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

Summary

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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

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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.

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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)

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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…”

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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

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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.

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

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Transcript

[A]

Hello. Hello. Thank you so much for tuning in today as a physical therapist of, let's see, over 12 years and a multiple sclerosis certified specialist of. Oh my gosh, next month will be 10 years of being an Ms. Specialist. With those credentials comes the question frequently over the last 10 years from my clients with Ms. And my social media following with Ms. Of how, how do I not overdo it with my exercise? This is such a big topic that a lot of people with Ms. Are curious about because it can be easy to overdo it with exercise when you have ms, especially when overdoing it now looks different than what overdoing it six months or a year or five or ten years ago would look like.

[B]

The big question is how does someone with Ms. Actually improve their mobility, strength, energy independence? The list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple sclerosis specialist. Welcome to the Missing Link podcast.

[A]

Today.

[B]

Tune in as I share the top strategies and exercises to help you gain control over your life with Ms. Using research driven insights and advice from top industry experts. Whether you're newly diagnosed or have had Ms. For over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode.

[A]

Ready?

[B]

Let's dive in.

[A]

So we're going to discuss how to know if you're overdoing it and then things that you can do to prevent yourself from overdoing it. We're specifically going to relate this to exercising and your exercise routine. But please know that the same concepts that we're going to talk talk about today can also be helpful. If overdoing it wasn't necessarily exercise, but it was errands or chores around your home or anything else. According to Ms. Research, one way that you can know if you pushed yourself too far is if the fatigue that you're feeling or if any symptoms worsened have not resolved within two hours after your exercise. Research shows that a regular amount of exercise should result in fatigue that lessens within the two hour mark after you stopped exercising. So 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. But also another sign that you're overdoing it is you feel it. You would say, I did too much, I am fatigued, I can't move My body, maybe I'm mentally fatigued. Not just physically fatigued. My balance might be worse. I'm tripping more. I once had a patient who absolutely loved riding his recumbent bike at home. And he'd come to PT and he'd say, Dr. Gretchen, I know that I'm overdoing it because when I'm done on my bike, I have to stay sitting on my bike for an hour because I don't have the strength to go up the stairs because his bike was in his basement. And he was okay with that. To him, he knew he was overdoing it, but it was worth it because it made him feel great. So if you know that you're overdoing it, but you don't mind because it makes you feel alive and it makes you feel good and strong, even if it means that you need to wait an hour before moving, then that's okay. Listen to your body and what you feel comfortable with. But if you're in the boat where you know you're overdoing it and you don't enjoy it because you can't move on with your day and you need to, then here's some notes. It can be really hard to know how you overdid it. If what you did felt fine in the moment, and it also has felt fine for years and years and years, you might look back at your exercise that you did earlier today or yesterday or two days ago and feel like, I didn't overdo it. That's the same thing I've been doing for years. But your Ms. Might be changing, and that might be too much for you on that day that you did it. Mississippi is different every single day, which makes this conversation really hard. Because what you did most recently for exercise might be fine for you on some days, but other days it might have been too much. But here's what you can do, regardless of what day you're having, to help you not overdo it so that you're able to keep moving and keep going about your day even after you exercise. There are three questions that I want you to ask yourself that can help you determine what about your exercise routine might have been overdoing it for you. So the first question is, how long did you exercise for? 60 minutes? 45 minutes? 30 minutes? 