Functional exercise training in persons with multiple sclerosis: a systematic review

Functional exercise training focuses on enhancing the body's capacity for everyday movements by targeting a combination of strength, stability, balance, coordination, and flexibility. More flexible and less standardized exercise approaches, such as functional exercise training, may offer further benefits on improving symptoms in persons with MS (pwMS), but they have been less investigated. This review aims to provide a comprehensive overview of the existing literature on the effects of functional exercise training on functional outcomes (mobility, walking capacity, balance, and proprioception), physical (strength and endurance) and physiological performance measures, as well as patient-reported outcomes (Quality of Life, Fatigue) in pwMS. The systematic review was conducted according to the PRISMA guidelines. Literature searches were conducted in Medline (PubMed) and Cochrane CENTRAL (inception to 19th February 2025). We included studies investigating the effects of functional exercise training on any outcome in adult pwMS. The quality and reporting were evaluated using the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX). A total of 19 studies were included in the review, ranging from smaller pilot studies to larger randomized controlled trials. Interventions lasted between six and 16 weeks. Results of the studies included in this review were highly heterogeneous. Some of the included studies have demonstrated improvements in mobility, short and long walking capacity, balance, strength, and endurance measures as well as on quality of life and fatigue. Adherence to training was poorly reported. Functional exercise training for pwMS is a comprehensive approach to achieving functional improvements, strength gains, and improved endurance simultaneously, thereby promoting beneficial health effects. In future, a clear definition of functional exercise training is required, research should focus on the consistent reporting of treatment adherence, and investigate the long-term effects of functional exercise training in pwMS.PROSPERO registration number: CRD42023448077.