Multiple sclerosis

Why / when / how

Exercise improves mobility and reduces fatigue in people with multiple sclerosis. The certainty of the evidence for the critical outcomes is low. The recommendation is therefore conditionally in favor, because the balance between benefits and harms is favorable, though with less certainty.

Cautions

Before prescribing physical activity, perform pre-participation screening and stratify cardiovascular risk: people with known chronic disease — cardiovascular, metabolic, renal — as well as those with suggestive symptoms not yet evaluated, require medical clearance before starting. Individualize the dose according to the clinical condition, comorbidities, and the patient's osteoarticular and functional limitations, and prefer supervised settings for complex cases and for decompensated patients. Advise stopping exertion and seeking immediate medical evaluation in the presence of warning signs such as chest discomfort, breathlessness disproportionate to effort, persistent dizziness, fainting, and unusual palpitations. Progress gradually and reassess tolerance periodically.

Quantitative evidence