Mark Mañago, PT, DPT, PhD, NCS, is an Associate Professor in the Department of Physical Medicine and Rehabilitation at the University of Colorado Anschutz Medical Campus, specializing in neurologic physical therapy. His research focuses on targeted exercise interventions to improve participation and quality of life for people living with MS and other neurological conditions. In this conversation with InforMS, Dr. Mañago shares practical insights about movement, physical therapy, exercise misconceptions, assistive technology, and why “anything is better than nothing” when it comes to staying active with MS.
When people hear the word “movement,” they often think of exercise. How do you define movement for people living with MS?
Dr. Mañago: Exercise is certainly one form of movement, but I think it’s important to think about movement more broadly as physical activity throughout daily life. Movement can include things like walking, doing chores around the house, shopping, gardening, biking, or structured exercise. It’s really any way that you’re moving your body throughout the day.
I think broadening the definition helps people realize that movement doesn’t have to mean going to a gym or doing an intense workout. It can look very different depending on the person and their abilities.
What would you want people to know about the role physical therapy can play at any stage of MS?
Dr. Mañago: I think it’s really valuable to connect with a physical therapist who has experience working with people with MS. And to do it early, even if you don’t feel like you “need” physical therapy yet.
One of the most important things PTs can do is establish a baseline. We look at things like strength, balance, walking, fatigue, dizziness, and mobility so we understand how someone is functioning early on. Sometimes that first visit may simply be a consultation. It might involve guidance about safe exercises, movement strategies, or ways to maintain mobility. Then, if symptoms change later, we already have that baseline and can provide more targeted support.
Physical therapists can also help address specific symptoms that interfere with movement, whether that’s weakness, balance challenges, dizziness, fatigue, or mobility changes. There are often strategies, exercises, bracing options, or assistive devices that can help people continue participating in daily life safely and confidently.
What does an initial physical therapy evaluation typically look like for someone with MS?
Dr. Mañago: The first visit is usually a fairly comprehensive evaluation. We’ll assess muscle strength, balance, walking ability, endurance, fatigue, fall risk, and other symptoms that may affect movement.
For example, we may look at gait speed, how long someone can walk over six minutes, or how well they can walk while turning their head or stepping over obstacles. There are also questionnaires that help us measure things like fatigue, dizziness, and confidence with balance.
The goal is to create a clear picture of how someone is functioning so we can tailor recommendations specifically to their needs and goals.
Many people feel intimidated by exercise or unsure where to begin. What are some realistic ways to start incorporating more movement into daily life?
Dr. Mañago: I actually think physical therapy can be a really good starting point because it’s often less intimidating than trying to join a gym or start a complicated exercise program on your own. For many people, simply starting with walking can be extremely beneficial. Most of our phones now track steps, so people can get a general sense of how active they are and gradually build from there.
One important thing I often talk about is that the popular “10,000 steps per day” goal is somewhat arbitrary. Research suggests that for many people — including people with MS — increasing activity by even 700 to 1,000 steps per day can lead to meaningful improvements in endurance, fatigue, and overall health. That’s only about a half mile of additional walking, but people often notice a real difference. The key is gradual progress, not perfection.
How does movement look different for someone who uses a wheelchair or has more advanced mobility challenges?
Dr. Mañago: Movement can absolutely still be meaningful and beneficial, even for someone who primarily uses a wheelchair. For some people, that might mean walking short distances safely with assistance. For others, it could involve seated exercise, an arm bike, a recumbent bike, pool exercise, bed-based exercises, or simply practicing standing and weight shifting.
The goal is really to maximize movement safely within someone’s abilities. That’s where working with a physical therapist can be especially important because exercise recommendations become much more individualized when mobility challenges are more significant.
What are some common misconceptions people have about exercise and MS?
Dr. Mañago: Probably the biggest misconception is the fear that exercise will make fatigue or weakness worse. Years ago, even clinicians weren’t completely sure how exercise affected MS. But we now have strong evidence showing that appropriately dosed exercise is generally very safe and very beneficial for people with MS.
It’s true that someone may temporarily feel more fatigued after exercise, but that doesn’t mean they’re causing harm. In fact, regular exercise tends to improve endurance, strength, fatigue, mood, and overall function over time.
The important thing is finding the right balance and learning how your body responds, and that’s another reason physical therapy can be so helpful.
What does “success” look like in physical therapy for someone living with MS?
Dr. Mañago: The ultimate goal is participation. We want people to be able to engage in the activities and parts of life that matter most to them, whether that’s working, traveling, spending time with family, volunteering, or simply moving through daily life more comfortably and confidently.
Exercise is often a tool that helps support that larger goal, but it’s not just about getting stronger for the sake of getting stronger. We also see benefits in areas like confidence, self-efficacy, mood, anxiety, depression, and cognition. There’s growing evidence that exercise can positively impact processing speed, memory, and mental health in people with MS. Sometimes one of the most powerful things is simply helping someone realize, “I can still do this.”
What role do assistive devices and newer technologies play in supporting movement?
Dr. Mañago: Assistive devices and technology can be incredibly helpful. If something like foot drop is limiting a person’s ability to walk, then using an orthotic device or technology like a Cionic sleeve may immediately help them walk farther and more safely. We still want to work on strengthening and rehabilitation, but if a device helps someone move more throughout the day, that’s a good thing.
I think we’ll continue to see more technologies emerge, and hopefully they’ll become more affordable and accessible over time. In physical therapy, we’re generally very supportive of devices and technology when they help people participate more fully in daily life.
What advice would you offer to caregivers or family members who want to support a loved one with MS in becoming more active?
Dr. Mañago: One of the biggest things we know from research is that motivation ultimately has to come from the individual themselves. That can be difficult for caregivers because it’s stressful to feel like you constantly have to push or remind someone to exercise.
A big part of physical therapy is helping people identify what matters most to them personally. Maybe they want to continue working, attend family events, travel, volunteer, or remain independent. Those goals often become the motivation for movement.
Sometimes having a third party — like a PT, wellness coach, or support professional — can help reduce tension within families and provide more structured support.
Any final message for people living with MS who may feel discouraged about movement or exercise?
Dr. Mañago: Anything is better than nothing. Any increase in activity is meaningful. Any change is better than no change. No matter where someone is starting from, there is almost always room for improvement, and often those early changes can make the biggest difference. You don’t have to do everything perfectly. You just have to start somewhere.
