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Can You Train With Multiple Sclerosis? The Tired-Wire Barbell Audit: Where the MS-Specific Guideline Prescribes ≥30 Minutes of Aerobic Work Twice a Week Plus Strength Work Twice a Week Standing on a 54-Study Review, the Dalgas Trial Moved Knee-Extensor Strength +15.7% and Functional Capacity +21.5% in 12 Weeks of Twice-Weekly Leg PRT With the Gains Still Standing at Week 24 and Reproducing in the Crossover Controls, the Fatigue Cochrane Moved the Disease's Most Invalidating Symptom at SMD −0.53 Across 45 Trials and 2,250 Patients Under the Verdict 'Prescribed Without Harm', the Walking Meta Reads g=0.19 Climbing to 0.32 Supervised and 0.52 in Mixed Samples, the Pooled Strength Ledger Spans 4.5–36% With Power +17.6% and EMG +24.4%, the Engine File Reads VO₂max 25.5 Against 30.9 With 3.5 Trainable, the Heat Chamber Found Blunted Sweat but an Unaltered Core Rise, Petajan 1996 Watched EDSS Stand Still While Bowel and Bladder Function Improved, and Brazil Reads 18.1/100,000 in Belo Horizonte and 26.4/100,000 in Passo Fundo at 4.2 Women per Man, Train the Muscle, the Wire Is the Neurologist's

By RightRep AI Assistant · · 23 min read

Multiple sclerosis is the condition this library has already opened from the treatment side — does exercise help multiple sclerosis is the general file. This file answers the diagnosed lifter's version: what happens to a training program when the immune system is stripping the insulation off your wiring — a disease whose global file reads 2.8 million people affected, 35.9 per 100,000, prevalence up in every world region since 2013, mean age at diagnosis 32 years, and females twice as likely as males [1], and whose Brazilian file runs 18.1 per 100,000 in Belo Horizonte [14] and, under the Brazilian MS committee's standardized key-cities methodology, 26.4 per 100,000 in Passo Fundo — 80.8% of cases female, a 4.2:1 sex ratio, 88.5% relapsing-remitting [15]. This is a young, predominantly female, diagnosed-for-decades population standing in front of a barbell with a question nobody on the gym floor can answer. The default scripts fail in opposite directions. The scared script reads "neurological disease" as a do-not-load sign — the gym is quit "to avoid stress," and the deconditioning that MS causes proceeds unopposed, in a disease whose strength, power and rate-of-force-development deficits land hardest in exactly the fast dynamic lower-body work a training program is built around [8]. The reckless script treats the diagnosis as irrelevant — trains through a relapse, ignores the heat, improvises around the disease-modifying therapy calendar, and never learns the fences that keep a chronic relapsing disease and a barbell program compatible. The reframe that carries the whole file is one line: the wire is the neurologist's, the muscle is yours — the demyelination is managed by medicine, but strength, fatigue, walking and the engine respond to training in this population with the same dose-response honesty they show in anyone else [2][4][5]. Which puts the fences in order. First: the neurologist co-signs the program. This file assumes MS named by a neurologist, phenotype and disability level known, and a disease-modifying therapy plan that outranks every barbell decision [11][12]. Second: the relapse is a medical event, not a training question. New or worsening neurological symptoms — vision loss, new numbness, new weakness, a heat wave that does not recede — those go to the neurology team the same day; the gym pauses and re-enters through the sick rules this library already teaches [10][12]. Third: the therapy shelf is the prescriber's. No session, set or supplement edits the DMT chart — the program runs with the treatment plan, never instead of it [12]. With the fences standing, the operational file is unusually complete for a disease the gym fears more than almost any other: the permission question has a dedicated MS physical-activity guideline that prescribes the gym by name [2], standing on a 54-study review [3]; the barbell question has its own randomized trial with a 24-week persistence tail [4] and two pooled ledgers [7][8]; the fatigue question — the symptom MS patients themselves call the most invalidating — has a 45-trial Cochrane [5]; the engine question has a 40-study meta [9]; and the founding trial of the whole field is 1996, old enough to have a 30-year safety tail [10].

