Abstract
Background: There have been significant advances in the medical treatment and management of multiple sclerosis pathogenesis, relapse and disease progression over the past 30 years. There have been advancements in the symptomatic treatment of multiple sclerosis, including management of secondary multiple sclerosis expressions such as walking, cognitive dysfunction, fatigue and depression. Scientific evidence and expert opinion suggest that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. This article presents the historical context of exercise training within the multidisciplinary management of multiple sclerosis. We guide neurologists and healthcare providers on the recommended prescription of exercise and practical, theoretical methods to overcome barriers to exercise. Method: We undertook a critical search of the historical and current literature regarding exercise and multiple sclerosis from the viewpoint of exercise promotion by neurologists and the multidisciplinary care team. Results: We highlight the ever-strengthening body of research indicating that exercise is safe and effective for improving symptoms of multiple sclerosis. Further, exercise training may be necessary for reducing disease progression. Conclusion: We seek to encourage neurologists and specialists in multidisciplinary healthcare teams to prescribe and promote exercise at diagnosis and across all stages of the disease trajectory using prescriptive guidelines as part of comprehensive MS care. Available tools include clinical education to dispel any historical myths related to exercise in multiple sclerosis, clinical exercise guidelines and behaviour change theory to overcome patients barriers to exercise.
Highlights
As we suggest, prescription of exercise training begins with the neurologist and multiple sclerosis (MS) nurses, this will require change across all levels of the socio-ecological model of healthcare [19,21,76] to ensure equity in the promotion of exercise, and not just to patients who have access to allied healthcare therapists
Exercise prescription has varied in the historical management of MS; research over the past 30 years has underscored a vital role of exercise in symptom management and potential disease modification
Patients with MS need and seek consistent messages regarding exercise training, and the neurologist is critical in this process alongside the multidisciplinary team
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The role of the healthcare provider and the patient-provider interaction to promote exercise is of high importance, as there is a current public health concern surrounding low physical activity levels in people with MS [4,5,6,7]. This public health concern has been underlined with recent events, including the COVID-19 pandemic where evidence indicates exercise levels may have declined even more for persons with MS [25]. What We Know about Exercise in MS, Including a History of Benefits and Safety
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