The effect of exercise interventions on physiological fitness, physical and cognitive function, common symptoms, and disease impact for people with severe Multiple Sclerosis: A systematic review

INTRODUCTION: Exercise may slow Multiple Sclerosis (MS) progression and is considered safe for all people with MS. A review of exercise for those with severe MS was published in 2017, with guidelines for physical activity and exercise updated in 2020. The evidence base has subsequently increased, warranting further review. OBJECTIVE: To investigate the effectiveness of exercise interventions on physiological fitness, physical and cognitive function, common symptoms, and disease impact in people with severe MS. METHODS: A search was conducted across five electronic databases. Randomised control trials applying an exercise intervention to participants diagnosed with MS, EDSS 6.5-8.0, with outcome measures of physiological fitness, physical function, cognitive function, spasticity, fatigue, or disease impact were included. RESULTS: In total 29 studies published in 31 articles were included, with 1181 participants. Only six studies included participants exclusively with an EDSS ≥6.5. Studies predominantly reported outcome measures of physiological fitness (n = 16), physical function (n = 25), and MS symptoms and disease impact (n = 25), with the majority finding an improvement in at least one outcome measure. Comparatively few studies reported outcome measures of upper limb function (n = 4) and cognitive performance (n = 3). CONCLUSIONS: Exercise appears to improve physiological fitness, physical function, and disease impact, but not disability status. These improvements largely occurred in studies which included participants at an EDSS