Review article (meta-analysis)
Effects of Exercise Training on Fitness, Mobility, Fatigue, and Health-Related Quality of Life Among Adults With Multiple Sclerosis: A Systematic Review to Inform Guideline Development

Presented as a poster The Consortium of Multiple Sclerosis Centres, Americas Committee for Treatment and Research in Multiple Sclerosis, International Organization of Multiple Sclerosis Nurses, May 30 to June 2, 2012, San Diego, CA.
https://doi.org/10.1016/j.apmr.2013.04.020Get rights and content

Abstract

Objective

To conduct a systematic review of evidence surrounding the effects of exercise training on physical fitness, mobility, fatigue, and health-related quality of life in adults with multiple sclerosis (MS).

Data Sources

The databases included EMBASE, 1980 to 2011 (wk 12); Ovid MEDLINE and Ovid OLDMEDLINE, 1947 to March (wk 3) 2011; PsycINFO, 1967 to March (wk 4) 2011; CINAHL all-inclusive; SPORTDiscus all-inclusive; Cochrane Library all-inclusive; and Physiotherapy Evidence Database all-inclusive.

Study Selection

The review was limited to English-language studies (published before December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, and/or health-related quality of life.

Data Extraction

One research assistant extracted data and rated study quality. A second research assistant verified the extraction and quality assessment.

Data Synthesis

From the 4362 studies identified, 54 studies were included in the review. The extracted data were analyzed using a descriptive approach. There was strong evidence that exercise performed 2 times per week at a moderate intensity increases aerobic capacity and muscular strength. The evidence was not consistent regarding the effects of exercise training on other outcomes.

Conclusions

Among those with mild to moderate disability from MS, there is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength. Exercise may improve mobility, fatigue, and health-related quality of life.

Section snippets

Scope of the review/study inclusion criteria

The review focused on English-language studies examining the fitness, mobility, fatigue, or HRQOL benefits of exercise training in persons with diagnosed MS. We ascribed to the following definition of exercise by Bouchard et al: “a form of leisure-time physical activity that is usually performed repeatedly over an extended period of time with a specific external objective such as the improvement of fitness, physical performance, or health.”19(p12) Other outcomes including balance, body

Results

Figure 1 shows the flow of articles through the search and screening process. In total, the electronic search yielded 4362 titles. The hand search yielded 3 additional citations. After removing duplicate citations, 2552 citations remained. In total, 2498 articles did not meet inclusion criteria and were excluded after review, leaving 54 articles for review in the final evidence base. The reasons for exclusion are included in figure 1.

The extracted data for trials included in the review are

Discussion

The purpose of this review was to examine the evidence regarding exercise training for improving fitness, mobility, fatigue, and HRQOL outcomes as a basis for developing evidence-informed physical activity guidelines for adults with MS. Approximately half of the studies identified were RCTs of good quality (ie, level 1); the remaining trials were of low quality (ie, level 4). There was consistent and strong evidence that aerobic and resistance exercise performed 2 times per week at a moderate

Conclusions

Moderate-intensity exercise performed 2 times per week is effective for increasing aerobic and muscular fitness among adults with mild to moderate disability resulting from MS. Exercise training may be effective in improving mobility and symptoms of fatigue. There is currently insufficient evidence to conclude that exercise training can improve HRQOL in this population. The conclusions from this systematic review and the accompanying prescriptive exercise information provide the necessary

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    Supported by the Canadian Institutes of Health Research (CIHR) #234747, an Ontario Neurotrauma Foundation Mentor-Trainee Award, and the CIHR Canada Research Chair program.

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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