Exercise guide
Restless legs syndrome (RLS) is a strong urge to move your legs, usually with tingling, throbbing or aching, that comes on when you rest in the evening or at night and eases when you move. Treatment starts with the basics: a GP can check your iron and your medicines, because low iron and some medicines make RLS worse, and other medicines help when it's troublesome.
Exercise helps some people. In the one trial, a 30-minute walk and leg strength exercises 3 days a week cut symptom scores by 39% within 6 weeks, but only 23 people finished it, and US sleep-medicine guidance makes no recommendation on exercise. The NHS advises exercising during the day rather than late at night.
This guide covers iron and medicines, what the exercise trials show, when to exercise, what to do when symptoms start, and how RLS differs from leg cramps and from leg pain caused by narrowed arteries. It ends with a daytime routine based on the trial, with 3D demos.
A strong urge to move your legs, usually with uncomfortable feelings such as tingling, throbbing or itching, worse when you rest in the evening or at night and eased by moving. RLS that is frequent and distressing affects 2% to 3% of adults.
US guidance from the American Academy of Sleep Medicine (AASM) says everyone with troublesome RLS should have their iron checked, and that iron is worth treating at a ferritin of 75 micrograms per litre or less, higher than the usual cut-off for anaemia. In trials, iron eased symptoms.
Alcohol, caffeine, and some antihistamines, antidepressants and anti-sickness medicines can make RLS worse. Gabapentin or pregabalin are now the main medicines, and dopamine medicines can make RLS worse over time. Never stop or change a medicine yourself: ask your GP.
In a 12-week trial, walking and leg strength work 3 days a week cut symptoms by 39% within 6 weeks (23 people finished), and gentle yoga helped in another small trial. The AASM makes no recommendation on exercise, so treat it as worth trying alongside the basics.
The NHS advises exercising during the day and not doing strenuous exercise late at night. The research on timing is thin and mixed, and some people find a gentle early-evening walk helps.
Walk, stretch or massage your legs. See a GP if RLS is stopping you sleeping, affecting your mental health, or self-help hasn't worked.
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A strong urge to move your legs, often with tingling, throbbing, itching or pain, that comes on when you rest and is worst in the evening or at night. Some people get it in their arms too. It's also called Willis-Ekbom disease.
There's no test: a doctor goes by your description. The urge has to start or get worse when you rest, ease when you move, and be worse in the evening or at night, and it mustn't be explained by something else, such as cramps or sitting awkwardly. Most people with RLS also have jerking leg movements in their sleep.
In a survey of 15,391 adults, 7.2% had some symptoms in a year and 2.7% had RLS at least twice a week that was at least moderately distressing. It affects 0.5% to 1% of children.
It's thought to be linked to iron and the brain chemical dopamine, and iron levels in the brain are low in RLS. Usually there's no clear cause, but it runs in families and is linked with pregnancy, iron-deficiency anaemia, kidney disease and some medicines.
About 9 in 10 people with RLS have trouble falling or staying asleep, so tiredness and low mood are common.
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RLS is about 50% more common in women, partly because of pregnancy, and more common in people of northern European heritage. In children it's often mistaken for growing pains, which our growing pains guide covers.
The AASM says to test ferritin and transferrin saturation in everyone with troublesome RLS, ideally in the morning and without iron supplements for 24 hours before. It suggests iron if ferritin is 75 micrograms per litre or less, or transferrin saturation is below 20%. These cut-offs are expert consensus, not tested in trials, and are higher than those used for anaemia.
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In a Cochrane review, iron improved symptom scores by about 4 points on a 0 to 40 scale compared with a dummy treatment (7 trials, 345 people; moderate certainty). Iron through a drip (ferric carboxymaltose) has a strong US recommendation, and iron tablets a conditional one.
The NHS says you may need iron supplements if your blood iron is low. Taking 17 milligrams a day or less from supplements is unlikely to cause harm; take more only on a GP's advice.
The first step is dealing with things that make RLS worse: alcohol, caffeine, untreated sleep apnoea, and medicines such as sedating antihistamines (including many cold and flu remedies), some antidepressants and anti-sickness medicines. Your GP or pharmacist can check what you take.
Gabapentin and pregabalin have strong US recommendations. The NHS also lists painkillers such as codeine or tramadol, sleep medicines, and dopamine medicines such as ropinirole or co-careldopa for occasional use or if other medicines haven't worked.
Over months to years, dopamine medicines can make RLS worse (augmentation): symptoms start earlier in the day, come on faster when you rest or spread to your arms. US guidance now advises against their standard use. Don't stop one suddenly, as RLS can rebound badly: see your GP.
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In the only trial of aerobic and strength training in people with RLS who weren't on dialysis, 41 adults were randomised and 23 finished. A 30-minute treadmill walk plus lower-body strength exercises, 3 days a week for 12 weeks, cut symptom scores by 39% by week 6, against under 8% in the comparison group, and the gain lasted to week 12. One person had knee pain. The trial was small, and people knew which group they were in.
