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The benefits of exercise training in multiple sclerosis

Abstract

Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammatory demyelination and neurodegeneration within the CNS. This damage of CNS structures leads to deficits of body functions, which, in turn, affect patient activities, such as walking, and participation. The pathogenesis and resulting consequences of MS have been described as concepts within the International Classification of Functioning, Disability and Health (ICF) model—an international standard to describe and measure health and disability. Evidence suggests that exercise training in people with MS has the potential to target and improve many of the components outlined in the ICF model. Although the body of research examining the effects of exercise training on depression, cognition and participatory outcomes is not sufficiently developed, some preliminary evidence is promising. Exercise training is proposed to affect inflammation, neurodegeneration, and CNS structures, but current evidence is limited. In this Review, we discuss evidence from clinical trials that suggests beneficial effects of exercise training on muscle strength, aerobic capacity and walking performance, and on fatigue, gait, balance and quality of life. Issues with current studies and areas of future research are highlighted.

Key Points

  • Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that results in the progressive accumulation of mental and physical symptoms

  • The International Classification of Functioning, Disability and Health (ICF) model for MS describes pathogenesis and downstream consequences on CNS structures, body functions, patient activities and participation

  • Exercise training has beneficial effects on muscular strength, aerobic capacity and ambulatory performance, and may improve fatigue, gait, balance and quality of life in patients with MS

  • Effects of exercise training on MS pathogenesis, CNS structures, depression, cognition, and participation outcomes have not been adequately investigated or consistently supported

  • Exercise training has meaningful consequences in people with MS, and continued investigation will further elucidate the range of benefits of exercise on the various constructs of the ICF model

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Figure 1: Interactions between exercise and the ICF model of MS pathogenesis.

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R. W. Motl and L. A. Pilutti contributed equally to researching data for the article, discussion of content, writing the article, and to the review and editing of the manuscript before submission.

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Correspondence to Robert W. Motl.

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Motl, R., Pilutti, L. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol 8, 487–497 (2012). https://doi.org/10.1038/nrneurol.2012.136

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