Structured exercise may help ease fatigue in people with multiple sclerosis
Cardiorespiratory exercise had the most consistent evidence in umbrella review
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Structured exercise, particularly cardiorespiratory exercise, was associated with reduced self-reported fatigue in people with multiple sclerosis, an umbrella review found. (Photo from iStock)
- Fatigue is a common and disabling symptom of multiple sclerosis that can affect daily functioning and quality of life.
- Structured exercise, particularly cardiorespiratory and resistance training, is associated with reduced self-reported fatigue.
- Exercise prescriptions should be individualized and integrated into multidisciplinary care, with careful monitoring of patient response and tolerability.
People with multiple sclerosis (MS) who engage in structured exercise programs tend to report lower levels of fatigue, according to an umbrella review of systematic reviews and meta-analyses.
The strongest evidence was seen for cardiorespiratory exercise. Resistance training, which often involves weights and resistance bands, also was associated with a reduction in self-reported fatigue, although results varied more across studies.
The umbrella review, “Structured exercise training for fatigue management in multiple sclerosis: an umbrella review of systematic reviews and meta-analyses,” was published in the journal Archives of Physical Medicine and Rehabilitation.
Why MS fatigue can be so difficult to manage
Fatigue is one of the most common and disabling symptoms of MS. Its effects can extend beyond physical tiredness, affecting cognition, employment, social participation, and quality of life.
While pharmacological treatments for MS-related fatigue have generally produced modest or inconsistent benefits, exercise has emerged as a promising strategy to reduce fatigue severity.
In recent years, many literature reviews have offered insights into the effects of different exercise-based interventions. However, differences in exercise type and dose, participant characteristics, fatigue measures, and study quality have made it difficult to draw firm conclusions. Some reviews also included many of the same trials, raising questions about whether similar findings reflected independent evidence.
To address these limitations, researchers at institutions in Spain and Colombia conducted an umbrella review that classified exercise programs using a standardized framework proposed by the American College of Sports Medicine. Under this framework, exercises were classified according to their primary type: cardiorespiratory or aerobic, resistance, flexibility, and neuromotor or mind-body exercises, such as yoga, Pilates, or Tai Chi.
The team aimed to compare the effects of different exercise categories on fatigue and examine key details of the exercise programs, including frequency, intensity, session duration, program length, and progression.
The final analysis included 35 reviews: five systematic reviews, which summarized earlier studies, and 30 meta-analyses, which combined results from multiple studies to estimate the overall effects of exercise.
Aerobic or cardiorespiratory training and resistance exercise, alone or combined, were the most common approaches. Others included high-intensity interval training, balance and motor-control exercises, mind-body practices such as yoga, Pilates, and Tai Chi, as well as mindfulness, aquatic exercise, whole-body vibration, inspiratory muscle training, dance, climbing, virtual reality, and exercise-based gaming.
Exercise programs most commonly lasted four to 24 weeks, with 30- to 60-minute sessions performed two to five times per week. Across the fatigue measures examined, structured exercise was associated with small to moderate reductions in self-reported fatigue.
Cardiorespiratory exercise had the strongest evidence
Cardiorespiratory exercise had the most robust evidence. Across 11 pooled estimates with a combined sample size of 4,460, it was associated with a small but statistically significant reduction in self-reported fatigue.
Resistance training also was associated with improvement. Across 11 pooled estimates with a combined sample size of 2,254, it was associated with a moderate, statistically significant reduction in self-reported fatigue. However, resistance-training results varied substantially, and the predicted range of effects included the possibility of no benefit in some settings.
Aquatic exercise, high-intensity interval training, mindfulness, yoga, balance training, and technology-assisted approaches such as virtual reality and exercise-based gaming were associated with reduced fatigue in some analyses. However, these findings were based on a small number of estimates, showed substantial variation across studies, or came from reviews with methodological limitations.
The findings suggest that structured exercise is associated with small to moderate reductions in self-reported MS fatigue, with cardiorespiratory exercise and resistance training showing the strongest evidence.
However, since the evidence does not establish one best exercise type or dose, “exercise prescriptions should remain individualised and integrated within multidisciplinary care, with careful monitoring of patient response and tolerability,” the researchers concluded.
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