Table 2.

Different types of physical activity performed by multiple sclerosis (MS) patients with fatigue.

Study, Year, PEDro Score, Reference	Study Design	Type of Intervention	Outcome Measures	Main Findings
Hasanpour et al., 2016 PEDro: 5/10 [45]	Randomized, controlled trial; n = 90	Yoga, aerobics exercises: 12 weeks, 3 sessions per week, 40 min per session	Rotten fatigue test, SF-36	Fatigue decreased in yoga and exercise groups, but in the control group, the fatigue severity increased. Physical function, physical and emotional role, social function, energy, mental status and overall hygiene increased; pain and fatigue were relieved among patients.
Mokhtarzade et al., 2017 PEDro: 5/10 [46]	Randomized, controlled trial; n = 40	Aerobic exercise: 8 weeks, 3 days per week, upper and lower limb aerobic interval training program	FSS, MSQOL-54	Significant decrease in fatigue after the 8-week aerobic interval training (p < 0.05). A considerable change in MSQOL-54 (total) and physical and mental quality of life subsequent to the exercise training (p < 0.05).
Mostert S, et al., 2002 PEDro: 3/10 [47]	Clinical trial; n = 26	Aerobics exercise: 4 weeks, 5 sessions a week, 30 min per session, bicycle exercise with individualized intensity	FSS, SF-36	A significant rightward placement of the aerobic threshold (VO2 + 13%; work rate + 11%), an improvement of health perception (vitality + 46%; social interaction + 36%), an increase of activity level (+17%) and a tendency to lower fatigue in the MS training group. The level of excessive fatigue measured by FSS was 60–67% higher in MS groups in comparison to matched controls.
Devasahayam et al., 2020 PEDro: none [48]	Clinical trial; n = 10	Aerobic walking training in a room cooled to 16 °C using bodyweight-supported treadmill	FSS, MFIS, SF-36	Fatigue in MFIS significantly improved. The effect was sustained after 3 months.
Kargarfard et al., 2017 PEDro: 7/10 [49]	Randomized, controlled trial; n = 34	Aquatic exercise: 8 weeks, 3 sessions per week, sessions 45–60 min, water temperature: 28–30 °C	MFIS	Aquatic exercise training improved functional capacity, balance, and perceptions of fatigue in women with MS. All outcome measures improved in the experimental group: MFIS (pretest mean ± SD, 43.1 ± 14.6; post-test mean ± SD, 32.8 ± 5.9; p < 0.01).
Kooshiar et al., 2015 PEDro: 4/10 [50]	Randomized, controlled trial; n = 37	Aquatic therapy: 8 weeks, 3 sessions per week and 45 min per session, water temperature: 28–29.5 °C	FSS, MFIS, MQLIM	Significant effects of aquatic exercise on physical and psychosocial fatigue perception, QoL, and fatigue severity (p = 0.001). Non-significant effect for cognitive fatigue perception (p > 0.05).
Razazian, et al., 2016 PEDro: 6/10 [51]	Randomized, controlled trial; n = 54	Aquatic exercise: 8 weeks, 3 sessions per week and 1h per session, water temperature: 28–30 °C Yoga: 8 weeks, three times per week, about 60 min	FSS, Beck Depression Inventory, 10-point visual analogue scale for paresthesia	A significant decrease in the yoga and aquatic exercise groups compared with the non-exercise control condition and fatigue, depression, and paresthesia over time.
Garrett et al., 2013 PEDro: 6/10 [52]	Randomized, controlled trial	Physiotherapist (PT)-led exercise (n = 80), yoga (n = 77), fitness instructor (FI)-led exercise (n = 86)	MFIS, MSIS	Statistically significant improvement in the MSIS-29 psychological component and both the MFIS total and physical subscales, which were greater than the control (p < 0.05).
Tarakci et al., 2013 PEDro: 8/10 [56]	Randomized, controlled trial; n = 99	Group exercise led by physical therapist	FSS	Statistically significant improvements for all outcome measures in the exercise group (n = 51) (p < 0.01). In the control group (n = 48), there was a statistically significant increment only in the FSS score (p = 0.002).
Sangelaji et al., 2014 PEDro: 3/10 [57]	Randomized, controlled trial; n = 59	Combination exercises: 10 weeks, 3 sessions a week, 20–40 min per session, stretching and aerobic exercises, strengthening exercises with and balancing exercises.	FSS, 6-min Walk Test, EDSS quality of life tests	Significant changes in the intervention group in comparison to the control group in the second phase of the study compared to the first one for all tests except EDSS, p = 0.60 (EDSS mean values at the beginning: intervention group: 1.7; control group 1.96; at the end: intervention group: 2.2; control group: 2.74); FSS: −6.9, p = 0.02, Mental Quality of Life: 16.36, p = 0.001; Physical QOL: 12.17, p = 0.001, six minute walking: 137.2, p < 0.0001; Berg: 3.34, p < 0.0001.
McCullagh et al., 2008 PEDro: 4/10 [58]	Randomized, controlled trial; n = 30	Exercise: 3 months, 2 sessions per week, participants also exercised independently once a week.	MFIS, MSIS-29, FAMS	Exercise group had significantly greater improvements in exercise capacity and fatigue (MFIS: -13 in exercise group versus 1 in control group, p = 0.02). Improvements in QOL and fatigue lasting beyond the program.

Abbreviations: PEDro: Physiotherapy Evidence Database; FSS: Fatigue Severity Scale; MFIS: Modified Fatigue Impact Scale; MQLIM: Multicultural Quality of Life Index; QoL: quality of life; MSIS: Multiple Sclerosis Impact Scale; MSQOL-54: Multiple Sclerosis Quality of Life Questionnaire; SF-36: 36-Item Short Form Health Survey; MSIS-29: Multiple Sclerosis Impact Scale-29; FAMS: Functional Assessment of Multiple Sclerosis.