The physical activity continuum, exercise-prescription and cardiometabolic health in persons with Multiple Sclerosis: The underexplored (inter) relations and care implications

Abstract

Multiple sclerosis (MS) is a chronic, inflammatory and autoimmune-mediated disorder of the central nervous system1. It is the leading cause of non-traumatic neurological disability in young to middle-aged adults, and there is no existing cure2,3. The vast majority of persons with MS (PwMS) experience a wide range of physically and cognitively debilitating symptoms, resulting in functional limitations, disability and reduced quality of life4,5. PwMS may also suffer from multiple mental and physical comorbidities, which further reduce their quality of life independently of neurologic disability6. Comorbidity typically encompasses the overall burden of illness beyond the specific disease of interest, which often receives minimal consideration in the context of many chronic diseases7. An important group of physical comorbidities in PwMS includes non-communicable cardiometabolic diseases, such as type 2 diabetes mellitus and cardiovascular diseases (e.g. coronary/peripheral artery disease, stroke and heart failure)8-13. These conditions not only further reduce quality of life6, but are also associated with a worsening of MS disability and largely contribute to all-cause mortality rates in MS populations13. Furthermore, similar to the general population, the prevalence of non-communicable cardiometabolic diseases is rising in PwMS14. This underscores the importance of investigating strategies to mitigate or prevent the onset of these conditions.