Exercise to Manage MS Fatigue: Counterintuitive Yet Effective

The natural history of multiple sclerosis (MS), a disease characterized by multifocal and unpredictable inflammatory attacks, varies widely both between and within affected individuals. Despite variable and often severe neurological symptoms, the vast majority of the approximately 2.5 million people worldwide with MS describe fatigue as the single-greatest impediment to quality of life. It is unknown whether fatigue in MS is a direct consequence of disease activity or if instead is secondary to co-morbidities such as medication side effects or depression. Regardless of its cause, physical exercise is becoming increasingly recognized as a safe and efficacious therapeutic approach for managing MS-related fatigue. In fact, there now exist evidence-based physical activity guidelines designed specifically for adults with MS. It remains unclear how peripheral adaptations might ameliorate symptoms originating centrally. Resolving such a paradox requires an understanding of exercise-induced changes at multiple levels of analysis spanning the molecule to the psyche. Mounting evidence for the safety and efficacy of physical activity together with the availability and relative affordability of exercise and rehabilitation facilities places this treatment modality as a potentially potent combatant in the fight against MS fatigue.