Exercise effectively reduces fatigue and improves muscular fitness in people with multiple sclerosis (MS), though the optimal exercise type and dose differ for each outcome, according to a meta-analysis of published studies involving more than 3,500 patients.

Mind-body exercise, which combines physical movement, mental focus, and controlled breathing, was the best exercise mode to reduce fatigue, the analysis found. In contrast, high-intensity interval training, known as HIIT, featuring intense bursts of exercise followed by a brief recovery period, was best for muscular fitness.

“Among nonpharmacologic management, exercise can be a beneficial rehabilitation approach for MS, particularly [for] reducing fatigue and addressing mobility problems,” the researchers wrote.

According to the team, the optimal amount of exercise needed to reduce fatigue was 650 MET-minutes per week — a measure of the amount of physical activity in an exercise regimen. That corresponds, for example, to 165 minutes, or slightly more than 2.5 hours, of yoga per week. For improving muscular fitness, the most effective dose was 530 MET-minutes per week, which corresponds to 75 minutes, or slightly longer than one hour, of HIIT.

The study, “Comparison of different exercise modalities on fatigue and muscular fitness in patients with multiple sclerosis: a systematic review with network, and dose-response meta-analyses,” was published in the journal Frontiers in Neurology.

Mind-body exercise best for reducing fatigue in MS, analysis finds

In MS, the immune-mediated damage to the brain and spinal cord often leads to problems with gait (walking) and balance, as well as muscle spasms. Such symptoms can contribute to fatigue, which is marked by feelings of exhaustion when performing daily activities.

A physical exercise regimen is often recommended for MS patients. It can help prevent or delay functional declines, ease symptoms, and improve overall physical fitness and quality of life.

Various exercises have been proposed for MS patients, including resistance training, aerobic exercise, HIIT, and mind-body exercise. Resistance training, or strength training, such as weightlifting, is designed to increase muscle strength and improve endurance, while aerobic exercise increases heart rate and the amount of oxygen the body uses.

Now, a team led by researchers at Chengdu Sport University in China conducted a pooled analysis of published studies investigating the impact of different types and amounts of exercise on fatigue and muscular fitness in MS patients.

“There is a need to further conduct systematic research on exercise modality and dose for MS patients to determine the minimum effective dose, the optimal dose, and the maximum safe threshold of different exercise modalities,” the researchers wrote.

Following a database search, the team selected 84 randomized controlled trials for their analyses. These studies included 3,786 participants, with a mean age of 42.5, and an average disease duration of 8.4 years. Exercise frequency varied widely, ranging from one to 14 weekly sessions, and each session typically lasted about 51 minutes.

Compared with control groups, the exercise intervention that was most effective in significantly reducing fatigue was mind-body exercise, which includes modalities such as yoga and pilates, followed by resistance training, a combination of aerobic and resistance exercises, and then aerobic exercise. HIIT was the sole exercise that didn’t significantly reduce fatigue levels in patients versus the controls, the data showed.

Regarding muscular fitness improvements, HIIT was the most effective exercise, followed by a combination of aerobic and resistance exercises, mind-body exercise, and resistance training. Here, aerobic exercise was the sole intervention that did not improve muscular fitness in patients relative to the controls.

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More research needed to determine optimal amount of exercise

The team then used a measure called MET minutes per week to calculate the amount of energy used during exercise for each patient. One MET is essentially the amount of energy spent at rest, or when a person is sitting quietly. In comparison, a person doing yoga is estimated to use four METs per minute, while HIIT involves seven METs per minute.

Overall, the analysis showed a nonlinear dose-response relationship between total exercise in MET-minuts per week, fatigue levels, and muscular fitness.

In particular, fatigue significantly dropped after 240 METs-min/week to about 600 METs-min/week, which, for reference, is the lower limit of the World Health Organization (WHO) recommended energy expenditure for physical activity. Between 650 and 1,200 METs-min/week, the upper limit of energy expenditure recommended by the WHO, the influence of exercise on fatigue slowed or stopped.

Likewise, a significant response was observed for muscular fitness from 430 to 530 METs-min/week of exercise. Between 600 and 710 METs-min/week, the influence of exercise approached zero.

These studies provide valuable insights to help patients with multiple sclerosis make more informed and personalized decisions regarding exercise regimens tailored to their specific needs.

In a pooled statistical analysis, a patient’s age was found to influence the effects of exercise interventions on fatigue and muscular fitness. At the same time, the duration of a person’s disease impacted the effects of exercise on fatigue.

The researchers noted “several important clinical implications” from this analysis, pointing out that the study “included a large sample of MS patients” and a wide range of exercise types.

“Given the positive effects of various exercise modalities, healthcare providers should engage in discussions with patients to tailor exercise interventions according to their specific needs, physical abilities, and goals,” the team wrote.

While large-scale clinical trials are still needed to evaluate the effects of different exercise doses, the researchers noted that, overall, “these studies provide valuable insights to help patients with multiple sclerosis make more informed and personalized decisions regarding exercise regimens tailored to their specific needs.”