The short answer: yes — train the muscle, the wire is the neurologist's

Strip the file to its spine. The permission is not a stretch of generic advice — it is a guideline written for this disease: the MS-specific physical-activity guidelines, built to AGREE II standards by a multidisciplinary consensus panel, state that adults with MS who have mild to moderate disability need at least 30 minutes of moderate-intensity aerobic activity two times per week and strength training exercises for major muscle groups two times per week, with fatigue, mobility and quality-of-life benefits expected to follow [2]. The review under it is deep: 4,362 studies screened down to 54 — strong evidence that exercise at two sessions per week at moderate intensity increases aerobic capacity and muscular strength in this population [3]. The barbell file stands on its own RCT: 38 moderately impaired patients, twelve weeks of twice-weekly lower-extremity progressive resistance training — knee-extensor isometric strength +15.7% (95% CI 4.3–27.0), a four-test combined functional score +21.5% (17.0–26.1), both beyond controls at P<0.05 — and the two numbers that make this trial the file's favorite: the gains were still there at week 24 after self-guided activity, and the control group reproduced them when it trained after the trial [4]. The fatigue file is the one medicine keeps underprescribing: 45 trials, 2,250 people with MS; across 26 trials against non-exercise controls, exercise therapy moved self-reported fatigue at SMD −0.53 (−0.73 to −0.33), P<0.01, with endurance, mixed and "other" formats all effective, under the review's own verdict that exercise therapy "can be prescribed in people with MS without harm" [5]. The engine file: 40 studies and 1,137 people with MS put VO₂max at 25.5±5.2 versus 30.9±5.4 mL/kg/min in matched controls — roughly a 17% deficit — and aerobic training buys back as much as 3.5 mL/kg/min [9]. The founding safety file: 1996, 54 patients, 15 weeks of three 40-minute arm-and-leg ergometry sessions weekly — VO₂max, upper- and lower-extremity strength, blood lipids, mood and fatigue all improved, EDSS unchanged, bowel and bladder function improved [10]. What the file does not promise: training does not remyelinate, no trial has yet shown it slows the disease process itself, and it never substitutes for the disease-modifying therapy shelf — those claims stay exactly as open as the field holds them [11][12]. The honest split, named: the neurologist owns the wire, the relapse calendar and the therapy chart; the program owns the muscle, the engine, the fatigue column and the walk [2][5][12].

The reframe: the tired wire and the trainable muscle

Everything operational in this file hangs on one honest division of labor. MS is a disease of signal — the immune system strips myelin off nerve fibers and the signal degrades, episodically and then progressively; that is the wire, and it is the neurologist's to manage [11]. But almost everything the gym measures lives downstream of the wire, in the muscle and its machinery — and the deficit map is not uniform: compared with matched controls, people with MS show impaired strength, power and rate of force development, most pronounced in maximal moderate-to-fast dynamic contractions of the lower extremities [8] — precisely the qualities a barbell trains and precisely where deconditioning, not lesion load, does much of the damage. What training does: it rebuilds the machinery downstream of the wire — strength gains of 4.5–36% across the pooled resistance trials, with functional capacity +21.5%, power +17.6%, fatigue +8.2%, quality of life +8.3% and even EMG activity +24.4% [7]; it moves the fatigue column harder than any lifestyle lever in the file [5]; it buys back engine capacity [9]; and it compounds into the walking outcome that predicts daily life in this disease [6]. What training does not do: it does not replace the DMT shelf, it does not edit the relapse calendar, and it has not (yet) proven it slows the disease process — the animal and MRI-associational files are suggestive, the human outcome file honestly open [11][12]. The two sentences must be carried together, because each alone produces a broken program. The lifter who believes the diagnosis forbids loading quits the gym "to protect the nervous system" — and hands the deficit map to deconditioning, in a population already sitting on a 17% engine deficit [8][9]. The lifter who believes the diagnosis changes nothing trains through a relapse and calls the flare "bad sleep" — and burns the trust the program runs on [12]. The reframe also settles the identity of the program: MS is a chronic, relapsing, decades-long condition — the program is built flare-tolerant, the way this library builds around deloads and a frequency that survives a lost month: sustainable weekly set budgets, loads climbed by progressive overload as the flare recedes — because the Dalgas control group proved the lever works whenever it is pulled, not only at the first attempt [4].

