New research: combining different types of exercise may improve strength, walking, fatigue and quality of life in MS

A 2026 systematic review and meta-analysis (one of the strongest types of evidence, combining results from multiple studies), published in the peer-reviewed journal BMC Neurology, looked at whether “combined training” – programmes that mix two or more types of exercise in the same routine – leads to better outcomes for people with MS than not exercising. The results are encouraging, particularly for strength, mobility, fatigue and quality of life.

What do researchers mean by “combined training”?

In this review, combined training meant exercise programmes that included more than one type of activity, such as: 

• strength (resistance) training 
• aerobic (cardio) exercise 
• balance or coordination exercises 
• flexibility or functional movement. 

These were usually done together within the same session, rather than focusing on just one type of exercise alone. This matters because MS can affect strength, balance, walking and endurance at the same time – so a more holistic approach may better reflect real-world needs. 

Most programmes involved moderate intensity exercise (sometime progressing to more vigorous), tailored to participants’ abilities and disability levels. 

The evidence: what this review found

Researchers analysed results from 20 studies, involving 577 people with MS. Combining results across studies helps identify consistent patterns and provides strong evidence for an approach.  

Overall, people who took part in combined training programmes experienced improvements across several areas that directly affect daily life: 

• Stronger legs, which support everyday activities like standing, climbing stairs and walking. 
• Better balance, an important factor for confidence and fall prevention. 
• Faster walking speed and improved walking endurance. 
• Reduced fatigue, one of the most common and challenging MS symptoms. 
• Improved quality of life, including both physical and mental wellbeing 

Importantly, these benefits were seen across a wide range of exercise combinations and programme lengths (most commonly 8–12 weeks).

Fatigue: a particularly encouraging finding 

Fatigue is often one of the hardest symptoms to manage – and it’s not always responsive to medication. 

In this review, combined training was consistently linked to lower fatigue levels, with very little variation between studies. This supports previous research showing that rehabilitation and lifestyle approaches can play a key role in fatigue management, sometimes more effectively than medication alone. 

Is this safe?

Across the studies included in the review: 

• The exercise programmes were generally safe and manageable. 
• Most people were able to stick with the programme they were given.
• Serious side effects were rare, with only occasional issues such as mild muscle soreness reported. 

That said, the authors caution that the results mainly apply to people with mild to moderate MS disability. There is less evidence for people with more advanced MS, highlighting the importance of individualised support and guidance. 

Why combined exercise may work better

Rather than targeting just one area or symptom, combined training addresses several at once. For example: 

• Strength training supports muscle power and stability. 
• Aerobic exercise improves endurance and cardiovascular fitness. 
• Balance and functional exercises support coordination and confidence. 

Together, these may reinforce each other, leading to more meaningful improvements in daily function. 

What this means for you

This evidence reinforces Overcoming MS’s evidence-based lifestyle approach: regular, appropriate physical activity that supports both physical function and quality of life. 

Because the studies used many different exercise combinations, it isn’t yet possible to say which mix works best. However, benefits were seen across a range of approaches. This means you can adapt exercise to suit you, mixing different forms of movement in a way that fits your abilities and energy levels, while still supporting strength, walking, fatigue and overall wellbeing. 

If you’re considering changing or restarting exercise, you may wish to: 

• Aim for a mix of strength, aerobic and balance activities ideally combining two or more in each session. 
• Start at a level that feels manageable and build gradually. 
• Work up to moderate exercise around three times per week, if possible. 
• Work with a physiotherapist or qualified professional who understands MS. 
• Focus on consistency, not perfection. 

As always, any exercise plan should be adapted to your symptoms, energy levels and preferences.