Making notes during a university lecture, Gina Ramage suddenly found her pen was too heavy to hold.It was odd, but the 18-year-old student brushed it off as cramp from writing for too long. Or perhaps she was simply tired.Over time, however, her symptoms began to multiply.Pins and needles spread through her scalp, hands and feet. She developed extreme fatigue, temporarily lost sensation in her legs and experienced blurred vision.Gina, now 29, recalls: 'At the time I didn't know what was going on. All I knew was that these bizarre things were happening to my body.'It would take seven years before she finally got an explanation.Gina was eventually diagnosed with multiple sclerosis (MS), an incurable autoimmune disease in which the body's immune system mistakenly attacks myelin – the protective coating around nerves in the brain and spinal cord.Over time, the damage disrupts communication between the brain and the rest of the body, causing symptoms ranging from crushing fatigue and numbness to blurred vision, muscle weakness and, for some patients, progressive difficulty walking. Gina Ramage, 29, has multiple sclerosis, a chronic autoimmune condition affecting the brain and spinal cord Through a structured exercise programme, Gina began to notice improvements in her energy levelsMS is one of the most common causes of disability in young adults in the UK. Most people are diagnosed between the ages of 20 and 40, and women are more than twice as likely to develop the disease than men.While researchers are still not sure what causes it, there is growing evidence that the disease develops when a combination of environmental triggers affect people who are genetically susceptible.In the UK, there is a striking north-south divide, with Scotland recording the highest rates of MS in the country, suggesting a lack of sunlight and low vitamin D levels may play a role.Certain viral infections – including severe Covid and Epstein-Barr virus (EBV), which causes glandular fever – may increase the risk of developing the disease, research has revealed.Treatment typically focuses on slowing the progression of MS, reducing the frequency of relapses and managing symptoms. Patients may be offered drugs to dampen the immune system – alongside steroids, which reduce inflammation – during flare-ups and therapies such as physiotherapy to help maintain mobility.Crucially, there is no cure, and many patients continue to live with debilitating symptoms.For Gina, an analyst from Glasgow, one of the most disabling symptoms was an overwhelming exhaustion that no amount of sleep could relieve.'It had a huge impact on my social life and relationship with my boyfriend,' she says. 'All I would have the energy to do was get up, go to work and go home to bed.'I was trapped in this cycle and my world was getting very small. I remember thinking, "Is this it? Will life always be like this?"'It wasn't until she began a structured exercise programme that she began to notice improvements in her energy levels. But Gina says that it took years for her to realise this. In fact, for a long time, she worried that exercising would make her symptoms worse.'I had been diagnosed with MS for four years before I began to incorporate lifestyle changes into my treatment but it's made such a huge difference,' says Gina.'When my neurologist told me to take up regular exercise to help deal with my symptoms, I was actually a bit offended and hurt, like what I was doing already wasn't enough.'I already felt like it was a struggle to get through the day and I couldn't see how exercise would make things better.'Through a support group meeting, she was recommended a free 12-week course tailored to people with long-term health conditions. The Long-Term Conditions programme, run by the healthcare charity Nuffield Health, includes two hour-long gym sessions each week.'If you told me a couple of years ago I'd be doing group exercise, I'd have laughed in your face,' says Gina. 'I was very nervous going into it, but there was a great sense of community being part of a group of around nine other people who also had a chronic health condition.'A typical session would include anywhere from five to 15 minutes of initial discussion about topics such as lifestyle, sleep or pain. This would be followed by 45 minutes of exercise targeting a specific muscle group. Gina is pictured with her dog after having a test in hospital to diagnose MS 'I have more energy and am saying yes to more things like trips out,' says Gina, pictured with her friend SophieThis could be Pilates or a fitness routine called stability circuits, which trains the core and joints to keep you balanced. Instead of moving heavy weights, the exercises challenge the body to stay steady.Doing this builds a stronger core, improves posture and reduces the risk of falls.'A lot of people go to the gym and do one thing, like lifting weights or running on the treadmill,' says Gina.'But I've learned that it's really important, especially for people with long-term health conditions, to balance exercises that combine flexibility, cardio and strength training.'Since completing the programme, Gina says she has seen a huge improvement in her energy levels.'The nature of the disease is that I am always going to have peaks and valleys when it comes to my symptoms, but even my lowest points are much better than they were.'It's opened a lot of doors for me. I now have the energy to go out with my friends, I'm not worried about standing on public transport and I feel a lot more stable in my body.'Gina now goes to the gym two or three times a week, combining strength and cardio workouts.Caitlin Astbury, senior research communications manager for the MS Society, explains: 'Research has shown that being physically active can improve things like mobility, muscle strength and mood.'There is also evidence that shows not doing enough moderate to intense exercise can be linked to worsening symptoms of MS.'While it sounds contradictory, we know that many people with MS do find that exercise can help to improve fatigue.'MS can have a huge range of symptoms, so exercises must be tailored to a specific person and what they feel able to do.'A study published in the Journal of Neurology found that resistance training, such as weightlifting or resistance band work, may be the most effective type of exercise for easing fatigue in people with MS, especially when programmes last longer than eight weeks.For Gina, the difference has been night and day.'After struggling for so long, I'm finally getting my head above water,' she says. 'Even having a small amount more energy feels massive when you've been so unwell.'My friends and family have seen a huge change in my confidence and I'm saying yes to more things, like trips out.'Realistically, I know there is a possibility that my condition may get worse and there may be a time that I can't walk anymore. But I've learned lots of future-proofing skills and I see exercise as necessary maintenance to stay healthy.'