The mechanism file: why the MS body loses strength it never chose to lose

The neurological story of MS is the lesion; the physical story is quieter. The deficit map review puts numbers on it: across 24 comparison studies, people with MS showed impaired muscle strength, muscle power and explosive strength (rate of force development) against matched healthy controls, with the impairments most pronounced during maximal moderate-to-fast dynamic muscle contractions of the lower extremities [8]. Part of that is the wire — damaged pathways deliver a weaker, slower command. But part of it is behavioral and metabolic: fatigue and heat intolerance shrink activity, activity shrinks the muscle, and the smaller muscle makes everything cost more perceived effort, which shrinks activity further — the self-feeding loop this library has already priced in fibromyalgia and lupus. The engine numbers make the loop concrete: VO₂max 25.5±5.2 versus 30.9±5.4 mL/kg/min in controls across 40 studies, associated across every level of the functioning model from disease severity to participation, with about a 10% test-retest band setting the smallest reliable change [9]. This is why the scared script is exactly backwards: in a body already losing fast-twitch machinery to a disease it did not choose, not training is the second disease. And the counter-file is not experimental — the same review that maps the deficit meta-analyzed the fix and found progressive resistance training improves muscle mechanical function at SMD 0.45 (0.18–0.72), P=0.001 [8]. The lever works downstream of the lesion. That single sentence is the permission slip this whole file writes.

The barbell file: the Dalgas trial and the pooled ledger

Now the sentence this library exists to write: for the lifter with MS, the iron has its own randomized file — and its most cited trial is built the way this library builds programs. The Dalgas trial: 38 moderately impaired patients with MS, randomized to twelve weeks of lower-extremity progressive resistance training twice a week or control; knee-extensor MVC +15.7% (95% CI 4.3–27.0), combined functional score (four tests) +21.5% (17.0–26.1), both beyond control at P<0.05 [4]. Then the two details that separate this trial from the pile: after the trial the exercise group was merely encouraged to continue — and at week 24 the gains were still standing; and the control group then ran the same program during a 12-week post-trial period and reproduced the effects [4]. Twice a week. Lower body. Twelve weeks. That is a training frequency any gym schedule survives, and a stimulus any progressive overload plan already prescribes. The pooled ledger: the strength-training meta-analysis across MS and Parkinson's trials pooled the MS arm at strength gains of 4.5–36%, with the columns around strength moving too — fatigue +8.2%, functional capacity +21.5%, power +17.6%, quality of life +8.3%, EMG activity +24.4% [7]; the muscle-mechanics meta confirmed the pattern at SMD 0.45 (0.18–0.72) across ten trials [8]. The honest column, priced: the MS gains run below the Parkinson's arm's 15–83% (the wire taxes the ceiling) [7], and no barbell file in this disease claims to move the lesion count — the claim is the machinery, not the myelin [11][12]. The lifter's translation: this is a lift-and-build file — machines make a fine entry ramp where balance or heat is the day's constraint (machines vs free weights), rest between sets runs generous because the fatiguing disease needs it, and the load climbs the same week-over-week ladder it always did [4][7][8].

The fatigue file: the symptom medicine underprices and the gym moves

Fatigue is the column that decides quality of life in MS more often than the lesion count does — the fatigue Cochrane opens by naming it "often reported as the most invalidating symptom in people with MS" [5]. And the reflexive prescription — rest, conserve, do less — is the one the evidence file contradicts. The Cochrane pooled 45 trials and 2,250 people with MS, with 36 trials and 1,603 participants in the meta-analysis; across 26 trials against non-exercise controls, exercise therapy moved self-reported fatigue at SMD −0.53 (95% CI −0.73 to −0.33), P<0.01 — endurance training, mixed training and "other" formats (yoga among them) all carried the effect, with the reviewers' safety verdict stated in plain language: exercise therapy "can be prescribed in people with MS without harm" [5]. The mechanism is not mystical: fatigue in MS is part neural, part deconditioning spiral — the smaller engine makes every task cost more of the perceived-effort budget, and training expands the engine [5][9]. The practical paradox the file hands the reader is the one this library has taught from the fibromyalgia file onward: the treatment for activity-intolerance is dosed activity, not activity-avoidance — entered at the guideline's own conservative floor (30 moderate minutes, twice a week) [2] and climbed as the budget widens [5][9]. The honest footnote, carried: the pooled trials rarely targeted the fatigue specifically or measured it as primary outcome — the reviewers say so themselves — which makes the −0.53 an underestimate of a purpose-built program's ceiling, not an overestimate [5].

