The role of physical fitness and exercise therapy on disease progression in people with multiple sclerosis

Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system, characterized by neuroinflammation and neurodegeneration. It manifests through a wide range of symptoms, including motor impairments, fatigue, cognitive decline, and reduced physical functioning, significantly impacting societal participation and quality of life. While disease-modifying therapies have advanced, pharmacological options specifically targeting neurodegeneration and disease progression remain limited. Exercise therapy and physical activity have emerged as promising non-pharmacological approaches for managing MS. Research suggests that exercise can enhance physical fitness, improve daily functioning, and potentially slow neurodegeneration. This thesis explores the role of physical fitness and exercise therapy in MS progression. Chapters 2 to 4 investigate how physical fitness influences walking, societal participation, and neurodegeneration. Chapters 5 to 8 outline the Exercise PRO-MS study protocol and examine the effects of exercise therapy on neurodegeneration and cardiovascular risk factors. Finally, the thesis synthesizes key findings, discusses methodological considerations, and offers recommendations for clinical practice and future research. While short-term resistance training improves muscle strength, its impact on neurodegeneration and cardiovascular health remains uncertain, highlighting the need for long-term, patient-tailored exercise programs.