Effect of Exercise Interventions On Perceived Fatigue in People With Multiple Sclerosis: Synthesis of meta-analytic Reviews

Abstract

Although exercise training has been advocated as a nonpharmacological treatment for multiple sclerosis (MS) related fatigue, no consensus exists regarding its effectiveness. To address this, we collated meta-analytic reviews that explored the effectiveness of exercise training for the treatment of MS-related fatigue. We searched five online databases for relevant reviews, published since 2005, and identified 172 records. Five reviews were retained for systematic extraction of information and evidence quality analysis. Although our review synthesis indicated that exercise training interventions have a moderate effect on fatigue reduction in people with MS, no clear insight was obtained regarding the relative effectiveness of specific types or modes of exercise intervention. Moreover, Grading of Recommendation Assessment, Development and Evaluation revealed that the overall quality of evidence emanating from these five reviews was 'very low'. The symptoms of MS include emotional lability, incontinence, pain, cognitive problems, oscillopsia, spasticity, mobility problems and fatigue. Fatigue, the most common symptom, has been reported as the most troubling symptom by more than 50% of people with MS (pwMS) [2,3]. The etiology of Practice points• Information reviewed is largely obtained from studies of 30-50-year-old participants of moderate disability with nonprogressive multiple sclerosis (MS).• Exercise interventions appear to elicit a moderately favorable effect on fatigue in people with MS when compared with usual care or a no-exercise comparison group.• Mixed training and other types of exercise such as balance and yoga appear to show larger effects than other types of exercise.• There is still a lack of convincing information regarding which type of exercise intervention/s and with what specific combination of exercise duration, frequency and intensity might be most effective in reducing MS-related fatigue.• The results should be interpreted with caution because of high risk of bias, poor applicability of results, heterogeneity and small sample size in the randomized control trials on which this review of review evidence is ultimately based.

An Overview of Physical Exercise Program Protocols and Effects on the Physical Function in Multiple Sclerosis: An Umbrella Review

“…The main finding of the study was the heterogeneity that still exists in the participants' characteristics and the protocols adopted in the studies that wanted to associate physical activity intervention and MS. Our findings are in line with another review of reviews [52], which highlighted the heterogeneity in the results with different types/modes of exercise interventions, comparison groups, and/or study populations. Even though several years had passed between the two works, as the other review of reviews was written in 2017 [52], it was also for us difficult to provide information about which specific combination of exercise duration, frequency, and intensities can be suggested. Despite the heterogeneity of the studies, one kind of activity adopted in most of the interventions was mindfulness activities such as yoga and Pilates, which seem safe and feasible, making them ideal as basic interventions.…”

Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis

“…Standard pairwise meta-analytic systematic reviews of exercise and/or behavioural interventions have attempted to summarise the findings across studies. 9 – 17 However, control conditions of included trials within these reviews differ considerably, making it challenging to directly compare effect sizes across intervention types. In contrast to pairwise meta-analysis which has been used in all previous reviews, network meta-analysis (NMA) allows for trial arm data to be compared across trials (e.g.…”

Efficacy of high‐intensity aerobic exercise on common multiple sclerosis symptoms

“…However, existing studies hold limitations that could compromise the completeness, applicability, and reliability of previous results on the effects of aerobic exercise on MS fatigue. Among these limitations are: large heterogeneity regarding the applied fatigue scales, lack of statistical power, inappropriate designs to detect effects of exercise on fatigue, and limited reporting on patient characteristics, adverse events, and intervention characteristics 14,15 . Specifically, the vast majority of previous aerobic exercise studies have applied low to moderate intensity interventions 12 despite the fact that high‐intensity aerobic exercise leads to greater cardioprotective benefits and may be superior in ameliorating secondary MS fatigue through a higher increase in fitness and motor efficiency 4,16 .…”

“…Among these limitations are: large heterogeneity regarding the applied fatigue scales, lack of statistical power, inappropriate designs to detect effects of exercise on fatigue, and limited reporting on patient characteristics, adverse events, and intervention characteristics. 14,15 Specifically, the vast majority of previous aerobic exercise studies have applied low to moderate intensity interventions 12 despite the fact that high-intensity aerobic exercise leads to greater cardioprotective benefits and may be superior in ameliorating secondary MS fatigue through a higher increase in fitness and motor efficiency. 4,16 Furthermore, interventions have generally been short lasting ≤12 weeks (and most often without follow-up), which is likely insufficient to induce potential cardiovascular, immunologic, neuroendocrine, and neurotrophic changes that may be required to improve primary MS fatigue.…”