10 minutes? There's no right or wrong answer to any of these. How long did you exercise for? Next question. How many exercises did you do? And we could even take this a step further and say, how many repetitions did you do of each exercise? How Many sets did you do? So as an example, did you do six different exercises? Did you do 10? Did you do three? Did you do 10 repetitions of each one, or did you do five? Again, there's no right or wrong answers, but let's get some numbers here. We could also take this one a step further and ask, what type of exercise did you do? Was it all strengthening? Was it all stretching? Were there balance exercises in there? Were there walking exercises in there? What exactly did you do, and what category of exercise would those exercises fall under? And then the third question is, how intense were you pushing yourself? For example, how high were you lifting your leg? How fast were you going? Did it feel like you were pushing yourself, or did it feel like you were just kind of going with the flow or somewhere in the middle? Your answers to these questions is what we will use to help you modify your exercise routine the next time that you do it. So these are seven things that you can do to not overdo it. And you don't need to do all of these often. What I recommend is just pick one of these solutions and try that one thing the next time that you exercise, and then check in with yourself and see, okay, did that make a difference or not? Let's get started. So here's some possible solutions for you to modify slightly just so that you're not overdoing it. The first one is to exercise for less time. And so that first question that we asked was, how long did you exercise for? If your answer was 45 minutes, then next time you exercise, maybe stop yourself at 40 minutes or 35 minutes or 30. It's up to you how much you want to pull back. But 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. So let's pull back a little bit there. The second question that you asked yourself was, how many exercises did you do? So as a solution, we could do fewer exercises. If you said that you did six exercises on that day, that you overdid it, okay, next time, maybe do five exercises or four. Or you could keep the same number of exercises, but do fewer repetitions or fewer sets. If you did 10 repetitions with every exercise last time, maybe only do six repetitions of each exercise or only one set instead of two, or two sets instead of three. The third question that you asked yourself was, how intense were you pushing yourself? And so the solution here would be possibly focusing on exercises that feel easier. Your exercises probably don't feel easy, but there are probably some exercises that feel easier than others. So you could purposely choose more exercises that feel easier. If on the day that you overdid it, you would rate the exercises as moderate to hard, then maybe keep one or two moderate or hard exercises, but choose more that would go into that easier category. And not only that, but when you're doing your exercises, don't push yourself as hard. So even if you kept the same exercises, if you were putting a ton of effort in, if you were putting 100% of your strength and effort in to every movement, while I love that for neuroplasticity and it might be too much for you right now, so keep the same exercise routine, but don't push yourself to 100%. Stop at about 80% of what you think you can do and see if that feels better afterwards if it doesn't impact you as much and you don't feel as fatigued or worse after your exercise. Similarly, if you were moving at a pretty quick pace, then slow yourself down and maybe even take more rest breaks. And this one gets a little bit tricky because if you remember, the first solution was don't exercise for as long. However, if you're going slower and taking more rest breaks, then that is going to prolong the amount of time that you exercise. So you wouldn't be able to try both of those solutions at the same time. You just want to pick one and see how it feels. For example, if you were not taking any rest breaks, like your rest break was doing an exercise for a different muscle group, then instead you might actually take 30 seconds rest between each exercise or maybe one minute rest. Or if you were taking one minute rest, then maybe you take a two minute rest. So that is going to extend your exercise time from possibly 30 minutes to maybe 40 or 45. Not because you're exercising more, but because you're resting more. So it's going to take longer to get through your routine. Those are a few of my favorite solutions that are pretty simple to implement. STEP 1. Ask yourself those questions that we identified so you can figure out what what it might have been, what contributing factors could have caused you to overdo it. And then step number two is pick one thing that you can do to modify your routine and give it a try. Because Ms. Is so different each day, I would recommend trying out that solution for a full week or so before you have any solid conclusions as to if that made any difference or not. Because if you just tried it once and it did work. That's great. But it might have just been a better day for you because Ms. Is so variable. So we want to make sure that what solution you are choosing or multiple solutions you're choosing will help you on any day, not just on your good days. Which brings me to a tip that I do with almost every client, and it's been extremely beneficial. So once you know the factors that we've discussed thus far, once you know the factors that cause you to overdo it and what factors you can implement to not overdo it, a great strategy to implement what we've just learned into your daily life that does work well with Ms. Is to come up with three different exercise plans. One plan that you feel would be appropriate for you on a good day for you, whatever that means, whatever a good day for you is, you have an exercise plan for that day. Maybe that plan is longer, or maybe you put 90% effort in instead of 80%. Maybe you're doing more exercises or more repetitions, but then you have a different exercise plan for a not so great day, whatever that means for you. If you're more fatigued, if you are on