Does exercise improve Restless Leg Syndrome (RLS)?

Exercise as Treatment for Restless Leg Syndrome

Regular exercise is recommended for patients with Restless Leg Syndrome (RLS) as it significantly improves symptoms and should be incorporated into the management plan of all RLS patients. 1

Evidence Supporting Exercise for RLS

The evidence supporting exercise for RLS is compelling:

• A randomized controlled trial demonstrated that a 12-week exercise program consisting of aerobic and lower-body resistance training 3 days per week led to significant improvement in RLS symptoms compared to a control group 1
• The American Academy of Sleep Medicine (AASM) includes regular exercise as part of sleep hygiene recommendations for RLS management 2
• Exercise is specifically mentioned as a non-pharmacological intervention that can help relieve RLS symptoms 2, 3

Exercise Prescription for RLS

Type of Exercise

• Aerobic exercise combined with lower-body resistance training shows the best evidence for symptom improvement 1
• Walking, stretching, and other forms of movement can provide immediate relief during acute RLS episodes 2, 3

Frequency and Intensity

• Exercise should be performed 3 days per week at minimum 1
• Aim for moderate intensity exercise sessions 2
• The total recommended exercise time is at least 150 minutes of aerobic exercise per week plus strength training twice weekly 2

Timing

• Morning or afternoon exercise is preferable for RLS patients 2
• Avoid intense exercise close to bedtime as this may exacerbate symptoms in some patients

Mechanism of Action

While the exact mechanism by which exercise improves RLS is not fully understood, several theories exist:

• Exercise may improve dopaminergic function in the central nervous system
• Physical activity can improve circulation to the legs
• Exercise may help regulate iron metabolism, which is implicated in RLS pathophysiology 4
• Regular physical activity improves sleep quality overall, which may indirectly benefit RLS symptoms

Important Considerations

• Safety: Exercise is safe for RLS patients and can be started at any age or stage of the condition 2
• Setting: Exercise can be performed alone or in groups, with some evidence suggesting slightly better outcomes with group exercise 2
• Individualization: The exercise program should be adapted based on the patient's abilities and comorbidities 2
• Complementary approach: Exercise should be considered alongside other treatments including:
  • Iron supplementation when indicated (ferritin < 45-50 ng/mL) 2
  • Pharmacological treatments when appropriate 2

Common Pitfalls to Avoid

• Overexertion: Excessive exercise may temporarily worsen symptoms in some patients
• Evening exercise: High-intensity exercise close to bedtime may trigger RLS symptoms
• Inconsistency: Irregular exercise patterns may not provide sustained benefits
• Relying solely on exercise: For moderate to severe RLS, exercise alone may be insufficient and should be combined with appropriate pharmacological therapy

Exercise represents an effective, safe, and non-pharmacological approach to managing RLS symptoms. The evidence strongly supports incorporating regular physical activity into the treatment plan for all RLS patients, with particular emphasis on aerobic and lower-body resistance training performed regularly at moderate intensity.