Dr. Fink's Recommendations

Dr. Fink is the leading HSP and PLS neurologist in USA.


Hello everyone,

As requested, this is a brief overview of my recommendations for exercise in HSP and PLS. One caveat: my recommendations are not based on scientific research of exercise methods in HSP and PLS. These recommendations are based on talking with many individuals with gait disturbance and finding what seems to be helpful.

The basic concepts are:

  • Find the problems
  • Address the problems specifically both as isolated exercises and importantly, through complex task-based exercises
  • Keep score of your progress
  • When tasks become easier, change the routine to make things more challenging
  • Expect improvement (recognizing it will be slow)
  • Core muscle exercise and aerobic conditioning are key


Here are a few notes.

Identify the factors that make walking difficult.

  • HSP and PLS affect walking differently in each person
  • For some individuals, spasticity (affecting hamstrings, quadriceps, adductors, "heel cords" in variable proportion) is the major problem
  • In other individuals weakness (hip flexion, foot dorsiflexion, hamstrings for example) or endurance is the major problem.
  • Often weakness (in certain muscles more than others) and spasticity (in certain muscles more than others) occur together (in variable proportions) with balance difficulty and slowness in muscle activation.
  • Consultation with a neurologist, physiatrist, physical therapist, personal trainer are often helpful in identifying which factors are particularly problematic. 
  • This is the basis for developing a function-specific exercise program.


Develop an exercise program that:

  • "starts low and goes slow" (begin with something you´re dapable of and increase the frequency and intensity by approximately 10% each week)
  • is graded (increasing intensity and frequency
  • is monitored (by you, keeping track of performance, and by your therapist or trainer)
  • addresses the function-specific goals
  • is varied (monotonous routines are difficult to maintain)
  • has days off each week where other exercises are performed
  • ideally is done with exercise partners (activities that are performed completely alone are difficult to maintain)
  • both complex/contextual exercises (e.g. climbing gym, water aerobics, kicking a weighted ball) and isolated exercises (leg lifts, abdominal exercise "crunch" machine at the gym) are useful.

In my view, the value of stretching, balance, core exercises, and aerobic conditioning can not be overstated and should have a central place in the exercise routine. In my opinion, "exercise frequency" (4 to 10 times a week) is at least as important if not more important than the intensity of a given exercise period.

I hope this is helpful.



John K. Fink, M.D.
Professor, Department of Neurology
University of Michigan