The influence of physical activity on changes in brain structure in patients with multiple sclerosis

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Introduction: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system that lads to brain atrophy, demyelination, and functional reorganization. Physical activity has been proposed as a non-pharmacological intervention with potential neuroprotective effects. Magnetic resonance imaging (MRI) enables objective assessment of exercise-related brain changes in patients with MS. Purpose of the work: This study aimed to summarize the effects of physical activity on brain structure and microstructure in patients with multiple sclerosis, based on MRI findings. Materials and methods: A narrative review of cross-sectional and longitudinal studies was conducted using PubMed, Scopus and Google Scholar. Original research and review articles published between 2006 and 2025 were identified using the following keywords: multiple sclerosis, neurological rehabilitation, brain atrophy and magnetic resonance imaging. The reviewed studies examined various forms of physical activity, such as aerobic exercise, endurance exercise, balance exercise, and multimodal rehabilitation programs, and their effectiveness based on imaging studies. Results: Most studies reported no significant effect of physical activity on global brain volume or overall brain atrophy. However, physical activity was associated with preservation or increased hippocampal volume, increased cortical thickness in motor regions, improved white matter integrity, and more efficient functional organization of motor networks. Spectroscopy findings suggested enhanced neuronal integrity without increased inflammatory activity. Conclusions: Physical activity in multiple sclerosis is associated with favorable regional and microstructural brain changes despite minimal effects on global brain atrophy, supporting its potential neuroprotective role and positive impact on cognitive function.