Once thought to exacerbate symptoms of MS, physical activity is now well established to be beneficial for people with MS. Exercise and physical activity improve spasticity, strength, fatigue, mood, cognitive function, and bladder function. In this issue, Albatineh and colleagues identify physical activity as a contributor to a less severe clinical course and reduced Multiple Sclerosis Severity Score in a Kuwaiti population. In their article, they characterize the impact of lifestyle and environmental factors in an area with an increasing prevalence of MS.

Counseling on the importance of exercise and encouraging more movement are on my agenda for every patient encounter. This often leads to questions and discussion about how to get started, barriers to adherence, and what types of exercises are best. In this issue’s CME/CNE article, Zhang and colleagues describe the differences in health promotion and quality of life by MS clinical course. Increasing mobility impairment is a barrier to physical activity, and this contributes to lower health promotion in people with progressive MS. Also in this issue, Donkers and colleagues explore benefits of and adherence to a Web-based home physical activity program for moderately-to-severely disabled persons with MS in Canada. Wheelchair users had the highest adherence with this physiotherapist-guided program. Clearly more work is needed to individualize a physical activity prescription based on patient preferences, mobility level, and access to resources.

Assessing mobility level in the clinic remains challenging. Completing a formal test of maximum walking distance is impractical, and estimates based on patient report are unreliable. Alshamrani and colleagues demonstrate that the more convenient Timed 25-Foot Walk test may be predictive of maximum walking distance for persons with moderate disability.

Awareness of the importance of psychosocial well-being for overall health has increased during the current coronavirus pandemic. Avoiding social isolation during this time is increasingly difficult for some people with MS. Marrow and colleagues describe the profound impact of adult day programs on the psychosocial health of persons with MS severe enough to interfere with employment and activities of daily living. Social support not only improved emotional well-being but also provided a community for people with MS to gain greater understanding of the disease. Pust and colleagues show that social support also contributes to adherence to disease-modifying therapy, although the specific motivational factors differ for persons on first-line and second-line therapies. Illness beliefs and psychosocial well-being must be considered whether discussing disease-modifying therapy, exercise, diet, or emotional health.

Finally, we are happy to share the work of an international panel convened by the Consortium of Multiple Sclerosis Centers to update and implement a standardized magnetic resonance imaging protocol in MS (see the article by Saslow and colleagues). We hope that you will review and consider the advocacy and dissemination strategies to raise awareness of the importance of the updated protocol.