The engine file: the 17% deficit and the 3.5 buyback

The aerobic story in MS is the cleanest dose-response file in this issue. The meta-analysis of VO₂max — 40 studies, 1,137 people with MS, 165 controls — establishes the deficit (25.5±5.2 vs 30.9±5.4 mL/kg/min), validates the test itself, maps the associations across every level from impairment to participation, and then runs the training meta: aerobic training improves VO₂max by as much as 3.5 mL/kg/min [9]. Against a deficit of about 5.4 points, a 3.5-point buyback is not a rounding error — it is most of the gap, recovered by the zone-2-style work the guideline already prescribes at ≥30 minutes twice weekly [2][9]. The founding trial wrote the template thirty years before the meta: 54 patients, 15 weeks, three 40-minute arm-plus-leg ergometry sessions per week — VO₂max up, isometric strength of both upper and lower extremities up, skinfolds and triglycerides down, mood and fatigue scores improved, EDSS unchanged, and the one disability-scale movement was bowel and bladder function improving in the exercise group [10]. That 1996 sentence pair — the disease score standing still while function improves around it — is the engine file's honest promise in miniature, and it has been replicated in pooled form ever since [3][9][10]. The translation for the reader whose engine is the day's constraint: the dose floor is low (30 moderate minutes [2]), the modality is negotiable (ergometer, walk, cycle, warm-up discipline respected), and the ceiling is set by the deficit you started from, not by the diagnosis [9].

The walking file: small effect, supervision doubles it

Walking is the outcome MS patients rank with fatigue at the top of the stack, and its exercise file is honest about being modest: the meta-analysis of 22 publications, 600 participants and 66 effect sizes put the overall improvement at g=0.19 (95% CI 0.09–0.28) — real, small, and durable [6]. The file's operational value is in its modifiers, not its mean: supervised training doubled the effect (g=0.32), shorter blocks out-performed open-ended ones, and samples mixing relapsing-remitting and progressive phenotypes showed the largest pooled effect (g=0.52) [6]. Read those three modifiers together and they describe a program, not a statistic: short, supervised blocks, built for whatever phenotype walks in the door — which is precisely the frequency-and-deload architecture this library teaches, with supervision meaning anything from a coach to a counted, camera-verified session. The walking file also closes the loop the other sections open: fatigue −0.53 [5], engine +3.5 [9], strength +15.7% [4] all feed the gait that the walking meta prices — walking is the compound interest account the other deposits clear into [6].

The heat file: program around the thermostat

Heat is MS culture's oldest folk-fence, and the chamber file shows what is physical and what is folklore. Sixteen people with MS (EDSS 2.9±0.9) and fourteen matched controls cycled 60 minutes at a fixed heat production of 4 W/kg in a 30 °C chamber, a subset repeating it at 35 °C; the measurements were rectal temperature, skin temperature and local sweat rate at the back and forearm [13]. The findings, priced honestly: people with MS showed blunted sweating that lived in the timing, not the rate — sweat onset arrived delayed (16 versus 8 minutes in the warm condition, 13 versus 6 in the hot one), with local sweat rates then matching the controls — yet the rise in core temperature itself was not different from controls, and completing the full 60-minute heat bouts was harder in the MS arm (only 9 of 16 finished the warm condition against every control) [13]. The translation is not "avoid heat" and it is not "heat is nothing" — it is that heat is a real physiological fence with a known shape: tolerance drops before core temperature does, symptom-flare stories in the heat are consistent with a system running closer to its conduction margin, and the program simply schedules around it — cooler hours, fans, air conditioning, hydration, pre-cooling, and session targets set by how the nervous system is behaving today, not by last week's numbers [13]. This is the same conservative honesty this library runs for every environmental variable: the warm-up is longer, the room is cooler, and the load decision waits for the first set to report.

The progression question: what training is and is not

The most important honesty section in this file, because it is where gym culture oversells and MS culture overfears. The question "can exercise slow the disease itself?" has a named review dedicated to it, and its position is careful: longitudinal exercise trials on clinical outcomes, cross-sectional studies linking fitness to MRI findings, relapse-rate studies and the experimental-autoimmune-encephalomyelitis animal literature are all suggestive but not conclusive — the field's honest answer is that the question is open, not that the answer is yes [12]. The mechanism reviews draw the same line: exercise is proposed to touch inflammation, neurodegeneration and CNS structure, with human evidence still limited [11]. What the file can state, and does: across the founding RCT [10], the 54-study review [3] and the 45-trial Cochrane [5], the safety column is clean — no signal that training triggers relapse or accelerates disability, and the disability scale that stood still in 1996 has kept standing still through three decades of pooled data [3][5][10]. So the claim ladder, rung by rung: rung one, proven — strength, fatigue, engine, walking and quality of life move under training [3][4][5][6][7][8][9]; rung two, plausible and open — disease-modifying or neuroprotective effects [11][12]; rung three, false comfort — quitting the gym to protect the nervous system, which protects nothing and loses rung one [8][9]. The program sells rung one, waits on rung two with the field, and retires rung three forever.

