Abstract
Exercise training represents a behavioral approach for safely managing many of the functional, symptomatic, and quality of life consequences of multiple sclerosis (MS). This topical review paper summarizes evidence from literature reviews and meta-analyses, supplemented by recent individual studies, indicating that exercise training can yield small but important improvements in walking, balance, cognition, fatigue, depression, and quality of life in MS. The paper highlights limitations of research on exercise training and its consequences and future research directions and provides an overview for promotion of exercise training in MS based on recent prescriptive guidelines. Collectively, the evidence for the benefits of exercise training in MS suggests that the time is ripe for the promotion of exercise by healthcare providers, particularly neurologists as a central part of the clinical care and management of MS patients.
Similar content being viewed by others
References
Hemmer B, Nessler S, Zhou D, et al. Immunopathogenesis and immunotherapy of multiple sclerosis. Nat Clin Pract Neurol. 2006;2:201–11.
Trapp BD, Nave K-A. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247–69.
Bjartmar C, Trapp BD. Axonal and neuronal degeneration in multiple sclerosis: mechanisms and functional consequences. Curr Opin Neurol. 2001;14:271–8.
Samkoff LM, Goodman AD. Symptomatic management in multiple sclerosis. Neurol Clin. 2011;29:449–63.
Benito-Leon J, Morales JM, Rivera-Navarro J, et al. A review about the impact of multiple sclerosis on health-related quality of life. Disabil Rehabil. 2003;25:1291–303.
Mitchell AJ, Benito-León J, González JM, et al. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of well-being. Lancet Neurol. 2005;4:556–66.
Katrych O, Simone TM, Azad S, et al. Disease-modifying agents in the treatment of multiple sclerosis: a review of long-term outcomes. CNS Neurol Disord Drug Targets. 2009;8:512–9.
Filippini G, Munari L, Incorvaia B, et al. Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet. 2003;361:545–52.
Confavreux C, Vukusic S. Natural history of multiple sclerosis. Brain. 2006;129:606–16.
Confavreux C, Vukusic S, Adeline P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain. 2003;126:770–82.
Goodin DS, Frohman EM, Garmany Jr GP, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002;58(2):169–78.
Dalgas U. Rehabilitation and multiple sclerosis: hot topics in the preservation of physical functioning. J Neurol Sci. 2011;311(S1):S43–7.
Bouchard C, Shephard RJ. Physical activity, fitness, and health: the model and key concepts. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health – International proceedings and consensus statement. Champaign, IL: Humans Kinetics; 1994. p. 77–88.
Dalgas U, Stenager E. Progressive resistance therapy is not the best way to rehabilitate deficits due to multiple sclerosis: no. Mult Scler. 2014;20:141–2.
Kraft GH. Rehabilitation still the only way to improve function in multiple sclerosis. Lancet. 1999;354:2016–7.
Coote S. Progressive resistance therapy in not the best way to rehabilitate deficits due to multiple sclerosis: yes. Mult Scler. 2014;20:143–4.
Asano M, Dawes DJ, Arafah A, Moriello C, Mayo NE. What does a structured review of the effectiveness of exercise interventions for persons with multiple sclerosis tell us about the challenges of designing trials? Mult Scler. 2009;15:412–21.
Pilutti LA, Platta ME, Motl RW, et al. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci In press. This paper reviewed the rates of relapse in exercise training and control conditions of randomized controlled trials of persons with multiple sclerosis. The summary evidence suggested a 25% reduction in the rates of relapses reported for exercise training compared with control conditions.
Dalgas U, Stenager E. Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis? Ther Adv Neurol Disord. 2012;5:81–95.
Klaren RE, Motl RW, Woods JA, et al. Effects of exercise in experimental autoimmune encephalomyelitis (animal model of multiple sclerosis). J Neuroimmunol. In press.
Vickrey BG, Shatin D, Wolf SM, et al. Management of multiple sclerosis across managed care and fee-for-service systems. Neurology. 2000;55(9):1341–9.
