Meeting Physical Activity Guidelines for Persons with Multiple Sclerosis Clinically Reduces Fatigue Severity and Impact

Objective(s): To summarize the effect of adhering to the physical activity guidelines for persons with multiple sclerosis (PwMS) on fatigue.

Data Sources: This systematic review was conducted according to the Cochrane handbook. A database search of peer-reviewed articles published in English was conducted through PubMed, EMBASE, Web of Science, SPORTDiscuss, Scopus, and PsycINFO in August 2023. The search strategy included a combination of the terms: physical activity, exercise, multiple sclerosis, and fatigue.

Study Selection: Only randomized clinical trials (RCTs) that examined the effects of physical activity and met weekly physical activity guidelines (≥150 min/week of total physical activity or 2 moderate-intensity aerobic sessions + 2 resistance sessions per week) for PwMS were included in this review.

Data Extraction: Two independent reviewers screened potential articles to determine their eligibility for inclusion. Eligible studies were summarized for participant characteristics, type of interventions, fatigue outcome measures, and findings. A meta-analysis was conducted to obtain the effect sizes of physical activity on fatigue outcome measures. Effect sizes were compared to the minimal important difference of the fatigue outcome measures. Methodological quality assessment of all studies was performed by two independent reviewers using the Cochrane risk-of-bias tool 2 for randomized trials.

Data Synthesis: A total of 27 RCTs were included in this review and 18 were included in the meta-analysis. Participants’ age varied from 28.31 ± 5.89 to 52.60 ± 12.60 years and the Expanded Disability Status Scale varied from 1.58 to 6. Meta-analysis included a total of 330 participants. Findings indicated that meeting physical activity guidelines for at least 8 weeks significantly reduced fatigue severity measured with Fatigue Severity Scale (MD = -4.32, 95% CI -6.05 to -2.59) and fatigue impact measured with modified Fatigue Impact Scale (MD = -11.88, 95% CI -20.57 to -3.19) and with Fatigue Impact Scale (MD = -21.08, 95% CI -31.01 to -11.15). The pooled effect sizes were all greater than the established minimal important difference of the fatigue outcome measures. Some methodological bias were noted among the included studies.

Conclusions: Fatigue is a highly prevalent symptom associated with poor outcomes including falls, activity restrictions, pain, cognitive problems, functional limitations, and mortality risk among PwMS. Engaging in a minimum of 150 min/week of physical activity or 2 sessions of moderate-intensity aerobic + 2 sessions of resistance training per week for at least 8 weeks results in a clinically significant reductions in fatigue severity and impact in PwMS.

Author(s) Disclosures: None to disclose.