Before prescribing a physical activity program, a brief exercise history should be obtained. The history should include ambulation, balance, coordination, and strength. A review of cardiopulmonary function and an electrocardiogram should be obtained. A graded exercise test using a preferred exercise should be performed in order to estimate VO2max and Rating of Perceived Exertion (RPE).

An appropriate exercise prescription can be formulated once assessment has revealed specific physical abilities and limitations. Physical activity may be classified in a pyramid fashion, permitting the selection of exercises that coincide with a given functional level. Two pyramids are described in this study: a muscular fitness pyramid and a physical activity pyramid.

Individuals with MS may be more susceptible to temperature-induced conduction block because of impaired ability to regulate body temperature due to dysautonomia. Pre-exercise cooling can be very beneficial and can enhance exercise performance as well as reduce subjective feelings of fatigue. A cool water bath for 20 to 30 minutes prior to exercise is suggested.

For balance and coordination, Swiss ball exercises may improve balance and range of motion. Balance and coordination drills can also be done in a pool, which would aid in temp control as well.