Can Persons with Multiple Sclerosis Tolerate Exercise?
Until recently, there was concern that persons with MS may not be able to tolerate aerobic exercise regimens, primarily because of their susceptibility to heat-related worsening of symptoms and neurological impairment. There are now evidence-based data that not only can persons with MS tolerate standard aerobic exercise, but also that they can benefit from it.¹ Most studies of the benefits of rehabilitation in persons with MS have focused primarily on functional outcomes. In contrast, the studies of exercise in the MS population have addressed more specific questions. These include the effects of exercise in ameliorating specific deficits such as muscle weakness, fatigue, improvement in fitness parameters, mood, and quality of life. Studies indicate that persons with MS can show improvement in all of these areas using a variety of training and exercise protocols.^2–6

In 1996, the seminal study of Petajan et al. conducted a randomized controlled trial of aerobic exercise in patients with moderately severe MS. The treatment group participated in 15 weeks of supervised aerobic training. Compared with the non-treated control group, they exhibited significant improvements in muscle strength, aerobic capacity, serum lipid profile, bladder and bowel function, and quality of life. Expanded disability status scale (EDSS) scores were unchanged.⁷ Studies that have examined the effects of exercise and resistance training on improving muscle strength in persons with MS include the study of Kraft et al., who used a progressive resistance-training regimen and demonstrated improved muscle strength in the upper and lower extremities.⁸ White and colleagues reported that an eight-week progressive lower limb resistance-training protocol improved leg strength and stepping ability.⁹ De Bolt et al. used lower body resistance training in a home-based design and found that leg extensor power increased, but there was no change in balance or overall mobility.¹⁰ Rodgers et al. reported that their six-month aerobic-training regimen had little effect on gait parameters in patients with MS.¹¹

However, more recently Romberg et al. examined the effects of a sixmonth exercise training program in persons with mild to moderate MS, and found significant improvements in muscle strength and walking speed compared with a control group.¹² Rampello and colleagues demonstrated that aerobic training on an exer-cycle for three sessions per week for eight weeks improved walking distance and speed, as well as fitness parameters, in patients with mild to moderate MS.¹³ In MS patients with moderate disability, functional improvement as measured on the Guy’s Neurological Disability Scale (GNDS) was demonstrated after a 12-week aerobic exercise program by Kileff and Ashburn.¹⁴ Importantly, none of these studies found any adverse effects of any of the training regimens, i.e. there were no increases in symptoms of deterioration in the usual level of function. A four-week study of aerobic training in persons with MS by Mostert et al. showed benefit in fitness and fatigue parameters, with only a 6% incidence of symptom exacerbation.¹⁵