January 21, 2026 | News | Living with MS MS Research MS Treatments

Non-drug options for treating MS: hits and misses in 2025

This past year saw hundreds of trials performed in multiple sclerosis as researchers explored new ways of managing the disease. There were a number of hits and misses, as you one might expect. Fenebrutinib, an oral drug that targets immune cells in the brain, posted promising results in the FENopta trial (Bar-Or and colleagues. Lancet Neurol 2025;24:656-666), and new trial results are expected this year. In contrast, two trials of elezanumab, which targets the repulsive guidance molecule (to improve remyelination), failed to show any benefit (Cree and colleagues. Ann Neurol 2025;98:590-602).

However, most studies last year looked at the ability of non-drug therapies to improve MS symptoms and quality of life. Here is a sampling of some of those studies.

Aquatic therapy (hydrotherapy): Exercising in a pool can improve muscle strength and flexibility while having less of an impact on joints. A small study found that improvements in balance and MS fatigue were significantly greater with aquatic therapy compared to standard physiotherapy (Tsatsakos and colleagues. Mult Scler Relat Disord 2025:104:106836). Pool exercises provided a boost both to physical and mental fatigue.

Head and neck cooling: Some of the benefit of aquatic exercise may be due to the water keeping the body cool – overheating is known to worsen MS symptoms. The benefits of keeping cool were seen in a study of men with MS who used head and neck cooling during exercise (Dauksaite and colleagues. Mult Scler Relat Disord 2025:100:106525). Participants who used cooling aids showed greater muscle contractile force and reported that they felt they required less exertion to get the job done.

Walking: The lowest-cost exercise option is walking and two studies looked at the benefits of taking to the trail or treadmill. One study of people from a range of age groups (from 27 to 68 years) looked at a seven-week walking regimen outdoors (Hvid and colleagues. Ann Phys Rehabil Med 2025;68:101985). The walk group could plan their own hikes but were required to walk at least twice a week at a moderate-to-high intensity. The control group just continued their usual lifestyle. At the end of the seven weeks, the walk group were able to walk more quickly and reported significant improvements in their fatigue and mental well-being. No changes were seen in the non-walk group.

A separate study looked at treadmill training in people with moderate disability (Massot and colleagues. NeuroRehabilitation 2025;56:243-253). A treadmill may be the preferred way for people with difficulty walking because the walking surface is smooth and there are guard rails to steady you. After a six-week program, the treadmill group significantly increased the distance they could travel and said they felt they had less difficulty getting in their steps.

Pilates: Many people with MS report benefits with low-impact, full-body exercises such as Pilates. But if you are unable or unwilling to go to a class or there is no Pilates studio in your community, online sessions may be an option. One study compared people who participated in an online Pilates group with those on a wait list (Eldemir and colleagues. Mult Scler Relat Disord 2025:97:106393). The online group received Pilates training via videoconferencing for three days a week. After six weeks, the Pilates group showed significant improvements in their balance, stability and mobility compared to the waitlist group. Pilates exercises were also associated with gains in mental functioning across a range of cognitive tests.

Vitamin D: Many doctors recommend vitamin D supplementation as an add-on to MS medications. The usual dose is typically 1,000 IU per day. The D-Lay trial looked at very high doses (100,00 IU taken once every two weeks) to see if supplements could delay the development of MS in people with clinically isolated syndrome (CIS) (Thouvenot and colleagues. JAMA 2025;333:1413-1422). People with CIS have had one bout of symptoms suggestive of MS but do not yet meet the full criteria for a diagnosis of MS. People taking vitamin D supplements were less likely to have inflammatory disease activity, although it is important to note that a majority did have disease activity despite vitamin D. And some caution is advised. The doses given were extreme and could cause a number of side effects. Talk to your neurologist before starting a high-dose vitamin D regimen.

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