Examining the Role of Physical Activity, Fitness, and Exercise for Managing Vascular Comorbidities in People with Multiple Sclerosis: A Scoping Review

Background: Vascular comorbid conditions in people with multiple sclerosis (MS) remain highly prevalent and have adverse disease-related consequences. In the general population, physical activity and exercise training have proven beneficial at all levels of cardiovascular disease risk management. People with MS exhibit particularly high rates of physical inactivity; therefore, physical activity represents a modifiable health behaviour for potentially managing vascular comorbidities in MS, and in turn, reducing disease burden. However, points of evidence justifying such an approach have yet to be summarized.

Objectives: To conduct a scoping review of existing evidence linking physical activity, fitness, and exercise training to potential modification of vascular comorbidities and related risk factors in people with MS.

Methods: We searched five databases (PubMed, OvidMEDLINE, EMBASE, PsychINFO, and CINAHL Plus) from inception to November 2017, for articles involving relevant vascular comorbidities in persons with MS (obesity, hyperlipidemia, ischemic heart disease, hypertension, and diabetes) in conjunction with measures of physical activity, physical fitness, exercise training, or sedentary behaviour. Studies were limited to English-language primary research articles, and data were extracted and summarized by article quality, comorbidity, and study design (observational vs. interventional).

Results: Our initial search identified 1028 articles; subsequent screening resulted in 36 articles meeting the final inclusion criteria for the review, including both observational (n=18) and interventional (n=18) studies. Most of the articles reported on obesity measures (n=31), although evidence surrounding hyperlipidemia (n=5), vascular function/hypertension (n=5), and diabetes (n=3) was also identified. Data supporting a beneficial role for physical activity could be drawn from each comorbidity subcategory, albeit inconsistently. The efficacy of exercise training in limiting vascular comorbidity risk and burden was dependent on intervention type and duration.

Conclusions: Evidence points to a potential relationship between physical activity and risk factors related to several vascular comorbidities in MS. Exercise interventions may represent an effective therapeutic strategy for increasing cardiorespiratory fitness and managing vascular comorbidities in persons with MS, justifying further investigation.

Funding: This study was supported by the endMS Scholar Program for Researchers IN Training (SPRINT) national training program of the Multiple Sclerosis Society of Canada.