Table 2.
Description of intervention subtypes based on total number of studies identified (N=135).
| Intervention subtype | Descriptor | N studies included |
|---|---|---|
| Exercise | ||
| Aerobic Both targeted and non-targeted interventions included |
Main fitness component in exercise in which the body’s large muscles move in a rhythmic manner for a sustained period of time. Aerobic activity, also called endurance activity, improves cardiorespiratory fitness. Examples include walking, running, cycling and swimming. | 25 |
| Resistive (also referred to as
resistance) Both targeted and non-targeted interventions included |
Main physical fitness component in exercise aiming at increasing skeletal muscle strength, power, endurance and mass (e.g. progressive resistance training (PRT) – fixed weights, PRT-free weights, resistance training and body-weight-resistance exercise). | 8 |
| Flexibility Non-targeted intervention |
Main fitness component in exercises aimed at increasing the range of motion possible at a joint. Flexibility is specific to each joint and depends on specific variables, including but not limited to the tightness of specific ligaments and tendons. | 1 |
| Balance Both targeted and non-targeted interventions included |
Main fitness component in static and dynamic exercises that are designed to improve individuals’ ability to withstand challenges from postural sway or destabilising stimuli caused by self-motion, the environment or other objects. | 9 |
| General exercise (aquatic and
land-based) Both targeted and non-targeted interventions included |
Exercise involving combination of two or more of the above components, no dominant fitness component focus provided. | 28 of which 6 aquatic |
| Combined exercise Both targeted and non-targeted interventions included |
Exercise explicitly aimed at more than one of the exercise components listed above, often using a progressive overload principle. | 24 |
| Behavioural | ||
| Energy conservation Only fatigue-targeted interventions included |
Energy effectiveness strategies or energy conservation (EC) education is defined as the ‘the identification and development of activity modifications to reduce fatigue through a systematic analysis of daily work, home and leisure activities in all relevant environments’ (p. 592).69 EC strategies include analysing and modifying activities to reduce energy expenditures; taking frequent rests; prioritising activities; planning; delegating some activities, using the body efficiently, organising tools, materials and work area, using assistive technologies to conserve energy; adopting good posture; leading a healthy lifestyle (regular exercise, healthy diet and stress management, examining and modifying standards and priorities). | 12 of which 3 incorporated elements of CBT |
| Cognitive behavioural therapy Both targeted and non-targeted interventions included |
CBT is founded on the premise that physiological, cognitive (thinking), emotional and behavioural responses influence one another in a reciprocal way within the context of the social environment, where change in any one of these responses may produce changes in others.70 CBT was originally developed to treat anxiety and depression. CBT has also been developed to treat fatigue specifically and MS-specific versions have been developed. CBT for fatigue is based on guided discovery where individuals identify which perpetuating factors may be relevant to them and are provided techniques to alter or manage these behavioural, cognitive, emotional and external factors.71 Protocols vary but tend to include creating consistent activity routines (including sleep wake cycles), graded increase of daily activity, identifying and managing unhelpful thoughts in relation to fatigue, and managing stress. | 14, of which 4 low intensity |
| Neurocognitive rehabilitation Only non-targeted interventions included |
Neurocognitive rehabilitation aims to reduce cognitive deficits, through learning and memory-based training to improve cognitive skills, like attention, or identification of alternative skills to compensate for cognitive deficits in daily living.72 | 7 |
| Relaxation and biofeedback Both targeted and non-targeted interventions included |
Relaxation techniques include ‘a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of increased well-being’.73 | 5 |
| Emotional expression therapy Only non-targeted interventions included |
The aim of emotional expression therapy is to facilitate and promote acceptance, expression, regulation and understanding of emotions.74 | 3 |
| Education or information Both targeted and non-targeted interventions included |
8, predominantly as active control plus 3 active controls re-categorised as education for inclusion in the analysis | |
| Combined (behavioural and exercise) | ||
| Behavioural plus exercise Both targeted and non-targeted interventions included |
Behavioural techniques to promote physical activity/exercise or behavioural interventions with integrated exercise (e.g. EC plus aerobic exercise). | 11 |
| Physical rehabilitation Both targeted and non-targeted interventions included |
Occupational therapy and physiotherapy. | 6 |
| Control | ||
| Treatment as usual | 82 | |
| Medication | 2, of which Nedeljkovic et al.,75 Methylprednisolone + TAU | |
Note. The number of studies for each intervention subtype captures studies where each intervention subtype was evaluated at least in one arm based on the total number of studies identified (N=135). In text, the number of studies and arms are reported for the top-level intervention groupings after exclusion of studies that did not provide sufficient data to be included in the analyses and combining/removing arms that were in the same intervention subcategory.