Rehabilitation in Multiple Sclerosis: Efficacy and Clinical Application
Dr. Uladzislau Tsvirko
23 April 2026
Strong evidence supports rehabilitation in multiple sclerosis — improvements in muscle strength, exercise tolerance, mobility and mood. The approach is safe and suitable for both relapsing-remitting and progressive forms of the disease.
Why Rehabilitation in MS
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that causes motor, sensory and cognitive impairment. Despite progress in immunomodulatory therapy, no intervention to date alters long-term prognosis. Physiotherapy and therapeutic exercise therefore remain central to symptomatic and supportive care in multiple sclerosis.
Daily Activity and Quality of Life
A systematic review of RCTs (9 high-quality trials, 260 patients) reported strong evidence that exercise benefits muscle strength, exercise tolerance, mobility and ambulation-related activity. Moderate evidence supports improvements in mood. No significant effect was found on fatigue severity or subjective perception of disability, and no adverse events linked to exercise were reported. Exercise is safe and improves key functional outcomes in MS patients outside relapse.
Rehabilitation in Progressive MS
A separate systematic review focused on progressive MS — traditionally the most challenging form to rehabilitate. It included 13 studies (15 publications) evaluating therapeutic exercise, multidisciplinary rehabilitation, functional electrical stimulation, respiratory muscle training, supported walking and therapeutic standing. Nearly all studies showed benefit on at least one clinical measure — mobility, strength, respiratory function or participation in daily activity. The authors emphasise the need for larger, more powerful trials.
Functional Training
Functional training is a less standardised but more flexible approach, aimed at developing strength, balance, coordination, stability and endurance. A PRISMA-compliant systematic review of 19 studies (including RCTs) found that functional training in MS patients improved mobility and walking speed, enhanced balance and proprioception, increased muscle strength and endurance, and in several studies positively influenced quality of life and fatigue. Methodological heterogeneity is high, but the authors conclude that functional training is a promising comprehensive rehabilitation approach.
Rehabilitation and Spasticity
Spasticity is one of the most common and disabling symptoms in MS. A systematic review and meta-analysis of 29 studies reports the strongest evidence for therapeutic exercise, robotic gait training and outpatient exercise programmes. Rehabilitation benefits both the subjective perception of spasticity and measured muscle tone; approaches are safe, including in progressive MS with limited mobility.
Clinical Takeaways
Rehabilitation in multiple sclerosis is an effective and safe modality. Exercise improves muscle strength, mobility, exercise tolerance and functional activity, with evidence for positive effects on mood and spasticity. Benefits are seen in both relapsing-remitting and progressive forms. No single modality is clearly superior — individualised programmes deliver the greatest clinical value. Rehabilitation does not alter the disease course, but it meaningfully improves functional status, independence and quality of life.