
Am Fam Physician. 2022;105(5):534-539
Author disclosure: No relevant financial relationships.
Key Clinical Issue
What are the benefits of physical activity in patients with multiple sclerosis (MS), cerebral palsy, and spinal cord injury who use or are at risk of using wheelchairs?
Evidence-Based Answer
Physical activity improves aerobic capacity, balance (i.e., reducing risk of falls), walking ability, depression, sleep, female sexual function, global function, and activities of daily living, depending on the population and activity being considered.1 (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.)

Intervention | Strength of evidence (direction of finding) | ||
---|---|---|---|
Multiple sclerosis | Cerebral palsy | Spinal cord injury | |
Aerobic exercise | |||
Dance (one randomized controlled trial in multiple sclerosis and cerebral palsy) | ● ○ ○ (function improvement) | ● ○ ○ (function improvement) | ○ ○ ○ |
Aerobics | ● ○ ○ (sleep improvement) | ○ ○ ○ | ○ ○ ○ |
Aquatics | ● ○ ○ (balance, activities of daily living, female sexual function improvement) | ○ ○ ○ | ○ ○ ○ |
Cycling | ● ○ ○ (no clear benefit on walking) | ● ○ ○ (function improvement) | ○ ○ ○ |
Robot-assisted gait training | ● ○ ○ (balance improvement, no clear benefit on function) | ○ ○ ○ | ● ○ ○ (activities of daily living improvement, no clear benefit on function) |
Treadmill | ● ○ ○ (walking, function, and balance improvement) | ● ○ ○ (function improvement) | ○ ○ ○ |
Postural control | |||
Balance exercises | ● ● ○ (balance improvement) | ○ ○ ○ | ○ ○ ○ |
● ○ ○ (fall risk improvement) | ○ ○ ○ | ○ ○ ○ | |
● ○ ○ (function improvement) | ○ ○ ○ | ○ ○ ○ | |
Hippotherapy | ○ ○ ○ | ● ○ ○ (balance and function improvement) | ○ ○ ○ |
Tai chi | ○ ○ ○ | ○ ○ ○ | ○ ○ ○ |
Motion gaming | ● ○ ○ (function, balance improvement) | ○ ○ ○ (balance improvement) | ○ ○ ○ |
Whole body vibration | ○ ○ ○ | ○ ○ ○ | ○ ○ ○ |
Yoga | ● ○ ○ (no clear benefit on function) | ○ ○ ○ | ○ ○ ○ |
Strength interventions | |||
Muscle strength exercise | ● ○ ○ (no clear benefit on walking, function, balance, quality of life, spasticity) | ● ○ ○ (no clear benefit on walking and function) | ○ ○ ○ |
Multimodal exercise | |||
Progressive resistance or strength plus aerobic and/or balance exercise | ● ○ ○ (walking, balance, VO2 improvement) | ● ○ ○ (no clear benefit on function, quality of life) | ○ ○ ○ |
All types of exercise | ● ● ● (walking improvement) | ● ○ ○ (function improvement) | ● ○ ○ (function improvement) |
● ● ○ (balance, depression improvement; no clear benefit on function) | ● ○ ○ (VO2 improvement) | ● ○ ○ (VO2 improvement, increased episodes of autonomic dysreflexia, no clear benefit on depression) |
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