Najafi Parisa, Motl Robert W, Moghadasi Mehrzad
Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.
Mult Scler Relat Disord. 2025 Jan;93:106225. doi: 10.1016/j.msard.2024.106225. Epub 2024 Dec 10.
Multiple sclerosis (MS) profoundly influences fatigue, depression, various physical and mental symptoms, and quality of life (QoL). Rehabilitation, including exercise training, has improved outcomes of MS, yet is often undertaken in facilities with direct supervision which present substantial barriers for accessibility and scalability. The delivery of exercise remotely via technology (tele-exercise) might overcome those barriers and improve outcomes in MS. This systematic review and meta-analysis examined the effect of tele-exercise for improving fatigue, depression, and overall health outcomes in MS patients.
We undertook a comprehensive literature search across 5 electronic databases (PubMed, Scopus, Web of Science, The Cochrane Library, clinicaltrials.gov, and EMBASE) from inception through February 2024. Three reviewers screened all randomized controlled trials (RCTs) and assessed quality, and two reviewers extracted data. The meta-analysis used standardized mean difference (SMD) with Hedges' g method, a random effects model adjusted by Hartung-Knapp, and assessed heterogeneity (I² statistic), weighted studies (inverse variance), and evaluated publication bias (Begg's funnel plot and linear regression test).
We located 13 RCTs for inclusion in the meta-analysis. Tele-exercise interventions demonstrated significant improvements across all outcomes: depression (SMD=-0.51, p < 0.001), fatigue (SMD=-0.58, p = 0.01), physical health (SMD=0.62, p = 0.001), QoL (SMD=0.38, p = 0.02), and mental health (SMD=-0.48, p = 0.001). Mind-Body Training consistently had larger effects than Combination Training.
Tele-exercise can improve fatigue, depression, mental and physical health, and overall QoL in MS patients. Further research is necessary to optimize tele-exercise protocols, assess long-term effects, and explore potential synergies with other intervention modalities such as telemedicine.
多发性硬化症（MS）对疲劳、抑郁、各种身心症状及生活质量（QoL）有深远影响。包括运动训练在内的康复治疗改善了MS的治疗效果，但通常在有直接监督的设施中进行，这对可及性和可扩展性构成了重大障碍。通过技术远程进行运动（远程运动）可能会克服这些障碍并改善MS的治疗效果。本系统评价和荟萃分析探讨了远程运动对改善MS患者疲劳、抑郁和整体健康结局的效果。
我们对5个电子数据库（PubMed、Scopus、Web of Science、Cochrane图书馆、clinicaltrials.gov和EMBASE）进行了全面的文献检索，检索时间从数据库建立至2024年2月。三名 reviewers 筛选了所有随机对照试验（RCT）并评估质量，两名 reviewers 提取数据。荟萃分析采用标准化均数差（SMD）和Hedges' g方法、经Hartung-Knapp调整的随机效应模型，评估异质性（I²统计量）、加权研究（逆方差），并评估发表偏倚（Begg漏斗图和线性回归检验）。
我们确定了13项RCT纳入荟萃分析。远程运动干预在所有结局方面均显示出显著改善：抑郁（SMD=-0.51，p < 0.001）、疲劳（SMD=-0.58，p = 0.01）、身体健康（SMD=0.62，p = 0.001）、生活质量（SMD=0.38，p = 0.02）和心理健康（SMD=-0.48，p = 0.001）。身心训练的效果始终大于联合训练。
远程运动可改善MS患者的疲劳、抑郁、身心健康及整体生活质量。有必要进一步研究以优化远程运动方案、评估长期效果，并探索与远程医疗等其他干预方式的潜在协同作用。
