Multiple sclerosis (MS) is an inflammatory neurodegenerative disease characterised by physical and cognitive symptoms resulting in disability and reduced social participation. It is the leading cause of neurological disability in young adults, particularly women. Global estimates indicate that there are more than 2.9 million people with MS and the prevalence of the condition is increasing. In Australia alone, the number of people with MS increased by more than 13 per cent between 2021 and 2024. These increases should be considered alongside increased awareness of the condition, better diagnostic sensitivity, improved treatments and increasing survival rates of people with MS.

MS is characterised by multiple lesions or focal areas of demyelination, accompanied by inflammation and neurodegeneration within the central nervous system. While no single sensitive diagnostic test can confirm MS, the diagnosis is underpinned by dissemination of lesions within the central nervous system over time and space. Classification of MS phenotypes is based on patterns of disease activity as well as the progression of symptoms over time. About 85 per cent of people with MS experience recurrent episodes of neurological dysfunction followed by partial or complete recovery. The remaining 15 per cent present with a gradual, continuously progressive disease from the outset.

Clinical features vary depending on the systems affected by the changes to the central nervous system. Common symptoms include balance and mobility impairments, which affect up to 90 per cent of people with MS and are a primary cause of falls. Other common physical symptoms include weakness, spasticity and ataxia, bladder and bowel dysfunction and sexual dysfunction. Cognitive dysfunction, fatigue and symptoms of depression and anxiety are also very common. Many people with MS do minimal physical activity. There is an elevated risk of skeletal, muscular, cardiac, ventilatory and metabolic dysfunction, and age-related comorbidities. Functional and neurological assessments are used to determine MS-associated disability by physiotherapists and neurologists or through patient self-report.

Many people with MS are unaware of the potential benefits of physiotherapy in treating the disease—not only soon after diagnosis or during relapse, but also when their disease is minimally active. Physiotherapy management typically includes physical activity, fatigue management as well as supporting treatments and behaviours to address movement disorders. Physiotherapists can also assist with other concerns relating to strength, mobility, balance and bladder/bowel function.

In her Journal of Physiotherapy Invited Topical Review, Yvonne Learmonth examines and evaluates the evidence for common approaches and interventions taken by physiotherapists for exercise safety, fatigue management, mobility difficulties, strength, psychological changes, cognitive dysfunction, physical activity and quality of life. Overall, Yvonne notes that high-quality studies have shown that aerobic exercise, resistance exercise, combined exercise and mind-body exercise have benefits for many MS symptoms including balance, fatigue, strength and physical activity participation.

While the evidence base for physiotherapy management of MS is growing, the author suggests that several areas warrant further investigation due to the heterogeneity of intervention protocols and outcome measures. Yvonne recommends the use of standardised core outcome sets and reporting guidelines to facilitate comparison of studies going forward. She also points out that research needs to span the full spectrum of MS to inform clinical decision-making, optimise intervention strategies for diverse patient populations and target real-world outcomes. Additionally, strategies to enhance adherence to exercise/physical activity programs and behaviour change should be prioritised.

For more information and to read the entire Invited Topical Review, visit the Journal of Physiotherapy (JoP) website. 

This blog is a Physiotherapy Research Foundation (PRF) initiative.

Associate Professor Yvonne Learmonth APAM is the associate dean (engagement) of the School of Allied Health at Murdoch University, as well as a research fellow and physiotherapist. She leads the clinical exercise and cognition stream within the Personalised Medicine Centre in Murdoch University’s Health Futures Institute where her research concentrates on exercise for MS.