Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers: Healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS. Early evaluation by a physical or occupational therapist or exercise or sport scientist, experienced in MS (hereafter referred to as “specialists”), is recommended to establish an individualized exercise and/or lifestyle physical activity plan. Taking into account comorbidities and symptom fluctuations, healthcare providers should encourage ⩾150 min/week of exercise and/or ⩾150 min/week of lifestyle physical activity. Progress toward these targets should be gradual, based on the person’s abilities, preferences, and safety. If disability increases and exercise/physical activity becomes more challenging, referrals to specialists are essential to ensure safe and appropriate prescriptions. When physical mobility is very limited, exercise should be facilitated by a trained assistant.

A community-based aquatic exercise programme is feasible and resulted in improvement in motor functions of individuals with multiple sclerosis. These findings indicate that an aquatic training programme is appropriate and beneficial for individuals with multiple sclerosis and should be considered to augment the rehabilitation of those individuals. This programme may provide a viable model for a community-based wellness programme for people with disability including individuals with multiple sclerosis.

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Objective Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable to traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. Methods (Case Description) The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities (LE) biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale (FSS), Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 LE strength tests. Results The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). FSS was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the FSS score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. Conclusion The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. Impact Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS.

The purpose of this study was to investigate the effect of physical telerehabilitation on the quality of life (QOL) in patients with multiple sclerosis (PwMS) in a randomized controlled trial. PwMS in both groups received home-based individualized exercise plan based on their physical therapy exam. PwMS in the intervention group were guided by a telerehabilitation system in following their exercise program on a daily basis whereas PwMS in the control group received periodic newsletters. Disease-specific QOL was assessed by MSQOL-54 survey at the baseline and the end of 3-month rehabilitation program. Among the MSQOL sub-scales, the mean sub-score values for pain and cognitive function in control and intervention groups were significantly different as demonstrated by one-way ANOVA (pain: F = 4.301, p = 0.044, cognitive function: F = 5.053, p = 0.030). Our results demonstrated positive effects of physical telerehabilitation on MS symptoms and QOL. Development of further approaches promoting continuous participation in telerehabilitation in PwMS is warranted.

Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent. Further study to determine the benefits of a walking exercise program using intermittent walking is recommended.Video Abstract available for additional insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A103).

There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (t(6) = −6.032, P = 0.001), left leg 1RM (t(6) = −5.388, P = 0.002), 6MWT distance (t(6) = −2.572, P = 0.042), and BBS score (Z = −2.371, P = 0.018) after the MST intervention. There was no significant change in FSS scores (F(1, 3.312) = 2.411, P = 0.092). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS.

Use of acupuncture to treat multiple sclerosis (MS) is fairly common, but little literature exists which studies its effectiveness. The purpose of this paper is to review the literature on the use of acupuncture to treat MS. A literature search resulted in twelve peer-reviewed articles on the subject that examined the use of acupuncture to treat MS related quality of life (QoL), fatigue, spasticity, and pain. The majority of the studies were poorly designed—without control, randomization, or blinding. Description of the subjects, interventions, and outcome measures as well as statistical analysis was often lacking or minimal. Although many of the studies suggested that acupuncture was successful in improving MS related symptoms, lack of statistical rigor and poor study design make it difficult to draw any conclusions about the true effectiveness of this intervention in the MS population. Further studies with more rigorous designs and analysis are needed before accurate claims can be made as to the effectiveness of acupuncture in this population.