Pilates, resistance training exercises may protect nerves in MS

Physical exercise may do more than improve muscle strength and mobility in people with multiple sclerosis (MS): Certain types of exercise may also help protect nerve cells from ongoing damage, according to a review of published studies.

The review linked resistance training, Pilates, and high-intensity interval training (HIIT) to significant reductions in levels of neurofilament light chain (NfL), a biomarker of nerve damage. Because NfL is widely used to monitor disease activity and progression in MS, the findings suggest these forms of exercise may have a protective effect on the nervous system.

“Physical exercise, specifically resistance training, Pilates, and HIIT, may be associated with reduced NfL concentrations in patients with MS, suggesting a potential neuroprotective role,” the researchers wrote, though they added that further research is needed to confirm these benefits.

The study, “Effects of physical exercise on neurofilament light chain in multiple sclerosis and other neurological disorders: A systematic review,” was published in Multiple Sclerosis and Related Disorders.

Recommended Reading

May 6, 2026 Columns by Desiree Lama

Every summer, rising temperatures require me to relearn my limits

Exercise and nerve cells

MS is marked by inflammation and damage that disrupt nerve communication in the brain and spinal cord, leading to MS symptoms such as muscle weakness, difficulty walking, and fatigue that tend to worsen over time.

NfL is a protein released when nerve fibers are damaged. It can be detected in the fluid surrounding the brain and spinal cord and in the bloodstream. In people with MS, higher NfL levels are associated with more active disease, poorer cognition, and worse outcomes.

Exercise is known to improve muscle strength and mobility, ease fatigue, and boost overall quality of life for MS patients. Scientists have also suggested it could help protect nerve cells, but “studies examining the effects of physical exercise programs on NfL levels show inconsistent results,” the researchers wrote.

To get a clearer picture, they reviewed data from studies published since the inception of five scientific databases. Fifteen studies involving 765 adults with neurological diseases met the inclusion criteria.

Nine of the 15 studies examined the effects of exercise in people with MS. The remainder included people with Alzheimer’s disease, vascular cognitive impairment, Huntington’s disease, and Parkinson’s disease.

The MS studies evaluated a range of exercise programs, including resistance training, which uses weights or other forms of resistance to strengthen muscles; Pilates; cardiorespiratory training, including HIIT, which alternates short bursts of intense exercise with periods of recovery; and concurrent training, which combines aerobic and resistance exercise in the same program.

Programs lasted from three weeks to nine months, with participants typically completing two or three 45- to 60-minute sessions per week.

Resistance training, Pilates, and HIIT were the approaches most consistently associated with significant reductions in NfL levels in people with MS. However, the effects of HIIT appeared to be short-lived. In one study, NfL levels declined immediately after exercise, but began to rise again within a few hours, a finding the team said highlights the need for further research on HIIT and neuroprotective benefits.

Moderate- to high-intensity aerobic training did not induce significant change, which the researchers said could indicate that “moderate continuous aerobic training may remain below a supposed threshold necessary for exercise-mediated modulation of NfL to occur.”

Exercise generally did not significantly change NfL levels in people with the other neurological diseases included in the review. Although the researchers noted that fewer studies were available for these conditions, they suggested the difference may partly reflect the underlying biology of the diseases. In MS, where inflammation plays a major role in nerve damage, NfL levels may respond more readily to exercise than in slowly progressive neurodegenerative diseases such as Alzheimer’s or Parkinson’s.

“Physical exercise, particularly resistance training, Pilates and HIIT, may be effective in reducing NfL concentrations in people with MS, representing the most robust and consistent evidence available,” the researchers wrote.

They cautioned, however, that available evidence remains limited. Many of the studies were small, and they differed substantially in the types and duration of exercise, participant characteristics, and the timing of NfL measurements. Moreover, few included long-term follow-up, making it unclear whether lower NfL levels ultimately translate into lasting protection against nerve damage or slower disease progression.

Larger, controlled studies that include a “longitudinal follow-up are required to establish causality and underlying physiological mechanisms that explain the reduction in NfL,” the team concluded.