Impact of Spasticity on Strength and Endurance Training in MS: A Systematic Review and Meta-Analysis

Introduction Exercise training is a cornerstone of rehabilitation and treatment for people with multiple sclerosis (pwMS). While studies have demonstrated benefits such as improved mobility and reduced fatigue, few have explored how exercise parameters such as frequency, intensity, or duration interact with spasticity severity. Indeed, symptoms like paresthesia, fatigue, pain, and spasticity may worsen following exercise. These exacerbations are generally transient and reversible. Exacerbation of spasticity following training is an issue in rehabilitation and treatment. Although the benefits of exercise are well established, the relationship between spasticity severity and training outcomes remains unclear. This systematic review and meta-analysis aims to address this knowledge gap by evaluating how spasticity affects exercise outcomes and identifying adaptations to optimise training for pwMS. Understanding this relationship could help to develop individualised exercise programs that maximise benefits while minimising side effects, thereby improving the quality of life for pwMS.

Methods A systematic review will be conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In the case of disagreement between reviewers, a third reviewer will be consulted to reach consensus. A comprehensive search will be performed in the following databases: PubMed, Embase, Web of Science Core Collection, CENTRAL, CINAHL Ultimate, Ovid/MEDLINE and PEDro, using predefined inclusion criteria. Studies evaluating strength and/or endurance training outcomes in individuals with any type of MS presenting with spasticity will be included. A descriptive analysis will be conducted, and a meta-analysis will be performed if sufficient data and homogeneity between studies are available.

Conclusion This study aims to fill a knowledge gap in the understanding of strength and endurance training in MS by investigating how spasticity influences exercise training outcomes in pwMS. Methodological challenges, including variations in spasticity measurement, training protocols and differences between participant subgroups, need to be considered. The results may be limited by the number of available studies, but will provide a foundation for understanding the complex interaction between spasticity and exercise. Ultimately, it could provide more effective recommendations for strength and endurance training, helping clinicians and patients better manage spasticity.

Publication History

Article published online:
23 October 2025