Role of exercise in multiple sclerosis: Potential application of adapted exercise modalities

Multiple sclerosis (MS) is an immune-mediated disease that targets and damages the central nervous system (CNS). Resulting CNS damage leads to physical, mental, and emotional disturbances that dramatically alter the lives of persons with MS. The progressive nature of MS results in long-term accumulation of symptoms and disability, which initially proceeds more rapidly in the progressive MS disease course. Disease-modifying therapies are effective early on in limiting disability accumulation; however, these therapies ultimately become ineffective. Further, effective treatments for persons with a progressive disease onset are lacking. Consequently, development of alternative treatments for patients with severe disability, particularly those with progressive MS, is necessary. Exercise may represent an alternative strategy for managing symptoms and disability in MS. Physical and mental health benefits of exercise have been established in persons with MS. Unfortunately, persons with MS with mobility impairment have limited opportunities to participate in traditional exercise modalities and have been studied infrequently in the exercise literature. Two adapted exercise interventions are body weight-supported treadmill training and total body recumbent stepper training. These strategies may represent viable alternatives for persons with progressive MS with mobility impairment to acquire exercise benefits.