Table 3.
Level 1 evidence of the benefits of exercise in multiple sclerosis
| Study | Evidence level | Population | Outcomes studied | Relevant conclusions/statistical significance |
|---|---|---|---|---|
| Langeskov-Christensen et al. [109] | Review (234 studies) | Adult RRMS | Pathways of fatigue in MS | Exercise may improve fatigue by directly and indirectly impacting on its biological pathways |
| Sa [116] | Review (11 RCTs) | Adult RRMS | Effects of exercise in MS | Exercise may improve fatigue |
| Heine et al. [110] | Meta-analysis (45 RCT) | Adult RRMS | Effects on fatigue in MS | Exercise, particularly endurance, mixed, or ‘other’ training (e.g., yoga) may improve fatigue |
| Cruickshank et al. [111] | Meta-analysis (20 RCT and non-RCT) | Adult RRMS | Effects of strength-based exercise in Parkinson and MS in fatigue, QoL, and other domains | Strength training improves fatigue (8.2%), functional capacity (21.5%), and QoL (8.3%) among others |
| Latimer-Cheung et al. [112] | Meta-analysis (54 RCT and non-RCT) | Adult RRMS | Effects on physical fitness, mobility, fatigue, and QoL in MS | Evidence is inconsistent regarding the effects of exercise on fatigue and QoL |
| Andreasen et al. [113] | Review (23 RCT and non RCT) | Adult RRMS | Effect on fatigue in MS | Evidence is heterogeneous but with a positive tendency regarding the effects of exercise on fatigue |
| Motl et al. [114] | Meta-analysis (13 studies including RCT and non RCT) | Adult RRMS | Effects on QoL in MS | Exercise is associated with a small improvement in QOL |
| Kjolhede et al. [115] | Review (14 studies including RCT and non RCT) | Adult RRMS | Effects of progressive resistance training in MS | Evidence is heterogeneous but with a positive tendency regarding the effects of exercise on QoL and mood |
| Ensari et al. [117] | Meta-analysis (13 RCT) | Adult RRMS | Effects on depression | Exercise is associated with a small reduction in depressive symptoms |
| Morrison et al. [118] | Review (19 studies including RCT and non RCT) | Adult RRMS | Effects on cognition | Evidence is heterogeneous (9/19 studies reported positive effect; 10/19 reported mixed results) |
| Sandroff et al. [119] | Review (26 studies including RCT and non RCT) | Adult RRMS | Effects on cognition | Evidence is heterogeneous |
MS multiple sclerosis, QoL quality of life, RCT randomized controlled trial, RRMS relapsing-remitting MS