Multiple Sclerosis: Approach to Management and Function

Multiple Sclerosis (MS) is a long-term neurological condition that affects the central nervous system, leading to a wide variety of physical and cognitive challenges. Although there is no cure, targeted exercise interventions play a vital role in managing symptoms, maintaining function, and improving overall wellbeing.

From an Exercise Physiology perspective, structured and individualised exercise programs can help people with MS maintain independence, improve movement efficiency, and reduce the impact of disease progression on daily life.

MS occurs when the immune system attacks the protective covering (myelin) of nerve fibres, disrupting communication between the brain and body. The progression and presentation of symptoms can vary significantly between individuals.

These changes may impact:

• Everyday activities such as walking, transferring, and reaching
• Muscle strength, endurance, and coordination
• Balance and postural stability
• Fatigue levels and energy management

Types of Multiple Sclerosis

Relapsing-Remitting MS (RRMS)

• Most commonly diagnosed form
• Characterised by periods of symptom flare-ups followed by recovery phases

Secondary Progressive MS (SPMS)

• Develops from RRMS over time
• Gradual worsening of symptoms with fewer clear relapses

Primary Progressive MS (PPMS)

• Steady progression from onset
• No distinct remission phases

Common Symptoms

• Persistent fatigue
• Muscle weakness and reduced endurance
• Spasticity and stiffness
• Impaired balance and coordination
• Changes in mobility and gait
• Sensory disturbances such as numbness or tingling
• Cognitive challenges (e.g., memory, processing speed)
• Sensitivity to heat

Risk Factors

While the exact cause is unclear, several factors are associated with increased risk:

• Genetic susceptibility
• Environmental influences (e.g., low vitamin D)
• Smoking
• Higher prevalence in females
• Typical onset in early to middle adulthood

Role of Exercise in MS Management

Exercise is widely recognised as a key component in the management of MS. When appropriately prescribed, it is both safe and effective across different stages of the condition.

Exercise can:

• Improve muscular strength and cardiovascular fitness
• Enhance balance and coordination
• Assist in fatigue management
• Reduce the risk of secondary health conditions
• Support independence in daily activities
• Improve mood and overall quality of life

Importantly, exercise helps prevent deconditioning, which can worsen functional decline over time.

Programs should be flexible and tailored, taking into account fatigue levels, symptom variability, and environmental factors such as heat sensitivity.

Key Exercise Considerations

Cardiovascular and Strength Training

• Moderate-intensity aerobic exercise can improve endurance and reduce fatigue
• Resistance training supports strength development and functional capacity
• Well-structured programs do not exacerbate symptoms when monitored appropriately

Balance and Postural Control

• Targeted balance training can reduce falls risk
• Exercises focusing on trunk control improve overall stability
• Functional, task-specific training enhances real-world mobility

Fatigue Management

• Incorporating rest breaks and pacing strategies is essential
• Lower intensity exercise may be more sustainable
• Gradual progression helps improve tolerance over time

A Holistic Exercise Approach

An effective MS program should include:

• Strength training
• Aerobic conditioning
• Balance and coordination work
• Flexibility and mobility exercises
• Fatigue management strategies

This integrated approach helps address key impairments, improve function, and support long-term participation in physical activity.

From an Exercise Physiology standpoint, the aim is to maximise functional independence, enhance quality of life, and empower individuals to confidently engage in movement despite the challenges of MS.

What Does the Research Say?

Halabchi et al., 2017 found a wide range of benefits exercise can produce in the management of MS, including the following:

Cardiovascular & Strength Training

• Aerobic exercise (cycling, walking, swimming) improves cardiovascular fitness and reduces fatigue, with benefits observed even at low–moderate intensities
• Resistance training (machine-based, sit-to-stand, step-ups) increases muscle strength and enhances functional mobility without exacerbating symptoms
• Regular participation helps reverse deconditioning and improves overall physical capacity and independence

Flexibility & Spasticity Management

• Stretching exercises reduce spasticity and muscle stiffness
• Improves joint range of motion and helps prevent contractures
• Daily, controlled stretching supports movement efficiency and comfort during functional tasks

Balance & Postural Control Training

• Balance training improves stability, coordination, and postural control
• Reduces falls risk, which is highly prevalent in MS populations
• Task-specific and trunk-focused exercises enhance functional mobility and gait

Fatigue Management & Exercise Tolerance

• Exercise reduces fatigue severity and improves energy efficiency
• Low-to-moderate intensity training is most sustainable and effective
• Incorporating rest breaks and pacing strategies is essential for adherence

Individualised & Progressive Programming

• Programs must be tailored to individual symptoms, disability level, and goals
• The “exercise staircase” model allows progression from passive movement to integrated training
• Multi-component programs (strength, cardio, balance) provide the greatest functional benefits