Arntzen Ellen Christin, Bidhendi-Yarandi Razieh, Sivertsen Marianne, Knutsen Karina, Dahl Stine Susanne Haakonsen, Hartvedt Maria Grytvik, Normann Britt, Behboudi-Gandevani Samira
Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Front Sports Act Living. 2023 Jul 31;5:1162278. doi: 10.3389/fspor.2023.1162278. eCollection 2023.
Reduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS.
A systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.
A total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (= 493) or Control group (= 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m (95% CI: 26.4, 29 kg/m), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all > 0.05). Data on the potential harms of the interventions were limited.
The results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42022343621.
身体活动减少是多发性硬化症（MS）患者面临的一项全球性挑战。本系统评价和荟萃分析的目的是确定通过设备测量的身体活动、运动和物理治疗干预对MS患者步数和身体活动强度水平的影响。
对PubMed（包括Medline）、Scopus、CINHAL和Web of Science数据库进行系统检索，以获取从数据库建立至2023年5月1日发表的英文研究。纳入所有关于不同类型运动对MS患者步数和强度水平有效性的试验。分别使用改良的报告试验统一标准和Cochrane偏倚风险工具对纳入研究的质量及其偏倚风险进行严格评估。采用随机效应模型估计干预组和对照组治疗前后步数结果以及中度至剧烈强度水平的合并标准化均数差（SMD）和95%置信区间（CI）。分别使用Harbord检验来分析研究间的异质性并评估发表偏倚。进一步的敏感性分析有助于验证我们综述结果的可靠性和稳定性。
共纳入8项随机临床试验（涉及919例MS患者）。参与者（包括715名（77.8%）女性和204名（22.2%）男性）被随机分配至干预组（=493）或对照组（=426）。参与者的合并平均（95%CI）年龄和体重指数分别为49.4岁（95%CI：47.4，51.4岁）和27.7kg/m²（95%CI：26.4，29kg/m²）。就干预组和对照组干预前后的比较而言，荟萃分析结果表明，干预组步数的合并标准化均数差（SMD）为0.56（95%CI：-0.42，1.54），而对照组为0.12（95%CI：-0.05，0.28）。此外，干预后身体活动干预组与对照组相比，步数的合并SMD无显著差异（合并标准均数差=0.19，95%CI：-0.36，0.74）。对中度至剧烈身体活动强度水平的亚组分析显示，干预后干预组与对照组相比，或组内干预前后，身体活动干预均无显著效果。荟萃回归结果显示，年龄、体重指数、病程和扩展残疾状态量表（EDSS）评分不是异质性的潜在来源（均>0.05）。关于干预潜在危害的数据有限。
本荟萃分析结果显示，在接受身体活动干预的MS患者组内和组间，步数以及中度至剧烈身体活动水平均无显著差异。需要更多客观测量身体活动的研究。