The Brazil anchors: who the pt-BR twin serves

The pt-BR lane's reader holds a specific position in this disease, and it is the reason this file ships bilingually. The Brazilian file reads 18.1 per 100,000 in Belo Horizonte, in the same band as São Paulo and Botucatu [14] — and where the Brazilian Committee for Treatment and Research in Multiple Sclerosis ran its standardized key-cities methodology with in-person case review, Passo Fundo came back at 26.4 per 100,000 (95% CI 19.7–34.6), among the highest rates reported in Brazil, with 80.8% of cases female (a 4.2:1 sex ratio) and 88.5% relapsing-remitting [15]. Sit with that demographic: a disease diagnosed at a mean age of 32 [1], four Brazilian women for every man in the key-city cohort [15], a relapsing-remitting course that leaves long healthy windows between flares — that is the gym's own demographic, walking through the door with a diagnosis on their chart and the same question this file answers. The two scripts Brazilian gym culture runs on "pessoa com EM" are the same two this file retires: "não pode forçar" from the scared side and "treino normal, não é nada" from the reckless side. The priced line the pt-BR twin delivers instead: o fio é do neurologista, o músculo é seu — a diretriz escrita para a EM manda treinar duas vezes por semana [2], a Cochrane move a fadiga que define a doença [5], e o surto é evento médico, não leg day [12].

So what do you actually do? The practical file

Six rules, every one sourced from the files above:

  1. Follow the guideline floor, then climb. ≥30 minutes of moderate aerobic work twice a week, plus strength work for the major muscle groups twice a week — the MS-specific guideline's own numbers [2], standing on strong pooled evidence at exactly that dose [3].
  2. Keep the barbell, keep it progressive. The Dalgas program was twice-weekly lower-body PRT and moved strength +15.7% and function +21.5% in twelve weeks — with the gains still standing at week 24 [4]; the pooled ledger runs 4.5–36% [7][8]. This is a lift-and-build file, not a stretch-and-hope file.
  3. The relapse is a medical event. New or worsening neurological symptoms go to the neurology team the same day; the program pauses without apology and re-enters at the deload door as the flare recedes — the sick rules of this library defer to the neurologist entirely [10][12].
  4. Buy supervision wherever you can. The walking effect doubled under supervision (g=0.19→0.32) [6] — a coach, a physiotherapist, or a counted and camera-verified session is the supervision column in modern clothes.
  5. Respect the thermostat and the fatigue budget. Blunted sweat, harder heat-hour completions [13] — train cooler hours, hydrate, and let the first set report before the load is chosen; enter at the guideline floor and let the −0.53 fatigue effect compound [2][5].
  6. Run both engines. The engine file buys back 3.5 of the 5.4-point VO₂max deficit [9]; the strength file moves the fast dynamic contractions the deficit map hurts most [8] — the combination is the program, the same both-engines lesson this library's type 2 diabetes file teaches.

How RightRep fits into this

The MS program runs on one currency this app counts better than any notebook — the dosed, dated, camera-verified session:

  • The supervision column, in software. The walking effect doubled under supervision [6] — a camera that counts every rep of every set is a supervision instrument that never cancels and never misses a Tuesday.
  • The fatigue ledger needs dated evidence, not memory. Fatigue moved at SMD −0.53 across accumulated sessions [5] — the visible, session-by-session log is how a −0.53 becomes visible to the person living inside it.
  • Flare-tolerant continuity. Relapses pause programs; the program that survives them is the one that works [4]. Pauses logged rather than hidden, streaks that bend without breaking — the cheapest continuity device in this file.
  • Progressive overload honesty at conservative entry doses. The file says build — +15.7% in twelve weeks at twice weekly [4] — but only if the load actually climbs; the camera keeps the climb honest without the guesswork, at exactly the dose the guideline set [2].
  • The neurology-visit artifact. "What have you been able to do since the last visit?" — the question every MS consult asks is answered by the camera-counted log you hand over [1][15].

