Physical Exercise Can Reduce Fatigue in Patients With MS, Review Finds

Physical exercise significantly reduces fatigue in patients with multiple sclerosis (MS), according to a study published in BMC Neurology.

Researches in Iran conducted a systematic review and meta-analysis of studies published between 1996 and 2019 on databases Embase, Cochrane, PubMed and Google Scholar. Keywords such as aerobic exercise, exercise training, physical activity, and multiple sclerosis were used as inclusion criteria. Thirty-one studies were included in the review, and there were 1434 participants (720 controls, 714 intervention groups). All of the studies were clinical trials; 15 were published in Persian while the rest were published in English.

According to the authors, previous studies found the most commonly reported symptom of MS is fatigue (75-90%), followed by weakness (30.8%), optic neuritis (20.1%), nerve damage (19.6%), and ataxia (14.3%). Complications such as muscle weakness and neurological problems contribute to fatigue; however the root cause of fatigue in patients with MS is unclear.

The National Multiple Sclerosis Society defines MS-specific fatigue (lassitude) as generally occuring on a daily basis. Lassitude does not appear to be directly correlated with depression or a patient's degree of physical impairment; however, it "tends to worsen as the day progresses, to be aggravated by heat and humidity, is generally more severe than normal fatigue, and is more likely to interfere with daily responsibilities."

The current researchers used standardized mean (SD) difference indices and relative risk to compare the studies. “Based on the results derived from the meta-analysis, the standardized mean difference between the intervention groups before and after the intervention were estimated to be 23.8 [6.2] and 16.9 [3.2], respectively,” the authors said.

Results of the meta-analysis illustrate that the severity of fatigue is higher preceding physical exercise intervention. The authors note this indicates the importance of fatigue level and duration, and its effect on patients’ well-being. “This decrease in physical activity will result in reduction of muscle mass and further decrease functions,” they said.

Patients with MS also recorded early benefits of regular exercise, including increased cardio-respiratory fitness, increased muscle strength and endurance, reduced body fatigue, improved morale, and increased ability to perform daily tasks with greater force.

“By doing exercise, the oxidation capacity of the muscles is increased; thereby, the aerobic biochemical system is stimulated to make the adaption and leads to [an increase in] the amount of oxygen intake in the body,” the researchers said.

Based on the findings, the researchers recommend a regular exercise program to mplement rehabilitation treatment, in addition to medication, for patients with MS.

Reference

Razazian N, Kazeminia M, Moayedi H, et al. The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol. 2020;20 (93). doi: 10.1186/s12883-020-01654-y.