Effects Of Exercise Training On Fatigue In Multiple Sclerosis: A Meta-Analysis

Background: Fatigue is a common and disabling, but poorly managed symptom experienced by persons with multiple sclerosis (MS). Exercise training may be an effective behavioral strategy for reducing fatigue in MS.

Objectives: To provide a quantitative review of randomized controlled trials (RCT) examining the effect of exercise training on symptomatic fatigue in persons with MS.

Methods: Electronic databases (Web of Science, PubMed, PsycInfo, and Google Scholar) were searched for articles published between 1960 and October 2012 using the key words ‘fatigue’, OR ‘tiredness’, OR ‘energy’, OR ‘mood’, OR ‘lassitude’, AND ‘exercise’, OR ‘physical activity’, OR ‘rehabilitation’, OR ‘fitness’ WITH ‘multiple sclerosis’. The initial search resulted in 311 articles, of which 74 were reviewed in detail, and 17 met inclusion criteria and provided enough data to compute effect sizes (ES; Cohen’s d). The meta-analysis was conducted using Comprehensive Meta Analysis software (Version 2.0, Biostat, Englewood NJ). The overall ES was computed using a random effects model and was expressed as Hedge’s g.

Results: The 43 ESs from 17 RCTs with 568 MS participants yielded a weighted mean ES of 0.45 (SE = 0.12; 95% CI = 0.22, 0.68; z = 3.88; p = <.001). The weighted mean ES was slightly heterogeneous (Q = 29.9, df = 16, p = 0.02). Exploratory moderator analyses indicated that study location, disease duration, training supervision, and mode of exercise might be important variables for understanding the effects of exercise training on symptomatic fatigue.

Conclusions: The cumulative evidence supports that exercise training is associated with a significant moderate reduction in fatigue among persons with MS.