Multiple Sclerosis (MS) is a complex neurological condition that affects millions of people worldwide. While it can pose significant challenges, there is growing recognition of the transformative impact that exercise, in conjunction with exercise physiology expertise, can have on managing and improving the lives of individuals living with MS. In this article, we will explore the importance of exercise for MS and the invaluable role that exercise physiologists play in tailoring exercise programs to meet the unique needs and goals of MS patients.

Understanding Multiple Sclerosis

Multiple Sclerosis is an inflammatory autoimmune and demyelinating disease that primarily affects the central nervous system, causing a wide range of symptoms such as muscle weakness, fatigue, numbness, and impaired coordination (Kuhlmann & Antel, 2023). It can be unpredictable and varies in severity among individuals. Managing MS involves a multifaceted approach, including medication, physical therapy, and lifestyle modifications. One of the most promising and empowering additions to this approach is regular exercise.

The Importance of Exercise for MS

Fatigue Management: Fatigue is a common and debilitating symptom of MS. Exercise, when appropriately tailored, can help reduce mental and physical fatigue and boost energy levels. It may seem counterintuitive, but regular physical activity has shown to increase overall energy and stamina (Torres-Costoso et al., 2022).

Improved muscle strength, mobility, and function: MS often leads to muscle weakness and loss of coordination. Engaging in a structured exercise regimen can counteract these effects by strengthening muscles and improving balance and coordination (Halabchi, Alizadeh, Sahraian, & Abolhasani, 2017). This, in turn, enhances mobility and the ability to perform daily activities. Study results demonstrate that all individuals with MS, despite disability levels, show improvement in muscle strength and endurance (Filipi, Kucera, Filipi, Ridpath, & Leuschen, 2011; Kierkegaard et al., 2016; Reina-Gutiérrez et al., 2023).

Neuroprotection and anti-inflammatory effects: This study (Mulero et al., 2023) examined the effects of a short-term resistance training program on neurofilament plasma levels, a biomarker of axonal destruction. A 6-week supervised resistance-training program of 18 sessions that consisted of 3 sets of 8-10 repetitions of 7 exercises showed that plasma neurofilament levels significantly decreased from baseline and interestingly this was maintained after 4 weeks of detraining. These results suggest a neuroprotective effect from resistance training on patients living with multiple sclerosis (Mulero et al., 2023). This study completed on patients living with relapsing–remitting multiple sclerosis performed high-intensity resistance training at an intensity of 80% of one-repetition maximum, twice a week for 12 weeks. Improvements were seen in inflammation levels as well as mood, fatigue, muscle strength, walking speed and cognition (Kierkegaard et al., 2016).

Improved Cognition and Mental Well-being: Exercise has well-documented mental health benefits and has shown superior results on improving mental health symptoms than medication or counselling (Singh et al., 2023), and this holds true for individuals living with MS. Exercise can reduce symptoms of depression and anxiety, providing a significant emotional boost and improving overall quality of life (Flores et al., 2023; Kierkegaard et al., 2016). Exercise has also shown to improve cognitive function and memory in patients living with multiple sclerosis (Li et al., 2023).

Enhanced Cardiovascular Health: MS patients often have an increased risk of cardiovascular problems due to reduced mobility. Studies highlight that engaging in aerobic and resistance exercise can enhance cardiovascular health and reduce this risk cardiovascular disease (Halabchi et al., 2017; Reina-Gutiérrez et al., 2023; Wens et al., 2015).

Pain Management: Many individuals with MS experience pain, which can be exacerbated by muscle stiffness and spasticity. Properly designed exercise programs can help alleviate these symptoms and reduce pain (Halabchi et al., 2017).

References

Filipi, M. L., Kucera, D. L., Filipi, E. O., Ridpath, A. C., & Leuschen, M. P. (2011). Improvement in strength following resistance training in MS patients despite varied disability levels. NeuroRehabilitation, 28(4), 373-382. doi:10.3233/nre-2011-0666

Flores, V. A., Šilić, P., DuBose, N. G., Zheng, P., Jeng, B., & Motl, R. W. (2023). Effects of aerobic, resistance, and combined exercise training on health-related quality of life in multiple sclerosis: Systematic review and meta-analysis. Mult Scler Relat Disord, 75, 104746. doi:10.1016/j.msard.2023.104746

Halabchi, F., Alizadeh, Z., Sahraian, M. A., & Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol, 17(1), 185. doi:10.1186/s12883-017-0960-9

Kierkegaard, M., Lundberg, I. E., Olsson, T., Johansson, S., Ygberg, S., Opava, C., . . . Piehl, F. (2016). High-intensity resistance training in multiple sclerosis — An exploratory study of effects on immune markers in blood and cerebrospinal fluid, and on mood, fatigue, health-related quality of life, muscle strength, walking and cognition. Journal of the Neurological Sciences, 362, 251-257. doi:10.1016/j.jns.2016.01.063

Kuhlmann, T., & Antel, J. (2023). Multiple sclerosis: 2023 update. Free Neuropathol, 4. doi:10.17879/freeneuropathology-2023-4675