Exercise in the Management of Multiple Sclerosis Relapses: Current Evidence and Future Perspectives

Abstract

Relapses are a common feature of multiple sclerosis; however, recovery from relapses is often incomplete, with up to half of people experiencing residual disabilities postrelapse. Therefore, treatments are required to promote recovery of function and reduce the extent of residual disabilities postrelapse. Accordingly, this Perspective article explores the role of exercise in relapse management. Current evidence from two studies suggests that exercise in combination with steroid therapy improves disability and quality of life postrelapse, and may be more beneficial in promoting relapse recovery than steroid therapy alone. However, given the small number of studies and methodological limitations, further studies are required to understand the effects of exercise in relapse management and the mechanism through which exercise influences relapse recovery.

The MoXFo initiative – study design: Considerations related to study design and methodology in exercise research for people with multiple sclerosis

“…Furthermore, it is not always clear how a relapse during an exercise intervention is handled, and studies investigating exercise as a supplemental acute/subacute treatment of MS relapses are therefore warranted. 36 Particularly in studies with progressive MS patients, the baseline assessment could be duplicated, creating two or more baseline timepoints to understand the trajectory of disease progression. Such an approach could also reduce the marked day-to-day variation observed in some MS patients.…”

Rehabilitation should be prescribed acutely in motor relapses – Yes

“…Authors of a perspective review have proposed conceptual mechanisms of how exercise can affect relapses in PwMS. 10 The conceptual proposal forms a foundation to generate further evidence. Moreover, evidence generation needs to take into account understanding the experience of PwMS, in terms of their needs and limitations following an acute relapse along different timeframes.…”

Rehabilitation should be prescribed acutely in motor relapses – Commentary

“…A recent review proposed a role for exercise, a specific form of rehabilitation, in reducing the severity and duration of relapses acutely to improve disability prognosis long term. 9 Posited mechanisms of action included anti-inflammatory effects, promotion of remyelination, adaptive neural plasticity, and physiological conditioning. 9 Conversely, Jonsdottir and Bertoni argue that rehabilitation during acute relapse may in fact encourage ongoing inflammation, maladaptive neural plasticity, and neurodegeneration.…”

“…9 Posited mechanisms of action included anti-inflammatory effects, promotion of remyelination, adaptive neural plasticity, and physiological conditioning. 9 Conversely, Jonsdottir and Bertoni argue that rehabilitation during acute relapse may in fact encourage ongoing inflammation, maladaptive neural plasticity, and neurodegeneration. 10 Presently, many unknowns remain regarding our understanding of rehabilitation during relapse in MS.…”