In a trial of 41 adults (30 finished), 12 weeks of gentle Iyengar yoga eased symptoms more than an educational film programme, with no side effects, and more home practice went with bigger gains. The AASM rates the evidence as low certainty.
A review of 11 small trials found exercise among the treatments that reduced severity more than no treatment, but the evidence wasn't high quality. Tension and trauma release exercises did no better than discussion groups.
In people on haemodialysis, exercise eased RLS in small trials. Leg stretches for 30 minutes during dialysis, 3 times a week for 8 weeks, lowered symptom scores from about 19 to 12 (33 people). Cochrane calls the evidence for every treatment of RLS in kidney disease uncertain.
The AASM found the exercise studies too limited to grade and made no recommendation on exercise or yoga. Iron and medicines carry most of the evidence.
In 18,980 Europeans, physical activity close to bedtime was linked with RLS, while in 1,803 Kentucky adults, lack of exercise was. In a small lab study, one maximal exercise test reduced related leg movements in sleep that night. None of these tested evening exercise in people with RLS.
The AASM's review judged the studies of magnesium, massage, heat, vibration pads and compression too limited to grade, and the NHS doesn't list magnesium as a treatment. They're not yet shown to work.
Exercise during the day, and don't eat a big meal or do strenuous exercise late at night.
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RLS-UK suggests regular moderate exercise, and says some people find a gentle walk early in the evening helps.
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Very little: surveys point both ways, and the exercise trial didn't record what time people trained. People with RLS often avoid vigorous exercise because of reports that it makes symptoms worse.
Do your harder exercise in the morning or afternoon, keep the effort moderate, and use gentle stretches in the evening. Notice what works for you.
A 30-minute walk at an easy to moderate effort (10 to 13 on the 6 to 20 Borg scale of effort; in practice, a pace you can still talk at) plus six lower-body strength exercises at about half the most you could lift once: 1 set of 8 to 12 for the first 2 weeks, then 2 sets, 3 days a week. The routine at the end of this guide is our editorial home version.
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Our editorial suggestion: a 20 to 30 minute walk or bike ride during the day, which counts towards the 150 minutes a week the NHS recommends for adults.
Walk, stretch or massage your legs, or distract yourself with a book or a puzzle. Moving eases the feelings for as long as you keep moving.
Try a warm bath or heat pads on your legs, regular bed and wake times, no caffeine after midday, no alcohol for 2 hours before bed, and no screens right before bed. RLS-UK adds daily stretching.
Choose an aisle seat so you can get up, and stop regularly for a stretch on long drives.
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In the trial, symptoms had eased by week 6. If nothing has changed and RLS still stops you sleeping, see your GP.
A muscle, usually in the calf, suddenly tightens with sudden pain for a few seconds to 10 minutes, often at night, and may feel sore for up to a day afterwards. Stretching, massage or standing on the leg can help, and regular calf stretches may reduce cramps. See our leg cramps guide.
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An urge to move rather than a knot in the muscle, coming on when you rest and easing while you move.
An ache, usually in the calf, that comes on when you walk and goes after a few minutes' rest. It needs a GP check, and our peripheral arterial disease guide covers the walking programme for it.
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Nerve damage that causes numbness, tingling or burning pain. The NHS notes it can cause symptoms like RLS; see our peripheral neuropathy guide.
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Cramps and sitting awkwardly can tick the same boxes as RLS, which is why a doctor's careful history matters.
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One swollen, painful leg can be a blood clot, and pain in your foot at rest, or toes turning cold and then red or black, need help fast: see the warning signs below.
About 1 in 5 pregnant women get RLS, most often in the third trimester, and it usually goes after the birth. Stretching, massage, a warm (not hot) bath and relaxation may help. Ask your midwife or GP about iron before taking any supplements or medicines.
RLS is common in kidney disease, and exercise and leg stretches during dialysis helped in small trials. Our kidney disease guide covers exercise with chronic kidney disease and dialysis.
30 minutes, 3 days a week, during the day, at an effort you can talk through (the trial's treadmill walk; the bikes are our alternatives).
1 set of 8 to 12 for 2 weeks, then 2 sets (the trial). At home, use the first six moves; at a gym, the trial's machines (the last six).
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoStanding hamstring curlBeginner · A wall
3D demoLying adductor ball squeezeBeginner · Other / check instructions
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoLeg pressBeginner · Strength machine
3D demoLeg extensionBeginner · Strength machine
3D demoMachine leg curlBeginner · Strength machine
3D demoCable hip adductionBeginner · A cable machine
3D demoHip abduction machineBeginner · Strength machine
3D demoSeated calf raise (machine)Beginner · Strength machineGentle 30-second holds when symptoms start or before bed (our editorial suggestion; a dialysis trial used short, repeated stretches of the same muscles).
