In patients with multiple sclerosis (MS), exercise training has been shown to improve overall health-related quality of life (HRQOL), with greater improvements observed in the physical domain than in the mental domain. These are the findings of a systematic review and meta-analysis published in the journal Multiple Sclerosis and Related Disorders.

Based on the extent and location of the central nervous system (CNS) damage, some of the challenges encountered by patients with MS include difficulty walking, cognitive dysfunction, fatigue, and depression. Thus, among individuals with MS, a negative cumulative effect on HRQOL, which comprises the physical (severity of impairment) and mental (underlying psychological function and emotion states) domains.

For the study, researchers looked at randomized controlled trials (RCTs) designed to establish the effects of resistance, aerobic, and combined exercise training on HRQOL among patients with MS.

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They sought to evaluate the overall impact of exercise interventions on HRQOL in patients with MS, the overall strength of evidence of exercise interventions on the physical and mental domains of HRQOL, and establish moderators of exercise interventions (ie, outcome evaluation, intervention characteristics, participant features) on the physical and mental domains of HRQOL.

The researchers searched 7 electronic databases from inception through August 2022. For inclusion criteria, HQROL instruments needed to report on the following physical and/or mental domains of the HRQOL:

  • Multiple Sclerosis Quality of Life-54 (MSQOL-54)
  • 36-Item Short Form Health Survey (SF-36)
  • World Health Organization QOL-BREF (WHOQOL-BREF)
  • Multiple Sclerosis Impact Scale (MSIS-29)
  • Multicultural Quality of Life Index (MQLIM)
  • Sickness Impact Profile (SIP)

The researchers found that 12 RCTs fulfilled inclusion criteria and generated 23 effect sizes (ESs) to be evaluated.  The studies included in the analysis involved a total of 593 participants with MS — 308 in the intervention group and 285 in the control group. Overall, 80% of the participants were women. The mean patient age was 42.4±6.5 years.

The pooled estimate generated a medium effect of exercise training for improving overall HRQOL (ES=64; 95% CI, 0.30-0.98; P = .0001), with high heterogeneity
(P <.001).

Exercise training was associated with a significantly large effect on the physical domain (P <.0009) and a medium effect on the mental domain (P <.0001). According to moderator analyses, the following were considered as significant influences of ES for HRQOL:

  • modality of exercise,
  • level of supervision,
  • delivery and length of the intervention,
  • HRQOL tool evaluated, and
  • The number of participants with relapsing-remitting MS.

Additionally, the percentages of I2 for total, sampling error, within-cluster, and between-cluster variance were 79%, 21%, 39%, and 40%, respectively.

Study limitations of the meta-analysis are attributable to publication bias and language restrictions. Only peer-reviewed RCTs translated into English were considered, which may have created an overestimation of the effect size. In fact, non-English studies and unpublished study results may influence the calculated ESs. Further, the researchers were unable to capture the impact of exercise intensity — a key feature of prescribed exercise programs — as a possible moderator.

“The moderator analysis suggests that supervised, aerobic, and group-delivered exercise training of ≥3 months yields the most influence on HRQOL,” the researchers noted. “Such results may have major implications for MS treatment and care,” they concluded.


Flores VA, Šilić P, DuBose NG, Zheng P, Jeng B, Motl RW. Effects of aerobic, resistance, and combined exercise training on health-related quality of life in multiple sclerosis: systematic review and meta-analysisMult Scler Relat Disord. Published May 1, 2023. doi:10.1016/j.msard.2023.104746

This article originally appeared on Neurology Advisor