When we talk about managing multiple sclerosis (MS), most people think of disease-modifying therapies (DMTs)—medications that slow disease progression and reduce relapse frequency. But could something as accessible as exercise offer similar benefits?
While pharmaceutical DMTs are typically studied over 2 to 4 years (MS Trust), most exercise studies in MS span only 12 to 26 weeks (Proschinger et al., 2022). That short timeline makes it challenging to draw conclusions about disease progression. Still, early research is promising.
A key concept in understanding MS is neurological reserve—the brain’s capacity to handle stress, injury, and disease. Neurologist Dr. Stephen Krieger’s topographical model of MS visualizes this reserve as water in a pool. Damage to the nervous system creates “hills” at the bottom. As reserve is lost, the water level drops and those hills emerge—manifesting as symptoms. Maintaining that “water level” is essential, and that’s where exercise comes in (Krieger et al., 2016).
Research shows exercise improves brain health by enhancing blood flow, reducing inflammation, and promoting neuroplasticity. A 2018 study found that 24 weeks of resistance training increased cortical thickness in people with MS, suggesting a neuroprotective effect (Kjølhede et al., 2018). A 2022 systematic review also reported reduced relapse rates and improved motor and cognitive function, though effects on brain volume and disability progression require longer-term data (Proschinger et al., 2022).
It’s important to emphasize: exercise is not a replacement for DMTs. Rather, it is an additional therapy—one that may also have disease-modifying effects while offering broad, holistic benefits.
What sets exercise apart is its added advantages: improved mood, better balance, reduced fatigue, and lower fall risk. Even challenges like Uhthoff’s phenomenon—where symptoms flare with increased core temperature—can be managed with cooling strategies, proper hydration, and pacing.
With low risk and high potential, exercise is one of the most underutilized tools in MS care.
Dr. Pamela Hutchison ND explores this topic in Season 2, Episode 7 of her podcast – The Well Nurtured Brain!
Want to know more? Check out this Episode of The Well Nurtured Brain! (Dr Pam’s podcast)
References:
Kjølhede, T., Siemonsen, S., Wenzel, D., Stellmann, J. P., Ringgaard, S., Pedersen, B. G., Stenager, E., Petersen, T., Vissing, K., Heesen, C., & Dalgas, U. (2018). Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis?. Multiple sclerosis (Houndmills, Basingstoke, England), 24(10), 1356–1365. https://doi.org/10.1177/1352458517722645
Proschinger, S., Kuhwand, P., Rademacher, A., Walzik, D., Warnke, C., Zimmer, P., & Joisten, N. (2022). Fitness, physical activity, and exercise in multiple sclerosis: a systematic review on current evidence for interactions with disease activity and progression. Journal of neurology, 269(6), 2922–2940. https://doi.org/10.1007/s00415-021-10935-6
Kim, Y., Lai, B., Mehta, T., Thirumalai, M., Padalabalanarayanan, S., Rimmer, J. H., & Motl, R. W. (2019). Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis. American journal of physical medicine & rehabilitation, 98(7), 613–621. https://doi.org/10.1097/PHM.0000000000001174
https://mstrust.org.uk/information-support/ms-drugs-treatments/disease-modifying-drugs-dmds
