Background: In Myasthenia Gravis (MG), the effect of exercise is not well documented in controlled trial. In the present study, the efficacy and safety of exercise in MG in comparison to rest is presented. Methods: In this single-center open-labeled randomized clinical trial the patients were randomized in 1:1 ratio to exercise (30 min walk) or rest arm in addition to standard treatment of MG. The Primary endpoint was 50% change in Myasthenia Gravis Quality of Life (MG-QOL15) at 3 months and secondary endpoints were change in Myasthenic Muscle Score (MMS), Myasthenia Gravis Activities of Daily Living (MGADL), grip strength, AChEI and prednisone dose, 6 minute walk test (6MWT), decrement in trapezius muscle and adverse events at 3 months. The Outcome was defined at three months by 50% change compared to the baseline parameters. Results: There were 20 patients in each arm which were matched for demographic and clinical parameters. The patients in exercise arm had significantly better QOL as evidenced by 50% improvement in MG-QOL15 (P = 0.02), increase in number of steps (P = 0.03) and the distance covered in 6MWT (P = 0.003). The scores of MG-QOL15 (P = 0.03), MMS (P = 0.048), and distance travelled (P <0.001) also revealed significant group difference. Intragroup comparison revealed that both exercise and rest arm significantly improvement with respect to MG-QOL15 in exercise (P = 0.001) and rest (P = 0.001), MMS in exercise (P = 0.001) and rest (P = 0.001), reduction in pyridostigmine (P = 0.03) and prednisone (P =0.001) dose in exercise, increase in number of steps in exercise (P =0.001) and increase in walking distance in 6MWT in both exercise (P =0.001) and rest arm (P = 0.023). There was no adverse event in any group. Interpretations: The study provides class II evidence of improved quality of life in mild to moderate MG by 30 min walk in comparison to rest. Trial Registration: The trial was registered in Clinical Trial Registry of India (CTRI/2019/11/021869). Funding Statement: World Congress of Neurology, the authors received no funding for this study. Declaration of Interests: All authors declare no competing interest. Ethics Approval Statement: This study was approved by Institutional Ethics committee (PGI/BE/632/2018), SGPGIMS, Lucknow.