# Promoting Exercise as a Therapeutic Intervention in Multiple Sclerosis: Barriers, Efficacy, and Social Prescribing Strategies

## TL;DR

Exercise helps people with multiple sclerosis, but barriers like social and economic factors limit its use, so new strategies like social prescribing are suggested to improve access.

## Contribution

The paper introduces social prescribing as a novel strategy to address barriers to exercise in multiple sclerosis.

## Key findings

- Aerobic exercise improves fatigue, mobility, cognition, mood, and quality of life in people with MS.
- Barriers to exercise include symptom-related, psychosocial, socioeconomic, and healthcare system factors.
- Social prescribing is proposed to connect individuals with community resources and reduce these barriers.

## Abstract

Multiple sclerosis (MS) is a chronic neurologic disease associated with significant physical, cognitive and social burden. Substantial evidence supports the safety and benefits of aerobic exercise for people with MS (pwMS), including improvements in fatigue, mobility, cognition, mood and quality of life. While exercise is recommended across all disability levels in clinical guidelines, real-world adherence remains low. This narrative review summarizes the benefits of aerobic exercise in MS and examines the symptom-related, psychosocial, socioeconomic, and healthcare system barriers that limits its implementation. These barriers reflect the broader influence of social determinants of health, which play a critical role in MS outcomes yet remain under-addressed in intervention research. We highlight social prescribing, a patient-centered approach that connects individuals to non-medical, community-based resources to address social needs, as a strategy to reduce barriers to exercise participation for pwMS. Future research should focus on developing and evaluating MS-specific interventions to improve exercise adherence and promote equitable access to physical activity to improve health outcomes.