What type of exercise is best to counter MS fatigue? A new meta-analysis

[ActiveMSers]

EFFECT OF EXERCISE ON FATIGUE IN MULTIPLE SCLEROSIS: A NETWORK META-ANALYSIS COMPARING DIFFERENT TYPES OF EXERCISE

Author links open overlay panelAnaTorres-CostosoPhD^aVicenteMartínez-VizcaínoMD^bcSaraReina-GutiérrezMSc^bCeliaÁlvarez-BuenoPhD^bdeMaría JoséGuzmán-PavónMSc^aDiana PPozuelo-CarrascosaPhD^abRubénFernández-RodríguezMSc^bMairenaSanchez-LópezPhD^bfIvánCavero-RedondoPhD^bdg

https://doi.org/10.1016/j.apmr.2021.08.008

ABSTRACT

Objective
A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity.

Data sources
MEDLINE, EMBASE, SPORTDiscus, PEDro, Cochrane Library and Web of Science. The search strategy combined relevant terms related to: a) multiple sclerosis; b) clinical trials; c) exercise; and d) fatigue, from inception to February 2021.
Study selection
Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included.

Data extraction
The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0) and to evaluate the quality of the evidence, the Grading of Recommendations, Assessment, Development and Evaluation tool was used.

Data synthesis
A total of 58 studies were examined. Data were pooled using a random effects model. A ranking of seven and eight different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training versus control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% CI: -2.01, -1.01) and resistance training (-1.15; 95% CI -1.81, -0.49) compared to the control group achieved the highest effects for physical and total fatigue, respectively.

Conclusion
Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both, physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.

[ActiveMSers]

And another...

Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis

Show all authors
Anthony M Harrison*, Reza Safari*, Tom Mercer, ...
First Published April 20, 2021
https://doi.org/10.1177/1352458521996002

Abstract

Background:
Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment.

Objective:
The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions.

Methods:
Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE.

Results:
Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect.

Conclusion:
Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.

FULL ARTICLE (FREE): https://journals.sagepub.com/doi/ful...52458521996002