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoSoleus wall stretchBeginner · A wall
3D demoStanding quad stretchBeginner · A wall
3D demoSupine hamstring stretch with a strapBeginner · No equipment
3D demoReclined figure four (eye of the needle, Sucirandhrasana)Beginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoSeated calf stretch with a towelBeginner · Other / check instructions
3D demoAnkle circlesBeginner · No equipmentA few minutes of slow breathing before bed; the NHS points people with RLS to breathing exercises for stress.
The restless legs routine 3 days a week, earlier in the day. Use the stretching and breathing routines in the evening.
A 45-minute daytime session for restless legs, our editorial home version of the one exercise trial: a 30-minute walk, six leg strength moves and three stretches.
45 minBeginner10 movesCardio machine, A bench or boxA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallLearn to squat, hinge and lunge: a 25-minute beginner lower body workout with bridges, clamshells and calf raises.
25 minBeginner11 movesA wall, A bench or boxA gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepSeven stretches for after a run: calves, soleus, quads, hip flexors, hamstrings and glutes.
10 minBeginner7 movesA wallA slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.
10 minBeginner7 movesFirm cushion, A wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentPoor sleep can wear you down. If you have thoughts of harming yourself, call 999 or Samaritans on 116 123 (free, any time) in the UK, or call or text 988 in the US.
In the one trial, walking and leg strength work 3 days a week cut symptoms by 39% within 6 weeks, and the NHS advises exercising during the day. Save strenuous exercise for earlier in the day.
The evidence is small and the AASM makes no recommendation on exercise. Iron, when it's low, and medicines carry most of the evidence.
For RLS, US guidance treats a ferritin of 75 micrograms per litre or less as worth treating, which is higher than the usual cut-off for anaemia. Ask your GP what your result means for RLS.
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The AASM's review judged the magnesium studies too limited to grade, and the NHS doesn't list it as a treatment.
A cramp is a sudden, painful tightening that passes within minutes; RLS is an urge to move that comes on at rest and eases while you move. They can be confused, so a doctor's history matters.
They help in the short term, but over months to years they can make RLS worse, so US guidance now advises against their standard use. Never stop or change a medicine yourself.
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The NHS advises against strenuous exercise late at night. The evidence on timing is thin and points both ways, so if you try evening exercise, keep it gentle and notice how you sleep.
One small trial found gentle yoga eased RLS more than an educational programme. It didn't compare yoga with medicines, and the AASM rates the evidence as low certainty.
Regular walking and lower-body strength exercises during the day: in a trial, a 30-minute walk plus leg strength work 3 days a week eased symptoms within 6 weeks. When symptoms start, the NHS suggests walking, stretching or massaging your legs.
It helped in small trials of exercise and yoga, but the evidence is limited, and US sleep-medicine guidance makes no recommendation on exercise. It's low-risk and worth trying alongside an iron check and any treatment your GP suggests.
During the day. The NHS advises against strenuous exercise late at night, while some people find a gentle walk early in the evening helps. The research on timing is thin and mixed, so notice what works for you.
Some people with RLS report that vigorous exercise makes their symptoms worse, though this is anecdotal; in the exercise trial, moderate walking and strength work helped. Keep the effort moderate, do harder sessions earlier in the day, and see your GP if it keeps happening.
Calf, hamstring and thigh stretches, held gently for about 30 seconds, are easy to do in the evening or when symptoms start (our suggestion). In a small trial in people on dialysis, leg stretches 3 times a week eased symptoms over 8 weeks.
Low iron is linked with RLS, and treating it can help. US guidance suggests iron if your ferritin is 75 micrograms per litre or less, a higher level than the usual cut-off for anaemia, so ask your GP for a blood test rather than taking supplements on your own.
First, dealing with triggers such as alcohol, caffeine and some medicines, then checking your iron. Gabapentin or pregabalin are the main medicines, and dopamine medicines can make RLS worse over time, so they're now used more sparingly. Your GP will advise; don't change a medicine yourself.
A cramp is a sudden, painful tightening of a muscle, usually the calf, that lasts from a few seconds to 10 minutes. Restless legs is an urge to move, with uncomfortable feelings, that comes on when you rest and eases while you move.
If your calves ache when you walk and the ache goes after a few minutes' rest, it may be narrowed leg arteries (claudication), which needs a GP check. Our peripheral arterial disease guide covers the walking programme for it.
Yes: about 1 in 5 pregnant women have it, mostly in the third trimester, and it usually goes after the birth. Stretching, massage and a warm bath may help; talk to your midwife before taking supplements or medicines.
In one small trial, 12 weeks of gentle yoga eased symptoms more than an educational programme, with no side effects. That's encouraging but not proven, and US guidance doesn't recommend it yet. Our yoga guide for anxiety and sleep has gentle evening options.
There isn't good evidence: the US sleep-medicine review judged the magnesium studies too limited to grade, and the NHS doesn't list it as a treatment. Ask your GP before taking supplements.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
