Multiple Sclerosis: Effectiveness of Physiotherapy and Therapeutic Exercise According to Scientific Evidence

Introduction

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to motor, sensory, and cognitive impairments. Despite significant progress in pharmacological therapy, there is currently no intervention capable of altering the long-term prognosis of the disease. For this reason, physiotherapy and therapeutic exercise are considered key components of symptomatic and supportive care for patients with MS.

The aim of this article is to summarise the findings of clinical studies and systematic reviews evaluating the effectiveness of physiotherapy and exercise interventions across different forms of multiple sclerosis.

Physiotherapy and Exercise in Multiple Sclerosis: What the Evidence Shows

1. Effects of Exercise on Daily Activity and Quality of Life

A systematic review of randomised controlled trials (RCTs), including nine studies of high methodological quality (260 patients), demonstrated:

• Strong evidence for the effectiveness of exercise compared with no therapy in improving:

  • muscle strength,

  • exercise tolerance,

  • mobility and movement-related activity.

• Moderate evidence for improvement in mood.

• No demonstrated effect on fatigue severity or subjective perception of disability.

• No adverse or harmful effects associated with exercise participation.

These findings indicate that exercise interventions are safe and improve key functional outcomes in patients with MS outside of relapse phases.

2. Physiotherapy in Progressive Multiple Sclerosis

A separate systematic review focused on patients with progressive forms of MS, which are traditionally considered the most challenging to rehabilitate.

The analysis included 13 studies (15 publications) assessing a range of physiotherapeutic interventions, including:

• therapeutic exercise,

• multidisciplinary rehabilitation,

• functional electrical stimulation,

• respiratory muscle training,

• supported walking,

• therapeutic standing, and other approaches.

Nearly all studies reported positive effects on at least one clinical outcome, including mobility, muscle strength, respiratory function, and participation in daily activities. The authors emphasised the need for larger, statistically robust studies to strengthen the evidence base.

3. Functional Training: A Contemporary Approach

Functional exercise represents a flexible and less standardised rehabilitation approach aimed at developing:

• strength,

• balance,

• coordination,

• stability,

• endurance.

A systematic review of 19 studies (including RCTs), conducted in accordance with PRISMA guidelines, found that functional training in people with MS:

• improves mobility and walking speed,

• enhances balance and proprioception,

• increases muscle strength and endurance,

• in several studies, positively affects quality of life and fatigue.

Despite methodological variability, the authors conclude that functional training is a promising comprehensive rehabilitation strategy.

4. Effects of Physiotherapy on Spasticity

Spasticity is one of the most common and functionally limiting symptoms in MS. A systematic review and meta-analysis of 29 studies demonstrated that:

• The strongest evidence of effectiveness was found for:

  • therapeutic exercise,

  • robotic-assisted gait training,

  • outpatient exercise programmes.

• Physiotherapy has a positive effect on both subjective perception of spasticity and objective muscle tone.

• These interventions were considered safe, including in patients with progressive MS and significant mobility limitations.
  

Key Conclusions

• Physiotherapy and therapeutic exercise are effective and safe rehabilitation approaches in multiple sclerosis.

• Exercise interventions improve muscle strength, mobility, exercise tolerance, and functional activity.

• There is evidence of beneficial effects on mood and spasticity.

• Physiotherapy is effective in both relapsing-remitting and progressive forms of MS.

• No single “best” type of exercise has been identified; individually tailored programmes provide the greatest clinical value.
  

Conclusion

Physiotherapy does not alter the course of multiple sclerosis; however, it significantly improves functional status, independence, and quality of life. Contemporary research supports the inclusion of regular, adapted physical exercise as a standard component of MS management. Future studies should focus on standardising intervention protocols, defining optimal exercise dosage, and evaluating long-term outcomes.

Physiotherapy may form part of a comprehensive medical support strategy for people with multiple sclerosis, aimed at maintaining mobility, functional activity, and quality of life.An individual medical consultation allows assessment of which rehabilitation approaches may be appropriate in a specific clinical situation.

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