Most people with MS report fatigue, and are unsure what to do about it. Maybe exercise doesn't seem the logical remedy when you have no energy. But is this true?

A group of Dutch researchers recently reviewed all the available trial data on how exercise affects fatigue in MS. They conclude that: "exercise therapy can be safely prescribed and is moderately effective in the treatment of fatigue in people with MS without increasing the risk of relapse."

They hypothesise three mechanisms through which exercise may improve fatigue:

1. Through improved cardiovascular fitness which increases energy

2. Through neuroprotective mechanisms which reduce long term disability

3. Through a normalised regulation of the hypothalamo-pituitary-adrenal (HPA) axis (which is involved in many processes in the body including stress response, immune system and energy).

Although the data was not strong enough to make definite recommendations on which type of exercise is the most effective, the data suggests that: "endurance training, mixed training, or 'other' type of training such as yoga may be more effective when compared to muscle power training and task-oriented training interventions."

They further point out the limitations of the study: "However, the overall quality of evidence was moderate due to the moderate risk of bias and the lack of studies specifically aimed at reducing fatigue through exercise therapy in fatigued people with MS."

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