Primary-progressive multiple sclerosis (PPMS) is the least common and perhaps most misunderstood type of multiple sclerosis (MS). Although all four types of MS can progress over time, the symptoms of PPMS don’t present in relapses, but steadily worsen. PPMS and other MS types are caused by nerve damage in the brain and spinal cord.

PPMS has certain identifying symptoms, but everyone’s experience with this condition is unique. Some common PPMS symptoms include:

  • trouble walking
  • extreme fatigue
  • weakness
  • pain
  • vision problems
  • sexual dysfunction
  • depression
  • spasticity (muscle stiffness or tightness)
  • balance issues

More than 85 percent of all people with MS deal with extreme fatigue.

This feeling isn’t the same as being tired after work, or needing a weekend nap. This kind of fatigue comes on with no apparent cause, and prevents people from doing regular daily activities. While exercising may be the last thing you want to do when you’re tired, it can help boost your energy levels.

Exercise not only helps alleviate fatigue. It also improves balance, coordination, range of motion, and muscle strength. A recent study found an association between physical exercise and possible improvement on disease progression, although a direct cause was not found.

Because MS affects everyone differently, there isn’t one recommended exercise routine. However, certain types of exercise are especially helpful for people with PPMS. These exercises include swimming, stretching, and yoga.


Swimming is often rated as the best exercise option for people with PPMS. It provides a low-impact, whole body workout that strengthens muscles and improves overall range of motion. Water is cool, which is beneficial because some PPMS symptoms flare up in heat. Plus, water’s natural buoyancy helps with balance and provides a safe area where people aren’t afraid to fall.


Many people with PPMS deal with spasticity issues, or muscle contractions that cause stiffness or tightness. As a result, people can lose the range of motion in their joints if they don’t stretch regularly. Dr. Ken Seaman recommends doing muscle stretching and range of motion exercises (ROM) two to three times per day. These exercises help alleviate spasticity symptoms, promote balance, and prevent muscle shrinkage. Focus on the most problematic areas of the body, doing three repetitions for 15-30 seconds.


Yoga is beneficial for both the mind and the body. It can help relieve stress, clear your mind, and improve your spirit. The main point of yoga is to perform controlled breathing, movement, and meditation. A big benefit of yoga for people with MS is that it can be done sitting on the floor or even lying down. Yoga is especially good for those diagnosed with MS because it can help to improve strength and balance.

Even the healthiest people need to be careful when starting a new workout routine. This is especially important for people with chronic diseases, such as PPMS. Follow these four tips to keep yourself safe while staying active:

  1. Check with your doctor or physical therapist before starting or switching exercise programs.
  2. Because your body has physical limitations, start off slowly. Begin with 10-minute exercise sessions, and work your way up so you don’t overexert yourself.
  3. If you have trouble with balance and coordination, assess the space where you plan to exercise. Stay clear of rugs, slippery floors, and other hazards.
  4. If you’re sensitive to heat, make sure to keep cool. Exercise in air-conditioned rooms, or outside in cooler temperatures. Stop the routine immediately if you start feeling bad.