FIGURE 1.

Effect of different exercise modalities on musculoskeletal and CNS changes affecting mobility in pwMS. MS is associated with defined musculoskeletal changes in skeletal muscle. Some of these changes are of structural (atrophy of type I and IIA fibers), while others are of metabolic nature (reduced mitochondrial activity and slowed phosphocreatine recovery). Ultimately, both impairments contribute to muscle dysfunction, i.e., reduced muscle strength and increased motor fatigability (decreased motor endurance). Moreover, changes in the CNS evoke a perception of general fatigue, which leads to reduced physical activity. Resistance training in pwMS promotes hypertrophy of type IIA fibers, increases muscle strength and counters fatigue. Thereby resistance training mends two prominent impairments that reduce mobility, accelerate disability, and decrease the quality of life. Aerobic exercise can restore phosphocreatine recovery and change the patient’s perception of fatigue. The direct comparison of the two exercise modalities highlights that the benefits of resistance exercise in terms of functional improvements are collectively more favorable than those of aerobic exercise.