.
Prevents Overheating. This might be the number one reason why MSers avoid exercising. Not being able to walk thirty minutes into a run is sorta an issue, especially when you are now also thirty minutes away from your home… and you have to pee. Taking breaks permits the body to cool down before revving up again.
Quickens muscle recovery. Muscle fatigue due to MS can come on fast and unexpectedly. You’ll be doing fine, fine, and then DONE. Foot drop in spades, weakness so severe you can’t lift your arms, the works. Backing off before the “done” means you can train harder, longer.
Maximizes time. This technically isn’t MS specific. But when you are managing a disease, everything takes longer, and shaving off time to get and stay healthy matters when you have jobs to go to, kids to care for, and dinner to make. Plus exercising for minutes sounds A LOT more manageable than going for a 2-hour bike ride.
IS HIIT FOR YOU?
“A wave of scientific evidence suggests that H.I.I.T. workouts are exactly the type of exercise a middle-aged, out-of-shape body should be doing. Research has shown that H.I.I.T. workouts are the best exercise at any age, and for older people especially, it’s the most efficient way to exercise and reverse the signs of aging within cells. It’s also faster and more interesting than the hourlong slogs on the treadmill that many of us think we should be doing (but often don’t.)”
*If MS has done a number on your legs, like me, the answer is still an emphatic YES. Just one arm works? I just tried, and the answer is still YES. No arms work? I just surprised myself getting into the high cardio zone just twisting my torso. So, still YES! But if your disease has taken out your arms, your legs, and your core, leaving you a step above a noodle, stand down when it comes to high intensity exercise. ANY exercise is beneficial— do what you can, and don’t beat yourself up if cardio is no longer a reasonable option.
KEY ADVICE: For goodness sakes, unless you are already a daily exerciser, start slowly. No, SLOWER. The temptation to ride that interval exercise bandwagon to glory is fraught with risk and will likely result in you just tipping said bandwagon over and quitting a few weeks (or days) in. This is a lifetime commitment. A slow and steady start will keep you in the race. Better health will gradually follow. I promise.
First, re-read the above advice to START SLOWLY... Next, gear up and figure out your max heart rate.
Gear up. What you’ll want: a heart rate monitor (HRM). That’s pretty much it—other than potentially some workout clothes and shoes—and technically you don’t even need an HRM if you can accurately measure (or guesstimate) your own pulse. I prefer the Polar or Garmin-made HRMs with a chest strap—I’m currently using a Polar model with Bluetooth and ANT+ technology so it can connect to the fitness apps on my phone—as they are the most accurate. As someone who relies on using my upper body for cardio, I’ve found the wrist trackers cannot accurately measure my heart rate when my arms are flailing. (That said, for folks with working legs, wrist-worn fitness trackers do a passable job, but are still not accurate enough in my opinion for HIIT. The New York Times currently recommends the FitBit Charge 3.)
Determine your max heart rate. According to the Mayo Clinic, “The basic way to calculate your maximum heart rate is to subtract your age from 220.” For HIIT, you’ll generally want to be in the 70-90% range. This calculator makes it easy to peg your target number. But that said, these are only estimates, and not terribly reliable as individuals vary so much. An easy rule of thumb: if you can sing, you might as well be in the shower; if you can talk but not sing, you are exercising moderately; if you can only speak at most a few gasping words, that’s HIIT. My 70% range is 118 beats per minute, laughably low and easily Ariana Grandable for me (well, if I knew the words to any of her songs). I have to enter the upper 130s or low 140s, my 80-85% range. On some hard sets I’ll bump into 90%, or into the 150s.
WARNING: If it doesn’t feel right, stop. Dizzy, sick, painful? Stop. If MS fatigue crushes you later that day or the following day, or the following day of the following day, you overdid it. Recalibrate, recharge and then retry. And avoid doing HIIT on back-to-back days; it’s too hard on the body. Three 20-second HIIT intervals is believed to be the minimum to get health benefits. That’s a total of one minute of hard exercise. You can do this.
