Structured exercise training for fatigue management in multiple sclerosis: an umbrella review of systematic reviews and meta-analyses

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Abstract

OBJECTIVE: To synthesise evidence from systematic reviews and meta-analyses of randomised controlled trials on structured exercise training for fatigue in people with multiple sclerosis (MS), and to compare effects across exercise modalities and fatigue instruments. DATA SOURCES: Web of Science, Cochrane Library, EBSCO, PubMed/MEDLINE, and Scopus were searched from inception to May 5, 2025. STUDY SELECTION: Systematic reviews, with or without meta-analysis, were eligible if they examined structured, multi-session exercise training interventions for fatigue among people with MS and included control conditions. DATA EXTRACTION: Two reviewers independently performed the study selection and data extraction. The extracted data included review and participant characteristics, exercise modality, fatigue instrument, effect estimates, methodological quality, and FITT-VP descriptors. Standardised effects were expressed as Hedges' g using a random-effects umbrella meta-analytic framework. Heterogeneity, prediction intervals, and small-study effects were assessed when feasible. Evidence robustness was graded using the Ioannidis credibility classification. DATA SYNTHESIS: Thirty-five reviews/meta-analyses were included (5 systematic reviews and 30 meta-analyses). Across fatigue instruments, structured exercise training was associated with small-to-moderate reductions in self-reported fatigue (g range, -0.56 to -0.39). Cardiorespiratory exercise showed the most consistent evidence (Class I; g = -0.376; moderate heterogeneity). Resistance training showed a moderate pooled effect (Class II; g = -0.505; substantial heterogeneity). Other modalities were supported by limited and/or inconsistent evidence, predominantly Class IV. Review-level reporting of key FITT-VP elements was incomplete, and overlap analyses indicated moderate-to-very high redundancy within several modality clusters. CONCLUSIONS: Structured exercise training is associated with reductions in self-reported fatigue in MS. Cardiorespiratory exercise provides the most consistent review-level evidence, whereas resistance training shows a moderate pooled effect but greater heterogeneity. Aquatic, mind-body, neuromotor, and technology-mediated interventions are supported by limited or low-certainty evidence and should be considered complementary or hypothesis-generating. Substantial heterogeneity, incomplete exercise-dose reporting, and high overlap across reviews constrain definitive modality-specific prescriptions.

Abstract as published, via PubMed.