Multiple sclerosis (MS) is a chronic neurological condition that can manifest in highly diverse ways. Fatigue, muscle weakness, problems with balance, walking and cognition are among the most common symptoms. For a long time, people with MS were advised to limit physical exercise, out of fear of overloading the body or triggering relapses. However, scientific research over recent decades has fundamentally changed this view. Today we know that physical activity is not only safe in MS, but also an important and effective complement to medical treatment.

Numerous clinical studies show that regular exercise leads to improvements in muscle strength, endurance and mobility. Everyday activities, such as walking or standing up, therefore become easier. In addition, physical activity has a beneficial effect on fatigue. Although this fatigue does not always disappear, many patients experience more energy and better tolerance after several weeks of training. The impact of fatigue on physical or cognitive functioning is reduced. Evidence is also growing that physical activity may have positive effects on cognitive functions such as attention, memory and processing speed. Mental wellbeing likewise benefits from an active lifestyle. Exercise reduces anxiety and improves mood, strengthens self-confidence and enhances quality of life. All these effects are relevant for good social functioning.

At a biological level, physical activity influences the brain in several ways. Intensive physical stimuli promote processes of neuroplasticity. As a result, structures such as nerve integrity and connections between brain regions are strengthened, and the nervous system becomes better able to adapt to damage caused by MS. Recent research even suggests that long-term physical training (24 weeks, several times per week) in the early stages of the disease may have a protective effect on disease progression by preserving overall brain volume. Although this requires further investigation, it highlights the potential of physical activity as a non-pharmacological intervention.

A frequently heard concern in the past was whether exercise could trigger relapses. The available scientific literature is clear: physical activity does not cause attacks. On the contrary, some studies show a slightly reduced risk in physically active individuals. However, some people with MS may experience a temporary worsening of symptoms during prolonged or intensive training. Examples include a local change in sensation, altered movement patterns, or fatigue. Slower movement may also occur when body temperature rises significantly during exercise, known as the Uhthoff phenomenon. This is a well-known and reversible effect that disappears after sufficient rest and cooling.

What, then, is the ideal way to exercise? Experts recommend a varied approach consisting of aerobic training, strength training, and exercises for balance and flexibility. Walking, cycling, swimming or dancing improve endurance and coordination, while strength training helps counteract muscle weakness. Balance and flexibility exercises reduce the risk of falls and promote suppleness. These activities can be spread throughout the week and adapted to age, abilities and personal preferences. Even short bouts of movement already have a positive effect. Importantly, no one is too old or too limited to begin exercising. Even with greater disability, movement remains possible. Exercises can be performed seated or with support, such as arm-cycling or seated core-stability work, always adapted to individual tolerance. At any stage of the disease, a tailored programme can be developed that also takes into account activities suited to one’s lifestyle and interests. Apps can also be used, for example, to set and achieve walking goals. Guidance from a physiotherapist with expertise in MS, together with a multidisciplinary care team, increases safety and the likelihood of success.

Physical activity is now a fully recognised component of good care in multiple sclerosis. Thanks to scientific research -- made possible by the continued support of donors and legators -- our understanding of how lifestyle and therapy can reinforce one another continues to grow. By investing in research, we invest not only in knowledge, but also in autonomy, resilience and quality of life for people with MS.

Professor Daphne Kos, KU Leuven & MS Center Melsbroek

Professor Peter Feys, UHasselt

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References

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Hvid, L. G., Langeskov-Christensen, M., Stenager, E., & Dalgas, U. (2022). Exercise training and neuroprotection in multiple sclerosis. Lancet Neurol, 21(8), 681-682. https://doi.org/10.1016/S1474-4422(22)00219-8 

Kalb, R., Brown, T. R., Coote, S., Costello, K., Dalgas, U., Garmon, E., Giesser, B., Halper, J., Karpatkin, H., Keller, J., Ng, A. V., Pilutti, L. A., Rohrig, A., Van Asch, P., Zackowski, K., & Motl, R. W. (2020). Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler, 26(12), 1459-1469. https://doi.org/10.1177/1352458520915629 

Van Geel, F., Geurts, E., Abasiyanik, Z., Coninx, K., & Feys, P. (2020). Feasibility study of a 10-week community-based program using the WalkWithMe application on physical activity, walking, fatigue and cognition in persons with Multiple Sclerosis. Mult Scler Relat Disord, 42, 102067. https://doi.org/10.1016/j.msard.2020.102067 

Van Geel, F., Van Asch, P., Veldkamp, R., & Feys, P. (2020). Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial. Mult Scler Relat Disord, 44, 102256. https://doi.org/10.1016/j.msard.2020.102256