the couch most of the day or in bed most of the day, or you're still going about your day, but you just don't feel energized at all, or you're tripping more, whatever it means you've got a different exercise routine for that day that is more doable for you. Maybe it's fewer exercises, maybe it's longer rest breaks, maybe it's fewer repetitions, but you've got something that you can do because on those days you can absolutely rest. That is very valid and something I would encourage. But for some people, doing light exercises can actually make those days feel a bit better. Better. But if you try to do the same routine that you do on your good days, that's probably not going to feel great because it's going to be too intense for you. So then the third exercise plan that you want to create is for a average day, it's not your best day, it's not your worst day, but it's an average day. And you'd use everything we've talked about to help you determine what might be appropriate for you on an average day. And the way that you would use this is when you're about to exercise, maybe it's first thing in the morning, maybe it's later. Morning, early afternoon, evening, whenever it is right when you're about to exercise, you ask yourself what type of day am I experiencing right now? Because let's be honest, if you ask yourself this first thing in the morning, your answer might be different than if you're doing your exercises in the afternoon. And it could go either way. Maybe in the afternoon you're feeling better, maybe in the afternoon you're feeling more fatigued. So it's important to ask yourself the question right before you exercise, what type of day am I experiencing right now? And then choose the plan that aligns with that. I also want to recognize that it can be really hard to not push yourself to not do your best. We all learn from a very young age. Go big or go home. You know, push yourself, do as best as you can. And while there might be a time and place for that, with ms, that is not the best advice. And so we are used to going 100% and putting our best effort in, when in reality that might actually be causing more harm than good. So it can be hard to get out of that mindset. It can be hard to purposely not put 100% effort in, especially if you're type A, it can be hard to do that. And so acknowledging that, 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 and see what can we put together for this exercise plan that doesn't cause you to overdo it. So thinking about exercising at about 80% of what you can do is a great start. For some, that might still be too much. Maybe you stop at about 75%. And another way you could think about this is only putting about 80% effort in or only put about 80% of time in. If you've exercised for 30 minutes and you feel like, all right, I could go for 10 more, you're going to actively choose not to. Or if you are pushing yourself to 80% of your strength and you feel like I do have more to give, you're not going to. And this is really hard mentally for us to do. So just acknowledging it is the first step, and then taking the action of pulling yourself back is the second part. Another way you could think about this is 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. If you feel like you are going to be out of breath by having a conversation, then you might be pushing yourself a bit too hard. As I mentioned in the beginning, while we did focus on exercise, the same thing applies. If you feel like you've overdone it from chores. So questions might be how many chores did I do today? Did the chores require going up and down stairs or squatting? Did you have to unload the dishwasher so you were up and down? Did you feed the dog so you were up and down? Those types of things are going to be more intense. Could you do those things on different days? Maybe the day that you unload the dishwasher won't be the same day that you take the trash out or that you fold laundry. Maybe you only do two chores in one day instead of four, or one chore instead of two. Or maybe you spread out one chore instead of doing it all at once in an hour. You spread it out throughout the day and you're taking breaks in between and you take five hours to do that chore. That is okay. So utilize the concepts, the principles, the strategies that we've discussed for exercise. Use those for whatever it is that you feel is overdoing it. And you should find that whether you just need to implement one of these solutions or maybe two or three, that you are able to find something that works for you. A lot of this is trial and error and it might take a month, two months, three months before you finally have tried enough and get a sense of what what is going to work for you and your Ms. But it is possible. So 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, not nervous of Am I going to be feeling this later? Am I going to be able to do what I want to do later? Or did I overdo it without realizing it in the moment?

[B]

Thank you for listening to today's show.

[A]

I am so grateful to have you as a listener.

[B]

If you'd like extra resources such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your question questions, head to missinglink.com insider. That link will be shared in the show notes along with links to my social media handles. If you loved this episode and think a friend or family member with Ms. Would benefit from listening, please go ahead and text or email this podcast to them right now. Sharing this podcast will help me educate and empower as many Ms. Warriors as possible. Thanks again for joining and be sure to tune in next week for another episode of the Missing Link podcast.