THE STANDARD HIIT ROUTINE
There are many ways to incorporate HIIT into your exercise routine. If this general routine doesn’t float your boat, modify it until it does. Experiment. And give it time to work. Your fatigue isn’t going to evaporate tomorrow. It will likely take weeks or even months before you start to feel the benefits of regular HIIT sessions. Patience, young Jedi. Also review this article in The New York Times on Really, Really Short Workouts for extra ideas and techniques you can incorporate into your routine.
The below program is just a baseline. The exercise portion can literally be anything that substantially increases your heart rate. I prefer sprints on my handcycle or, if weather is icky, an upper-body ergometer at the gym. (At home I will exercise to workout videos without any equipment, but I find it is harder to get into the high cardio zones without some form of resistance.) When working legs, I'd be doing hill sprints, jump roping, kickboxing, stair climbing, rowing, racquetball, swimming, CrossFit, you name it.
NOTE: Some HIIT routines have shorter recovery periods than this program, as little as 10 seconds between intervals. Because heat is such a negative with MS, a longer rest period seems more prudent, but if getting your heart rate elevated is a challenge, briefer breaks could help. Also, three cardio intervals (of at least 20 seconds) is the minimum to gain benefit according to research. I often do double that or more (and at longer intervals), but in no way does that translate into doubling the fitness benefit. I just like to exercise.
Warm up. The recommended warm up is at least 2-3 minutes of light to moderate exercise. Nothing too hard. Just waking up your body.
HIIT it! Exercise at near max effort for 20 seconds. Going all out for 30 seconds is great if you can get there. These days I try to get to 45 seconds, the average hockey shift in the NHL (hockey is great for HIIT), if I’m feeling fresh.
Recovery. Lightly exercise—spin gently, walk slowly, stand and sway, whatever—for at least 2 minutes, lowering your heart rate and cooling you down. Go longer if you need it. Maybe grab a sip of ice water. Keep your body moving. Just two more sessions to go.
HIIT it again! Crank it! If 100% effort is a 10, you should be at least at a 7, ideally an 8 or 9. If you are going bzonkers and doing a SIT session (Sprint Intervals), then you’ll be near a 10. Twenty seconds is the minimum.
Recover again. Your effort here should be rather light, no more than a 3 to 4 on our 10-point exertion scale. A couple minutes should do it.
HIIT it one more time! Once more put the pedal to the metal (far more effective than putting the petal to the medal or the peddle to the meddle). Just 20 seconds!!!
Cool down. Again, cool down with light exercise for at least 2-3 minutes. We’re talking a 2 or 3 on the effort scale, as it is time to chill. Then stretch. You’re done!
A HIIT workout can take as little as 10 minutes. Note, however, I burned fewer than 50 calories. HIIT is not ideal for weight loss.
A HIIT SESSION SNAPSHOT
Below are three screenshots of three different HIIT sessions I recently completed. The two sessions on the left were two bike rides, both long(ish) and included a number of intervals. The session on the right was completed at the gym, which included circuit training on weight machines to keep my heart rate elevated. Notice that during my recovery sessions my heart rate dropped substantially and I wasn't too concerned about the length of the breaks.
The Polar app breaks down my HR training into zones. On this hour-long ride I spent 3 minutes in the "hard zone" at 80-90%, almost 13 minutes in the "moderate" zone of 70-80%. But most of my ride was in the lowest two zones.
Above, you'll see five distinct sprint intervals where I got my HR above 140, maxing at 146. The first "interval" was actually a steady hill. In general my HR stayed rather low except for the sprints. Even my average speed is low.
This gym session included 3 HIIT intervals (far left) on the upper body ergometer (max HR 153), two hard efforts on the upper/lower recumbent cardio machines (136 max HR), and multiple low-intensity intervals on weight machines.
HOW TO VIDEOS
Getting into your aerobic zone while seated, and with no equipment, can be tricky. But as I demonstrate in these videos, it's definitely doable. There are many, many variations (fake swimming, air guitar, even mimicking umpires—SAFE!), but these are my go-tos. I find adding a light exercise resistance band—e.g., wrap it around your back, grab it with your fists, and then punch away—can help elevate your heart rate further. Of course if you have proper gear, like an upper-body ergometer, you'll see in this demonstration that I can rocket my heart rate from my 110 in my warmup to 150 in 30 seconds.