Vollmer T, Benedict R, Bennett S, et al. Exercise as prescriptive therapy in multiple sclerosis. A consensus conference white paper. Int J MS Care. 2012;14:2–14.
Latimer-Cheung AE, Pilutti LA, Hicks AL, et al. The effects of exercise training on fitness, mobility, fatigue, and health related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800–28.
Pearson M, Dieberg G, Smart N. Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta-analysis. Arch Phys Med Rehabil. 2015. doi:10.1016/j.ampr.2015.02.011. in press.
Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23:108–16.
Paltamaa J, Sjogren T, Peurela SH, et al. Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. J Rehabil Med. 2012;44:811–23.
McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurological disorders: a systematic review. Arch Phys Med Rehabil. 2011;92:1044–52.
Motl RW, Sandroff BM, Benedict RHB. Cognitive dysfunction and multiple sclerosis: developing a rationale for considering the efficacy of exercise training. Mult Scler. 2011;17:1034–40.
Asano M, Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014;2014:798285.
Pilutti LA, Greenlee TA, Motl RW, et al. Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis. Psychosom Med. 2013;75:575–80.
Dalgas U, Stenager E, Sloth M, et al. The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature. Eur J Neurol. 2015;22(3):443–e34.
Ensari I, Motl RW, Pilutti LA. Exercise training improves depressive symptoms in people with multiple sclerosis: results of a meta-analysis. J Psychosom Res. 2014;76:465–71.
Adamson BC, Ensari I, Motl RW. Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015. in press.
Motl RW, Gosney JL. Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis. Mult Scler. 2008;14:129–35.
Motl RW, Learmonth YC. Neurological disability and its association with walking impairment in multiple sclerosis: brief review. Neurodegener Dis Manag. 2014;4(6):491–500.
Larocca NG. Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners. Patient. 2011;4:189–201.
Heesen C, Böhm J, Reich C, et al. Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler. 2008;14:988–91.
Motl RW, Pilutti LA, Hubbard EA, et al. Cardiorespiratory fitness and its association with thalamic, hippocampal, and basal ganglia volumes in multiple sclerosis. Neuroimage Clin. 2015;661-666.
Sandroff BM, Sosnoff JJ, Motl RW. Physical fitness, walking performance, and gait in multiple sclerosis. J Neurol Sci. 2013;328(1-2):70–6.
Prosperini L, Fortuna D, Gianni C, et al. Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis. Neurorehabil Neural Repair. 2013;27(6):516–25.
Gunn JH, Newell P, Haas B, et al. Identification of risk factors for falls in multiple sclerosis: a systematic review and meta-analysis. Phys Ther. 2013;93:504–13.
Sandroff BM, Motl RW. Fitness and cognitive processing speed in persons with multiple sclerosis: a cross-sectional investigation. J Clin Exp Neuropsychol. 2012;34(10):1041–52.
Coote S, Finlayson M, Sosnoff JJ. Level of mobility limitations and falls status in persons with multiple sclerosis. Arch Phys Med Rehabil. 2012;95(5):862–6.
Prosperini L, Fanelli F, Petsas N, et al. Multiple sclerosis: changes in microarchitecture of white matter tracts after training with a video game balance board. Radiology. 2014;273(2):529–38. There is an abundance of evidence for the benefits of exercise training in multiple sclerosis, but very little is known about adaptations in the central nervous system as mechanisms. This paper provides the first evidence from a randomized controlled trial of balance training and its effects on brain structure using magnetic resonance imaging in multiple sclerosis.
Benedict RHB, Zivadinov R. Risk factors for and management of cognitive dysfunction in multiple sclerosis. Nat Rev Neurosci. 2011;7(6):332–42.
Prakash RS, Snook EM, Lewis JL, et al. Cognitive impairments in relapsing-remitting multiple sclerosis: a meta-analysis. Mult Scler. 2008;14:1250–61.
Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci. 2008;9(1):58–65.
Voss MW, Nagamatsu LS, Liu-Ambrose T, et al. Exercise, brain, and cognition across the life span. J Appl Physiol. 2011;111:1505–13.
