Exercise is an effective therapeutic strategy for fatigue in patients with multiple sclerosis (MS), and combined exercise is the most effective modality for both physical and total fatigue, according to a review study published in the Archives of Physical Medicine and Rehabilitation.
In people with MS, fatigue is one of the most common and debilitating symptoms, affecting up to 80% of this population. The cause of fatigue is complex and can be difficult to manage, especially when looking for interventions that can be effective in reducing fatigue in people with MS. However, regular exercise has been suggested as a non-pharmacological measure that is beneficial to MS-related fatigue.
The aim of the current study was to assess whether exercise had a positive effect on reducing overall and physical fatigue in patients with MS, to determine which exercise had the greatest impact, and which type of exercise had the greatest impact to predict the exhaustion based on the disease severity.
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Researchers performed a network meta-analysis (NMA) by searching MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science for terms relevant to MS, clinical trials, exercise, and fatigue through February 2021.
A total of 58 randomized controlled trials (RCTs) with 2644 participants were included in the analysis. The exercise interventions included were aerobics, resistance, aerobics with resistance, balance, combined training, body weight support, mind-body exercises (yoga or Pilates), and a control group.
The Grading of Recommendations, Assessment, Development and Evaluation was used to assess the quality of the evidence. The surface under the cumulative ranking (SUCRA) was estimated for each intervention and the main summary measure was the standardized difference in means.
The researchers found that all estimates supported exercise as being effective for total and physical fatigue. Combined exercise and strength training had the highest effect size (ES) for pairwise comparisons with control participants (range –0.74 and –1.24). The NMA showed that combined training (-1.51; 95% CI, -2.01 to -1.01) and strength training (-1.15; 95% CI, -1.81 to -0.49) did the had the highest effects on physical or total fatigue in comparison with the control group.
In terms of physical exhaustion, combined exercise (86.3%) and bodyweight support (85.4%) had the highest SUCRA. At total exhaustion, strength training (83.9%) and combined training (77.9%) had the highest SUCRA.
Analyzes according to the severity of the disease were only carried out for the mild and intermediate levels. With regard to physical exhaustion with mild disease severity, the highest statistically significant ES was -1.05 (95% CI, -1.42 to -0.67) for combined training compared to the control group. For total fatigue with a slight severity, combined training vs. control group had an ES of -0.50 (95% CI, -0.80 to -0.20) and mind-body vs. control group had an ES of -0.80 ( 95% CI, -1.36 to -0.23). With regard to overall fatigue at moderate severity, strength training and combined training had an ES of -0.52 (95% CI, -1.02 to -0.02) and -0.58 (95% -), respectively, compared to the control group. KI, -0.89 to -0.28).
Under several limitations of the study, the researchers were unable to account for the intensity of exercise due to a lack of data for most exercise modalities. In addition, the study does not make any recommendation on the appropriateness of the individual types of training depending on the duration of the illness, as newer innovative therapies such as gene therapy could have influenced the progression of the disease. In addition, grouping of interventions was necessary due to the limited number of studies in some exercise categories.
“Our results are based on evidence based on RCTs and represent the most comprehensive research effort to synthesize the best evidence available for the type of exercise that is most effective at improving fatigue in this population,” the researchers concluded.
reference
Torres-Costoso A, Martínez-Vizcaino V, Reina-Gutiérrez S, et al. Effect of exercise on fatigue in multiple sclerosis: a network meta-analysis comparing different sports. Arch Phys Med Rehabil. Published online 10 September 2021. doi: 10.1016 / j.apmr.2021.08.008
