Study: Online Resources Don’t Match Established Physical Activity, Exercise Training Guidelines for MS

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A study confirmed that many online resources showed inconsistencies or omissions compared with established guidelines related to physical activity and exercise training, which are known to provide clinical benefits for patients with multiple sclerosis (MS).

Investigators found that many online resources fail to include or accurately address established physical activity guidelines (PAGs) for people with multiple sclerosis (MS), highlighting the current inconsistencies between educational resources that are easily accessible to patients with MS.

In a study, published in Multiple Sclerosis Journal—Experimental, Translational and Clinical, the authors descriptively and comparatively evaluated the quality of informational content on web pages, finding that not only were web pages inconsistent with established PAGs on activity and exercise training, but some did not even address the guidelines.

“This is troubling as the Internet represents a popular source for physical activity information among people with MS; however, the lack of consistency with established PAGs undermines the efforts of these online educational materials for promoting behavior change in MS,” warned the investigators.

Exercise training and lifestyle physical activity can benefit walking and cognitive dysfunction, fatigue, depression, pain, and quality of life in patients with MS. Evidence regarding the benefits and safety of exercise training and physical activity has warranted the development of guidelines, which have been summarized and consolidated by an expert panel organized by the National MS Society for broad-scale dissemination and implementation by providers and patients.

Internet platforms and social network sites offer an opportunity for dissemination and easy knowledge translation in MS. However, little is known about the accuracy of information regarding guidelines for exercise training and lifestyle physical activity in MS.

The investigators conducted a Google search in September 2020 for web pages containing information on physical activity and exercise for people with MS. They limited each keyword search to the first 4 pages of search results, which was signified to be a conservative estimate of the number of pages the average internet user would view. Webpages that were directed at health professionals or that served as promotional material for a product were excluded.

Four unique searches yielded 157 web pages, of which 27 met the inclusion criteria and were assessed in the analysis. Regarding website association, 59% were generated by a nonprofit/voluntary agency, 30% were considered commercial, 7% were from professional associations, and 3% were government websites. The purpose of the web pages was to provide ideas or suggestions on exercise training or physical activity (52%) or to provide an overview of exercise training principles (26%).

On average, the webpages accurately addressed 5 of the 18 guidelines. The most common guidelines mentioned were PAG18, which addresses MS-specific symptom identification and discussion and was included in all web pages except 1; PAG4, which was included in 20 web pages and addresses examples of modalities for aerobic training; and PAG10, which was included in 10 web pages and addressed example modalities for strength training. None of the webpages included PAG5, the guideline that talks about advanced aerobic exercise.


Overall, 13 of the guidelines had worse than expected distributions between being accurately addressed and not accurately addressed among the web pages. Three guidelines met the expected distribution between being addressed accurately vs not accurately.

PAG1, which addressed aerobic activity for 2 to 3 times a week, was the most inaccurately reported guideline, where the guideline was mentioned but was presented with inaccurate information. Two web pages inaccurately reported guidelines PAG11 (lifestyle physical activity of 150 minutes weekly) and PAG 5 (rest between sets).

“This is important as lifestyle physical activity may represent a better approach for rehabilitation than exercise training in MS, as it is more easily accessible and sustainable than exercise training, and there are established methods, namely behavior change interventions, for increasing lifestyle physical activity in persons with MS,” the investigators noted.

Limitations of the study included that the investigators did not examine video or linked content for guidelines, that the guidelines were not classified based on their focus, and that Google’s algorithm shifts daily, potentially producing different results for people. The investigators conducted another search in February 2021, but the new results did not alter the conclusions of the present study.

“Based on the findings of the current study, we underline the necessity and the importance of engaging primary healthcare providers in assisting patients with finding precise and standard online information about established exercise programs….This lays the groundwork for further research that develops wide-spread approaches for accurate dissemination of PAGs given the majority of sources do not mention the PAGs or provide consistent guidance,” the investigators said.


Sadeghi-Bahmani D, Silverira SL, Baird JF, Motl RW. Do internet resources align with exercise training and physical activity guidelines for people with multiple sclerosis? Mult Scler J Exp Transl Clin. Published September 30, 2021. doi:10.1177/20552173211038035