Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise.

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS), and researchers wanted to know whether exercise helps and which type works best. This network meta-analysis pooled 58 randomized controlled trials comparing different exercise interventions against control groups for both physical fatigue and total fatigue scores in people with MS. Combined exercise (mixing modalities such as aerobic and resistance work) showed the largest effect for physical fatigue, while resistance training showed the largest effect for total fatigue, both compared with control groups. The analysis ranked seven to eight different exercise types by effectiveness, with combined exercise and resistance training consistently showing the strongest pairwise effects.

The authors describe exercise overall as an effective fatigue management strategy, though the review does not report on risk of bias or heterogeneity in a way that lets us judge how consistent findings were across the 58 trials, which is worth keeping in mind when interpreting the strength of these rankings.

If you live with multiple sclerosis, fatigue is often one of the toughest symptoms to manage day to day. This study pulled together 58 separate clinical trials that tested different kinds of exercise against doing nothing (control groups), looking at how each affected both physical fatigue and overall fatigue. Across all these trials, combined exercise, meaning programs that mixed different types of training like aerobic and strength work, showed the biggest improvement in physical fatigue.

Resistance training, or exercises that build muscle strength, showed the biggest improvement in overall fatigue. Both were compared with people who did not exercise. The researchers describe exercise as an effective way to manage fatigue in MS based on this combined evidence.

That said, the abstract does not tell us how consistent the results were between all 58 studies or how much risk of bias existed in the individual trials, so it is hard to know just how solid these rankings are. No information on side effects or safety was reported in this summary.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This network meta-analysis (NMA) synthesized 58 randomized controlled trials examining exercise interventions for fatigue in multiple sclerosis, ranking seven exercise types for physical fatigue and eight for total fatigue against control groups. Combined exercise produced the largest pooled effect for physical fatigue, and resistance training produced the largest pooled effect for total fatigue, with confidence intervals reported for both.

Pairwise comparisons for combined exercise and resistance training also showed the strongest effects relative to control. The NMA structure allows indirect comparisons across a broader set of interventions than pairwise meta-analyses alone, which is a methodological strength. However, the abstract does not specify heterogeneity statistics, risk of bias ratings by intervention type, or how GRADE certainty ratings varied across comparisons, despite the authors noting they used RoB 2.0 and GRADE tools.

Without these details, it is difficult to judge how much confidence to place in the ranking order, particularly given the diversity of exercise protocols, MS severity levels, and outcome measures likely present across 58 trials. The findings support a general fatigue-reducing role for exercise in MS, but the relative superiority of combined exercise and resistance training over other modalities should be interpreted with attention to the underlying evidence quality, which is not fully detailed here.