Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion

Abstract

Background: There have been significant advances in the medical treatment and management of multiple sclerosis pathogenesis, relapse and disease progression over the past 30 years. There have been advancements in the symptomatic treatment of multiple sclerosis, including management of secondary multiple sclerosis expressions such as walking, cognitive dysfunction, fatigue and depression. Scientific evidence and expert opinion suggest that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. This article presents the historical context of exercise training within the multidisciplinary management of multiple sclerosis. We guide neurologists and healthcare providers on the recommended prescription of exercise and practical, theoretical methods to overcome barriers to exercise. Method: We undertook a critical search of the historical and current literature regarding exercise and multiple sclerosis from the viewpoint of exercise promotion by neurologists and the multidisciplinary care team. Results: We highlight the ever-strengthening body of research indicating that exercise is safe and effective for improving symptoms of multiple sclerosis. Further, exercise training may be necessary for reducing disease progression. Conclusion: We seek to encourage neurologists and specialists in multidisciplinary healthcare teams to prescribe and promote exercise at diagnosis and across all stages of the disease trajectory using prescriptive guidelines as part of comprehensive MS care. Available tools include clinical education to dispel any historical myths related to exercise in multiple sclerosis, clinical exercise guidelines and behaviour change theory to overcome patients barriers to exercise.

Developing evidence-based guidelines for the safety of symptomatic drugs in multiple sclerosis during pregnancy and breastfeeding: A systematic review and Delphi consensus

“…Physiotherapy and rehabilitation NICE guidelines on symptom management in MS highlight the importance of offering people with MS and mobility problems access to rehabilitation specialists and physiotherapists with expertise in MS. 11 Evidence and expert opinion have suggested that the combination of mechanical, manual and educational interventions in physiotherapy programmes which are tailored to the individual's needs may be the single most effective non-pharmacological symptomatic treatment for MS. 12 Apart from mobility, physiotherapy has also been found to be beneficial in treating cognitive and mood disturbances, pareses, spasticity and fatigue. 13 At least one physiotherapy-amenable symptom was reported by 75% of women during pregnancy and postpartum in a large MS clinic based in the US.…”

The pathophysiology of motor fatigue and fatigability in multiple sclerosis

“…Relevant critical events or severe deteriorations of mental or physical health have hardly ever been reported to occur in physical exercise programs for multiple sclerosis and relapses do not occur more frequently in MS patients on exercise programs. An instructive review on practical aspects of exercise training in MS is given by Learmout and Motl ( 125 ).…”

Identifying unanswered questions and setting the agenda for future systematic research in Multiple Sclerosis. A worldwide, multi-stakeholder Priority Setting project

“…In the past decade there has been an acceleration of research in this area and there is evidence that supervised and individualized exercise programs or home-based exercise training can improve physical fitness, functional capacity, fatigue and quality of life (Sá, 2014, Halabchi et al, 2017, Ghahfarrokhi et al, 2021, Even for PwMS with severe functional impairment, exercise could be considered, in some circumstances, as an alternative valid approach to drug intervention (Edwards et al, 2017). Moreover, exercise can decrease neural apoptosis and neurodegeneration, and may be effective at stimulating neuroplasticity, speculating a disease modifying effect (Learmonth et al, 2021). There is the need however to move forward, with all stakeholders, in advancing standardized and shared outcome measures (Dalgas et al, 2021).…”