The MSing Link, Episode 242

How to NOT Overdo Exercise with MS: 7 Strategies by an MS Physical Therapist

Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: July 23, 2025

Overview

In this episode, Dr. Gretchen Hawley leverages her decade-long expertise as an MS Certified Specialist and physical therapist to answer a pressing question among people living with Multiple Sclerosis: How do you improve mobility, strength, and energy without overdoing exercise? She shares research-backed methods and personal coaching strategies to help listeners recognize the signs of “overdoing it,” and provides seven practical ways to adjust their exercise routines so they can stay active and empowered—without triggering undue fatigue or symptom exacerbation.

Key Discussion Points & Insights

Recognizing When You've Overdone Exercise

• Two-hour recovery rule:
  According to MS research, post-exercise fatigue or symptom worsening should resolve within two hours.
  • “If it’s been over two hours and you’re still feeling fatigued or you’re still feeling worsened symptoms…and also, let’s just add, exercise shouldn’t ever worsen your symptoms. So if that’s the case, that is a huge sign that you’re overdoing it.” (03:05)
• Self-awareness:
  Trust your body’s signals—feeling unable to move on with your day, significant fatigue, balance issues, or needing extended rest after exercise are all signs. Your benchmark for “overdoing it” might shift over time:
  • “Mississippi is different every single day…what you did most recently for exercise might be fine for you on some days, but other days it might have been too much.” (05:23)

The Three Reflective Questions

After a session that felt like too much, ask yourself:

1. How long did you exercise for?
   (10 min, 30 min, 45 min? There’s no right or wrong answer.)
2. How many exercises, sets, reps did you do?
   (Categorize, count and note if you did more or less than usual.)
3. How hard were you pushing yourself?
   (Intensity level, speed, size of movements—were you going all-out or pacing?)

Use the answers to guide your next modifications.

Seven Strategies to Avoid Overdoing It

Dr. Hawley shares a set of solutions—pick and try just one at a time, then assess over a week.

1. Exercise for less time
   • E.g., if you normally do 45 minutes, try reducing to 40, 35, or 30 minutes.
   • “Don’t exercise for as long, because it could mean that you overdid it purely because you don’t have the stamina or endurance to exercise for that number of minutes all at once.” (09:45)
2. Decrease the number of exercises
   • Fewer total moves; or keep the list, but do fewer sets/reps.
3. Focus on easier exercises
   • Choose more moderate/easy moves instead of always pushing hard.
4. Dial back the intensity
   • If you usually go “all-in,” try stopping at 80% effort instead of 100%.
   • “While I love that for neuroplasticity… it might be too much for you right now.” (12:20)
5. Slow your pacing
   • Move at a gentler rhythm, and take more rest breaks.
6. Lengthen rest breaks
   • E.g., instead of minimal rest, take 30 seconds to two minutes between exercises.
   • Note: Adding breaks will make the workout longer in clock time, but actual exercise effort is less.
7. Trial and error—give each change a chance
   • Try one modification for a week to account for MS variability.

Tailoring Exercise to Your Day

• Dr. Hawley recommends creating three different plans:

  • Good day plan: Push a bit more, longer or higher-intensity session.
  • Not-so-great day plan: Focus on restorative, shorter, or easier exercises.
  • Average day plan: Middle ground—use everything discussed to decide what’s best.

• Choose your plan right before you exercise, as MS symptoms and energy may change through the day:

  • “It’s important to ask yourself the question right before you exercise: what type of day am I experiencing right now?” (15:54)

Changing Your Mindset

• Pushing yourself to the max isn’t always appropriate with MS. Culture teaches us to “go big or go home,” but MS demands a conscious shift:
  • “With MS, that is not the best advice. And so we are used to going 100%…when in reality that might actually be causing more harm than good.” (16:53)
• It may feel unnatural to NOT do your absolute best, but restraining effort can be key for your health:
  • “Could you push yourself more? Yes, most likely. Are you going to? No, you are going to choose not to, at least for now, so that we can do this trial and error…” (17:19)

Additional Practical Tips

• “80% rule”:
  If you feel you could do more, actively choose to stop at 80% of your capacity—whether time, effort, or repetitions.
  • “Try to have a pace with your exercises where you could carry on a conversation. This is a great way to have an indicator of appropriate intensity levels.” (18:20)
• Apply concepts beyond exercise:
  Same strategies can help you manage chores, errands, and other activities—spread them out, take breaks, and avoid stacking difficult tasks all at once.
• Allow time for experimentation:
  It may take several weeks or months to refine your approach, and that’s okay.
  • “Giving yourself that grace, taking the time and viewing your exercise as this trial and error phase so that you can get those three exercise plans and start feeling good about your exercise routine…” (19:23)

Notable Quotes & Memorable Moments

• On recognizing overdoing it (03:05):
  “Exercise shouldn’t ever worsen your symptoms…if that’s the case, that is a huge sign you’re overdoing it.”
• On MS variability (05:23):
  “Mississippi is different every single day, which makes this conversation really hard…”
• On changing mindset (16:53):
  “With MS, that is not the best advice…we are used to going 100% and putting our best effort in, when in reality that might actually be causing more harm than good.”
• On strategic self-limiting (17:19):
  “Are you going to [push yourself]? No, you are going to choose not to, at least for now, so that we can do this trial and error…”
• Conversation pace hack (18:20):
  “Try to have a pace with your exercises where you could carry on a conversation…”
• On patience and experimentation (19:23):
  “Giving yourself that grace, taking the time and viewing your exercise as this trial and error phase…”

Timestamps for Important Segments

• Recognizing overdoing it & the 2-hour rule: 02:02 – 05:55
• Three self-assessment questions: 06:00 – 08:45
• Seven adaptive strategies: 09:00 – 13:43
• Crafting three exercise plans: 13:45 – 15:54
• Mindset shift & 80% rule: 16:53 – 18:20
• Applying principles beyond exercise: 18:31 – 19:50

Takeaways

• Overexertion with MS is common and can be managed through specific, mindful adjustments.
• Use reflective questions and the “80% rule” to self-regulate effort.
• Creating customized exercise routines for your varying day-to-day capacities is empowering—and essential.
• Accept that personalization may take time, and view it as a process of learning and grace.

For further resources—including exercise demonstration videos and Q&A opportunities—Dr. Hawley directs listeners to her website, with links in the show notes.