Effects of exercise on fatigue and quality of life in multiple sclerosis: a network meta-analysis and systematic review.

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.