OBJECTIVE: To estimate, among people with multiple sclerosis, the extent to which a personally tailored exercise programme (MSTEP) resulted in greater improvements in exercise capacity and related outcomes over 12 months in comparison with general exercise guidelines. DESIGN: Two-group randomized trial. SUBJECTS: Ambulatory and sedentary. INTERVENTIONS: MSTEP, a personally adapted exercise regimen done on most days including two days of high intensity exercise; guidelines recommending 30 minutes of moderate intensity aerobic and strength training two times per week. MAIN MEASURES: Primary outcome was peak oxygen consumption (VO2peak) at 12 months; secondary outcomes were composite measures of physical function, fatigue, and health-related quality of life. RESULTS: In total, 137 people were randomized, 66 were lost over 12 months leaving 71 with outcome data, 34 in MSTEP group, and 37 in the Guideline group. Exercise enjoyment and confidence and exercise-induced fatigue predicted retention. There were no differences between groups on the proportion making a 10% increase in VO2peak (27.1% MSTEP versus 29.6% Guidelines; OR 0.83; 95% CI 0.23 to 3.08) by the 12 month assessment. The effect on fatigue was larger in the MSTEP group than the Guideline groups (OR 1.59; 95% CI 0.93 to 2.74), the effect on physical function was more modest (OR 1.35; 95% CI 0.80 to 2.25), and null for health-related quality of life outcomes. CONCLUSIONS: The disappointing exercise retention suggests that people with multiple sclerosis may not consider exercise important to their brain health. Either type of exercise resulted in stable exercise capacity over 1 year in those sticking with the programme.

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