{"title":"Effects of exercise on fatigue and quality of life in multiple sclerosis: a network meta-analysis and systematic review.","authors":"Jiangxi Yang, Huangyan Li, Yeting Zhang, Shiliang Hu, Zuoyin Yu","doi":"10.1007/s00415-025-13368-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effects of various physical therapy interventions on fatigue and quality of life in patients with multiple sclerosis (MS) using a network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, and Cochrane databases through April 1, 2025. Eligible RCTs compared different exercise interventions in MS patients, focusing on fatigue and quality of life outcomes. Methodological quality was assessed using the Cochrane Risk of Bias tool. Standardized mean difference (SMD) was used as the effect size, and surface under the cumulative ranking curve (SUCRA) was applied to rank interventions. Subgroup and heterogeneity analyses were also performed.</p><p><strong>Results: </strong>This network meta-analysis included 31 randomized controlled trials involving 1,232 patients with multiple sclerosis. Exercise interventions were overall superior to conventional treatment in alleviating fatigue, with resistance training showing the most significant effect (SMD = - 0.91, p = 0.023). Subgroup analyses indicated that resistance training significantly reduced fatigue in both relapsing-remitting MS and female patients. Interventions lasting more than eight weeks, particularly resistance training and hippotherapy, demonstrated greater benefits. No overall improvement in quality of life was observed; however, female patients experienced significant improvement following resistance training.</p><p><strong>Conclusions: </strong>Resistance training appears to be the most effective intervention for improving fatigue and quality of life in MS patients, especially in women and during long-term programs. Hippotherapy and coordination training also show promise but require further high-quality trials for validation.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"621"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00415-025-13368-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: This study aimed to evaluate the effects of various physical therapy interventions on fatigue and quality of life in patients with multiple sclerosis (MS) using a network meta-analysis of randomized controlled trials (RCTs).
Methods: A comprehensive literature search was conducted in PubMed, Web of Science, and Cochrane databases through April 1, 2025. Eligible RCTs compared different exercise interventions in MS patients, focusing on fatigue and quality of life outcomes. Methodological quality was assessed using the Cochrane Risk of Bias tool. Standardized mean difference (SMD) was used as the effect size, and surface under the cumulative ranking curve (SUCRA) was applied to rank interventions. Subgroup and heterogeneity analyses were also performed.
Results: This network meta-analysis included 31 randomized controlled trials involving 1,232 patients with multiple sclerosis. Exercise interventions were overall superior to conventional treatment in alleviating fatigue, with resistance training showing the most significant effect (SMD = - 0.91, p = 0.023). Subgroup analyses indicated that resistance training significantly reduced fatigue in both relapsing-remitting MS and female patients. Interventions lasting more than eight weeks, particularly resistance training and hippotherapy, demonstrated greater benefits. No overall improvement in quality of life was observed; however, female patients experienced significant improvement following resistance training.
Conclusions: Resistance training appears to be the most effective intervention for improving fatigue and quality of life in MS patients, especially in women and during long-term programs. Hippotherapy and coordination training also show promise but require further high-quality trials for validation.
目的：本研究旨在通过随机对照试验（rct）的网络荟萃分析，评估各种物理治疗干预对多发性硬化症（MS）患者疲劳和生活质量的影响。方法：到2025年4月1日，在PubMed、Web of Science和Cochrane数据库中进行全面的文献检索。符合条件的随机对照试验比较了MS患者的不同运动干预措施，重点关注疲劳和生活质量结果。采用Cochrane偏倚风险工具评估方法学质量。采用标准化平均差（SMD）作为效应量，采用累积排序曲线下曲面（SUCRA）对干预进行排序。还进行了亚组分析和异质性分析。结果：该网络荟萃分析包括31项随机对照试验，涉及1232例多发性硬化症患者。运动干预在缓解疲劳方面总体优于常规治疗，其中阻力训练效果最显著（SMD = - 0.91, p = 0.023）。亚组分析表明，阻力训练显著减少了复发缓解型MS患者和女性患者的疲劳。持续超过八周的干预，特别是阻力训练和海马疗法，显示出更大的益处。没有观察到总体生活质量的改善；然而，女性患者在阻力训练后表现出明显的改善。结论：抗阻训练似乎是改善MS患者疲劳和生活质量最有效的干预措施，特别是在女性和长期项目中。海马疗法和协调训练也显示出希望，但需要进一步的高质量试验来验证。
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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