Abstract
Objective
A network meta-analysis (NMA) of current evidence was conducted to determine if physical
exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise
with the largest effect on fatigue also according to disease severity.
Data Sources
MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and
Web of Science. The search strategy combined relevant terms related to (1) MS; (2)
clinical trials; (3) exercise; and (4) fatigue from inception to February 2021.
Study Selection
Randomized controlled trials concerning the effectiveness of different types of exercise
on total and physical fatigue in people with MS were included.
Data Extraction
The data were extracted into predesigned data extraction tables. Risk of bias was
evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations,
Assessment, Development, and Evaluation tool was used to evaluate the quality of the
evidence.
Data Synthesis
A total of 58 studies were examined. Data were pooled using a random-effects model.
A ranking of 7 and 8 different exercise interventions for physical and total fatigue
scores, respectively, was achieved. The highest effects for pairwise comparisons were
for combined exercise and resistance training vs control (ranging between −0.74 and
−1.24). In the NMA, combined exercise (−1.51; 95% confidence interval [CI], −2.01
to −1.01) and resistance training (−1.15; 95% CI, −1.81 to −0.49) compared with the
control group achieved the highest effects for physical and total fatigue, respectively.
Conclusions
Exercise should be considered an effective fatigue management strategy. Among the
different exercise modalities, combined exercise is the most effective exercise modality
for improving both physical and total fatigue. Resistance training is also an effective
exercise for total fatigue among people diagnosed with MS.
Keywords
List of abbreviations:
CI (confidence interval), ES (effect size), MS (multiple sclerosis), NMA (network meta-analysis), RCT (randomized controlled trial), SUCRA (surface under the cumulative ranking)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 09, 2021
Accepted:
August 11,
2021
Received in revised form:
July 28,
2021
Received:
June 16,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Supported by Consejería de Educación, Cultura y Deportes-JCCM and FEDER funds (grant no. SBPLY/17/180501/000533).
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
