Can aerobic or strength training help reduce fatigue in people with Multiple Sclerosis?

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Many people with MS wonder whether exercise can help, and if so, which type is best. Research shows that both aerobic training (like walking, cycling, or swimming) and strength training (using weights or resistance bands) can reduce fatigue. Studies have found that these exercise types are similarly effective, and combining them may also be helpful. The key is to choose an activity you enjoy and can do safely.

What the research says

A 2021 systematic review and meta-analysis of 22 randomized controlled trials involving 966 people with MS found that aerobic training and resistance training were equally effective for improving perceived fatigue and lower extremity physical function ¹⁰. This suggests that neither modality is clearly superior for fatigue reduction.

A randomized trial directly compared strength training, aerobic training, combined strength and aerobic training, and general rehabilitation in 62 people with MS over 8 weeks ⁶. All groups showed reductions in fatigue. Aerobic training led to an 18.8% decrease in Fatigue Severity Score, while strength training led to a 16.8% decrease ⁶. The combined group also showed significant improvement ⁶.

Another trial examined high-intensity resistance training in 71 people with MS who had significant fatigue ⁹. After 12 weeks, those who trained twice a week reduced their fatigue score by an average of 10.9 points, and those who trained once a week reduced it by 9.8 points, both significantly better than a non-exercise control group ⁹.

A 2015 Cochrane review of 45 studies concluded that exercise therapy (including aerobic, resistance, and mixed programs) likely reduces fatigue in people with MS, though the quality of evidence was moderate due to variability in study designs ¹¹.

For older adults with MS (average age 60), a 16-week home-based program of aerobic and resistance exercise improved fatigue and cognition compared to a stretching control group ⁸.

Importantly, a study of 255 people with MS undergoing inpatient rehabilitation found that various active therapies, including strength and endurance training, led to clinically meaningful improvements in walking and mobility ⁵. While this study did not focus solely on fatigue, better mobility can reduce the effort of daily activities, which may help with fatigue.

What to ask your doctor

• Given my current MS symptoms and fitness level, what type of exercise (aerobic, strength, or both) would be safest and most effective for my fatigue?
• How often and for how long should I exercise each week to see a benefit for fatigue?
• Are there any MS-specific precautions I should take before starting an exercise program, such as heat sensitivity or balance issues?
• Can you refer me to a physical therapist or exercise specialist who has experience working with people with MS?
• How should I monitor my fatigue levels to know if the exercise is helping or if I need to adjust my routine?