Pajonk FG, Wobrock T, Gruber O, et al. Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen Psychiatry. 2010;67(2):133–43.
Briken S, Gold SM, Patra S, et al. Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial. Mult Scler. 2014;20(3):382–90.
Leavitt VM, Cirnigliaro C, Cohen A, et al. Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary findings. Neurocase. 2014;20(6):695–7.
Sandroff BM, Klaren RE, Pilutti LA, et al. Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis. J Neurol. 2014;261(2):363–72.
Krupp LB. Fatigue in multiple sclerosis: a guide to diagnosis and management. New York: Demos; 2004.
Motl RW, McAuley E. Symptom cluster and quality of life: preliminary evidence in multiple sclerosis. J Neurosci Nurs. 2010;42(4):212–6.
Puetz TW, O’Connor PJ, Dishman RK. Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychol Bull. 2006;132:866–76.
Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res. 2004;4(5):581–5.
Jones KH, Ford DV, Jones PA, et al. A large-scale study of anxiety and depression in people with multiple sclerosis: a survey via the web portal of the UK MS Register. PLoS One. 2012;7(7):e41910.
Feinstein A, Magalhaes S, Richard JF, et al. The link between multiple sclerosis and depression. Nat Rev Neurol. 2014;10(9):507–17.
Minden SL, Feinstein A, Kalb RC, et al. Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82:174–81.
Herring MP, Puetz TW, O’Connor PJ, et al. Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172:101–11.
Feinstein A, Rector N, Motl R. Exercising away the blues: can it help multiple sclerosis-related depression? Mult Scler. 2013;19:1815–9.
Lankhorst GJ, Jelles F, Smits RC, et al. Quality of life in multiple sclerosis: the disability and impact profile (DIP). J Neurol. 1996;243:469–74.
Naess H, Beiske AG, Myhr KM. Quality of life among young patients with ischaemic stroke compared with patients with multiple sclerosis. Acta Neurol Scand. 2008;117:181–5.
Rudick RA, Miller D, Clough JD, et al. Quality of life in multiple sclerosis. Comparison with inflammatory bowel disease and rheumatoid arthritis. Arch Neurol. 1992;49:1237–42.
Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8:487–97.
Motl RW, Learmonth YC, Pilutti LA, et al. Top 10 research questions related to physical activity and multiple sclerosis. Res Q Exerc Sport. 2015;86(2):117–29. There is an increasing interest in the study of physical activity and its rates, predictors, and consequences among persons with multiple sclerosis. This paper provides a list of the top 10 research questions for guiding future research on physical activity in multiple sclerosis.
Marrie RA, Horwitz RI. Emerging effects of comorbidities on multiple sclerosis. Lancet Neurol. 2010;9(8):820–8.
Griffith G, Klaren RE, Motl RW, et al. Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis. Contemp Clin Trials. 2015;41:280–6.
Wens I, Hansen D, Verboven K, et al. Impact of 24 weeks of resistance and endurance exercise on glucose tolerance in persons with multiple sclerosis. Am J Phys Med Rehabil. 2015; in press.
Latimer-Cheung AE, Martin Ginis KA, Hicks AL, et al. Development of evidence-informed physical activity guidelines for adults with multiple sclerosis. Arch Phys Med Rehabil. 2013;94:1829–36. This paper provides guidelines for the prescription of exercise training among persons with mild and moderate MS-related disability. The researchers propose that meeting or exceeding the amount of physical activity in the guidelines should provide a stimulus for accruing many of the benefits of this health behavior.
Compliance with Ethics Guidelines
Conflict of Interest
Robert W. Motl reports personal fees from EMD Serono, grants from Acorda Therapeutics, and grants from Biogen IDEC.
Brian M. Sandroff declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Demyelinating Disorders
Rights and permissions
About this article
Cite this article
Motl, R.W., Sandroff, B.M. Benefits of Exercise Training in Multiple Sclerosis. Curr Neurol Neurosci Rep 15, 62 (2015). https://doi.org/10.1007/s11910-015-0585-6
Published:
DOI: https://doi.org/10.1007/s11910-015-0585-6