SHARE YOUR SUCCESSES (And Failures): There is a thread on our forum devoted to interval exercise. Read up on tips, successes, and hiccups with interval training here. You’ll find lots of practical advice from fellow exercisers with a disability, including workarounds to common problems. Better still, add your personal experiences. The best tips will eventually be incorporated into this article.
GENERAL HIIT TIPS FOR MS
A few more pearls of advice before you begin.
Precool. Put on a cooling vest 15 minutes before you start exercising. Also start taking sips of ice water or a slushy about this time. If heat is a serious issue, talk to your doctor about taking an aspirin, which can help with overheating.
Stay cool. Sip an icy drink regularly during your recovery intervals. Heat is not your friend when exercising with MS.
More isn’t necessarily better. When I do HIIT I’ll often do six or more intervals on my bike, and sometimes I’ll extend one or two sprint intervals to over a minute, an eternity when you are expending that much effort. And the extra work is probably improving my fitness very little. But it’s fun, so I do it. I’m weird that way.
A HIIT twist. If 20 seconds is too hard for you, don’t despair. A HIIT research study found a 10-20-30 training technique nearly as effective and more enjoyable. In it, participants warmed up for a few minutes and then eased into HIIT. 30 seconds of relaxed exercise (3 or 4 on our exertion scale), 20 seconds of moderately hard exercise (5 or 6 exertion), and just 10 seconds of insanity (8 or 9 exertion). Do five of these intervals in a row, without breaks, then rest for a couple minutes before doing another set of five. Conclude with a cooldown and stretch.
FREQUENTLY ASKED QUESTIONS
What type of exercise is best for HIIT? Pretty much anything that you do physically can be turned into HIIT. Sprint up stairs, wash your car like your hair is on fire, rapidly flip large truck tires (if you happen to work at a truck tire store), till a garden hella fast, skip rope like Ali, punch invisible White Walkers from the ironic comfort of walker (or wheelchair), you name it. Long rallies in racquet sports are naturals for HIIT, especially racquetball, squash and singles tennis.
How often should you do HIIT? Strive for two to three sessions per week, and no more than four. Your body needs recovery time, so never do HIIT on back-to-back days.
Do I need to do HIIT on vacation? Probably not—taking an exercise holiday is often a welcome respite. However, to enjoy your trip, you might need to exercise. A week into a cruise last year, I noticed that the fog of fatigue was starting to roll in. So instead of getting another drink at the bar or gambling in the casino, I stole away time for a quick HIIT session in the ship’s tiny underused gym. That righted my sluggishness ship.
How good are HIIT videos? Most “HIIT” routines you see on YouTube or on fitness videos are interval training, not HIIT. They are just too long and not high intensity enough. But they are still good exercise. And if you modify the exercises to up the effort, and add recovery time, you may be able to turn it into a HIIT session.
What is the best way to achieve HIIT if your legs don’t work well? Personally, I gravitate to my arm cycle. An upper body ergometer (aka arm spinny thing) that you find at the gym is also extremely effective, as is the recumbent cross trainer, a cardio machine that works both your legs and your arms at the same time that you can find at some fitness centers and at physical therapy. The kind you put on your kitchen table? No. If you are creative, modifying exercise videos work. But for me at my current fitness level, it’s much harder to raise my heart rate much above the 70% range.
What’s the most effective way to raise your heart rate while seated? There are five exercises I regularly do from the comfort of my bottom to crank up the ticker: rapid punching (straight ahead, hooks, upper cuts, speed bag), running in place (fast and faster!), the double punch (quickly thrust out both arms, and repeat), the sky punch (hitting above your head, one or both arms), and the axe chop (virtually swing your axe from your right shoulder to your left knee and vice versa). Seated jumping jacks work well too. I demonstrate seated cardio below in a YouTube video. I typically just modify able-bodied exercise videos using these techniques. (For example, when they do burpees, I punch above my head; when they kick, I double punch straight ahead, etc.)
Read up on more exercise advice from ActiveMSers!
A FINAL NOTE: Exercise research in multiple sclerosis is continually evolving. Which means this article and our other articles change over time. Please check back regularly for updates and note the date of the last revision.