Exercise has a significant and positive effect on brain volume in people with multiple sclerosis (MS), helping to preserve and even improve brain structure despite the disease’s neurodegenerative nature. In MS, the immune system attacks the protective myelin sheath around nerve fibers, leading to inflammation, brain tissue loss, and shrinking of gray matter and other brain regions. Regular physical activity, particularly aerobic and multimodal exercise, can counteract some of these damaging effects by promoting brain health, reducing inflammation, and supporting neuroplasticity.
One of the key impacts of exercise on the brain in MS is the preservation of **gray matter volume**, which includes the neurons and their connections essential for processing information and controlling movement. Studies show that exercise helps maintain the microstructural integrity of the brain, meaning it supports the health of neurons, axons, and myelin. This is crucial because MS often accelerates brain aging and leads to faster loss of brain tissue compared to healthy individuals. By engaging in regular physical activity, people with MS can slow down this accelerated brain atrophy, potentially delaying progression of symptoms and cognitive decline.
Aerobic exercises such as walking, cycling, and treadmill workouts are particularly effective. These activities improve cardiovascular fitness, which enhances blood flow to the brain, delivering oxygen and nutrients that support brain cell survival and function. Aerobic exercise also reduces systemic inflammation, a major contributor to MS progression, by lowering inflammatory markers in the body. This anti-inflammatory effect helps protect brain tissue from further damage.
Beyond aerobic training, combining different types of exercise—such as resistance training, flexibility exercises, and sensorimotor activities—provides a broader range of benefits. Resistance training strengthens muscles and supports mobility, while flexibility exercises help maintain joint function and reduce stiffness. Sensorimotor training, which challenges balance and coordination, can improve neural pathways involved in movement control. Together, these modalities contribute to better physical function and may indirectly support brain health by encouraging more active lifestyles and reducing disability.
Exercise also positively influences the **hippocampus**, a brain region critical for memory and learning. In MS, the hippocampus can shrink, contributing to cognitive difficulties. Physical activity stimulates neurogenesis (the creation of new neurons) and enhances synaptic plasticity in the hippocampus, which helps preserve cognitive function. This effect is particularly important because cognitive impairment affects a large proportion of people with MS and can severely impact quality of life.
Fatigue, one of the most common and disabling symptoms of MS, is also alleviated by exercise. Reducing fatigue allows individuals to engage more fully in daily activities and social interactions, which further supports mental and emotional well-being. Improved mood and reduced depression are additional psychological benefits of regular exercise, which together create a positive feedback loop encouraging continued physical activity.
Safety and individualized exercise prescription are important considerations. People with MS may face barriers such as mobility limitations, fatigue, and heat sensitivity, which require tailored exercise programs designed by healthcare professionals like physiotherapists. These programs typically recommend at least 150 minutes per week of moderate-intensity exercise, combining aerobic, resistance, and flexibility components to maximize benefits while minimizing risks.
In summary, exercise acts as a powerful non-pharmacological intervention in MS by preserving brain volume, reducing inflammation, enhancing cognitive function, and improving overall physical and psychological health. It supports the brain’s structural integrity and function, helping to counteract the neurodegenerative processes of MS and improve quality of life for those affected.