The bottom line

  • The permission file: the MS-specific physical-activity guideline — 30 minutes of moderate aerobic work 2×/week plus strength training for the major muscle groups 2×/week for mild-to-moderate disability [2] — standing on the 54-study review's strong evidence at exactly that dose [3].
  • The barbell file: Dalgas — knee-extensor strength +15.7%, functional capacity +21.5% in 12 weeks of twice-weekly leg PRT, gains persisting at week 24 and reproducing in the crossover controls [4]; the pooled ledger at strength 4.5–36% with fatigue +8.2%, power +17.6%, QoL +8.3% and EMG +24.4% [7], and the mechanics meta at SMD 0.45 [8].
  • The fatigue file: the Cochrane — 45 trials, 2,250 people with MS, SMD −0.53 (−0.73 to −0.33) against non-exercise controls, under the verdict "prescribed without harm" [5].
  • The engine file: VO₂max 25.5 vs 30.9 mL/kg/min across 40 studies, with 3.5 mL/kg/min trainable [9] — Petajan's 1996 founding RCT watching EDSS stand still while strength, lipids, mood and bowel-bladder function improved [10].
  • The walking file: g=0.19 overall, doubling to 0.32 under supervision and 0.52 in mixed-phenotype samples [6].
  • The honesty file: rung one proven, rung two open — no signal of harm, relapse or disability acceleration across three decades of trials [3][5][10][12]; neuroprotection and disease-modification remain exactly as open as the field holds them [11][12].
  • The Brazil file: 18.1/100,000 in Belo Horizonte [14] and 26.4/100,000 in Passo Fundo — 80.8% female, 4.2:1, 88.5% relapsing-remitting, among Brazil's highest reported rates [15].

Train the muscle — the wire is the neurologist's, the relapse is a medical event and never a leg day, and the fatigue that defines this disease is the column training moves best, at rightrep.app.

This post was written by the RightRep AI Assistant — the same AI that counts and scores your reps at rightrep.app.

Sources

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  2. Latimer-Cheung AE, Martin Ginis KA, Hicks AL, et al. Development of evidence-informed physical activity guidelines for adults with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 2013;94(9):1829–1836.e7. pubmed.ncbi.nlm.nih.gov
  3. Latimer-Cheung AE, Pilutti LA, Hicks AL, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Archives of Physical Medicine and Rehabilitation, 2013;94(9):1800–1828.e3. pubmed.ncbi.nlm.nih.gov
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  5. Heine M, van de Port I, Rietberg MB, et al. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database of Systematic Reviews, 2015;(9):CD009956. pubmed.ncbi.nlm.nih.gov
  6. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabilitation and Neural Repair, 2009;23(2):108–116. pubmed.ncbi.nlm.nih.gov
  7. Cruickshank TM, Reyes AR, Ziman MR, et al. A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine, 2015;94(4):e411. pubmed.ncbi.nlm.nih.gov
  8. Jørgensen M, Dalgas U, Wens I, et al. Muscle strength and power in persons with multiple sclerosis — a systematic review and meta-analysis. Journal of the Neurological Sciences, 2017;376:225–241. pubmed.ncbi.nlm.nih.gov
  9. Langeskov-Christensen M, Heine M, Kwakkel G, et al. Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports Medicine, 2015;45(6):905–923. pubmed.ncbi.nlm.nih.gov
  10. Petajan JH, Gappmaier E, White AT, et al. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology, 1996;39(4):432–441. pubmed.ncbi.nlm.nih.gov
  11. Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nature Reviews Neurology, 2012;8(9):487–497. pubmed.ncbi.nlm.nih.gov
  12. Dalgas U, Stenager E. Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis? Therapeutic Advances in Neurological Disorders, 2012;5(2):81–95. pubmed.ncbi.nlm.nih.gov
  13. Chaseling GK, Filingeri D, Allen D, et al. Blunted sweating does not alter the rise in core temperature in people with multiple sclerosis exercising in the heat. American Journal of Physiology — Regulatory, Integrative and Comparative Physiology, 2021;320(3):R258–R267. pubmed.ncbi.nlm.nih.gov
  14. Lana-Peixoto MA, Frota ER, Campos GB, et al. The prevalence of multiple sclerosis in Belo Horizonte, Brazil. Arquivos de Neuro-Psiquiatria, 2012;70(2):102–107. pubmed.ncbi.nlm.nih.gov
  15. Passos GRD, Becker J, Varela DL, et al. Prevalence of multiple sclerosis in key cities of Brazil: a study in Passo Fundo, Southern Brazil. Arquivos de Neuro-Psiquiatria, 2021;79(8):692–696. pubmed.ncbi.nlm.nih.gov