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Evidence summaries

Exercise Therapy for Multiple Sclerosis

Exercise therapy may be a beneficial symptomatic and supportive treatment for multiple sclerosis (MS) patients by improving muscle function and mobility. It may also be moderately effective in the treatment of fatigue in MS without increasing the risk of relapse. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 9 studies with a total of 260 subjects. Six trials compared exercise therapy versus no exercise therapy, 3 trials compared two exercise therapy interventions. There is strong evidence in favour of exercise therapy compared to no exercise therapy in terms of muscle power function, exercise tolerance functions and mobility-related activities. Moderate evidence was found for improving mood. No evidence was observed for exercise therapy on fatigue and perception of handicap when compared to no exercise therapy. No evidence was found that specific exercise therapy programmes were more successful in improving activities and participation than other exercise treatments. No evidence of deleterious effects of exercise therapy was described in included studies.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients and interventions).

Another Cochrane review [Abstract] 2 included 45 studies with a total of 2250 people with MS. Only two trials defined fatigue as an inclusion criterion and only 3 trials identified fatigue as a primary outcome. The exercise interventions were categorised as endurance training in 23 studies, muscle power training (n=9), task-oriented training (n=5), mixed training (n=15), or 'other' (e.g. yoga; n=17). Thirty-six trials (n=1603) provided sufficient data on the outcome of fatigue for meta-analysis. In general, exercise interventions were studied in mostly participants with the relapsing-remitting MS, and with an Expanded Disability Status Scale (EDSS) less than 6.0. Based on 26 trials (n=1304) that used a non-exercise control, there was a significant effect on fatigue in favour of exercise therapy (SMD -0.53, 95%CI -0.73 to -0.33). There was also a significant effect on fatigue in favour of exercise therapy compared to no exercise for endurance training (SMD -0.43, 95% CI -0.69 to -0.17; 11 studies, n=266), mixed training (SMD -0.73, 95% CI -1.23 to -0.23; 6 studies, n=495), and 'other' training (SMD -0.54, 95% CI -0.79 to -0.29; 9 studies, n=295). Given the number of relapses reported for the exercise condition (n = 25) and non-exercise control condition (n = 26), exercise does not seem to be associated with a significant risk of a relapse. However, in general, MS relapses were defined and reported poorly.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, interventions, controls and outcomes) and indirectness (differences in patients and outcomes)

References

  • Rietberg MB, Brooks D, Uitdehaag BM et al. Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev 2005;(1):CD003980. [PubMed]
  • Heine M, van de Port I, Rietberg MB et al. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 2015;9():CD009956. [PubMed]

Primary/Secondary Keywords