Current perspectives on exercise training in the management of multiple sclerosis

ABSTRACT

Introduction

The science supporting the application of exercise training and physical activity in persons with multiple sclerosis (MS) has expanded considerably in strength and scope over the past 25+ years. Exercise training is now a strategy that is commonly recommended for management of MS in clinical practice. Yet, there are still many opportunities for expanding the breadth and strength of research on exercise training in MS.

Areas covered

This paper provides the authors’ perspective on eight emerging areas of research involving exercise and physical activity behavior in persons living with MS. Those areas include behavior change interventions, research across the activity continuum, telerehabilitation, neuroplasticity, heterogeneity of outcomes, inclusion of targeted samples, combined interventions involving exercise training, and multi-site trials.

Expert opinion

Additional research addressing those areas will greatly expand the opportunity for translation of exercise and physical activity into the clinical care of persons with MS.

KEYWORDS:

• Exercise
• physical activity
• rehabilitation
• symptom management
• implementation science

Article highlights

• The manifestations of MS include walking and cognitive dysfunction, symptoms of fatigue, depression, anxiety, and pain, and loss of independence and compromised quality of life (QOL).

• Exercise training represents an important second-line approach for managing MS and its manifestations alongside the first-line approach of disease-modifying drugs

• The evidence from over 275 randomized controlled trials (RCTs) of exercise training in persons with MS indicating that it reliably improves aerobic and muscular fitness, walking and balance outcomes, symptoms of fatigue and depression, and QOL.

• Exercise training has a strong safety profile in persons with MS.

• The evidence of benefits and safety has further been leveraged for the development of physical activity guidelines regarding the minimal amount or dosage of exercise training necessary for experiencing the general benefits of this health behavior.

• There are still many opportunities for expanding the breadth and strength of research on exercise training in MS, and this is critical as there is considerable evidence for low rates of physical activity participation.

Over the next 5 years, we believe that researchers will focus on addressing eight emerging research topics on exercise and physical activity in MS, and such efforts will better positioning exercise and physical activity for promotion within MS clinical practice based on highly rigorous research that is more broadly generalizable within this population.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.