Abou Libak, Murphy Tanner, Truong Ethan, Peters Joseph
Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States.
Phys Ther. 2025 Jun 2;105(6). doi: 10.1093/ptj/pzaf046.
Regular physical activity is a recommended behavioral goal for persons with multiple sclerosis. This review aimed to determine the effect of interventions that met physical activity guidelines for persons with multiple sclerosis on fatigue measures and to compare the magnitudes of the effect sizes for meeting these guidelines with the minimal clinically important differences for fatigue measures.
The search was conducted in PubMed, Embase, Web of Science, SPORTDiscus, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO from inception to October 2024. Only randomized clinical trials that explicitly met physical activity guidelines and evaluated fatigue were included. Two independent reviewers screened articles for inclusion and evaluated the risk of bias of included trials using the Cochrane risk-of-bias tool for randomized trials. Findings were summarized, and a meta-analysis was conducted. Fatigue measures included the Fatigue Severity Scale, Fatigue Impact Scale, and modified Fatigue Impact Scale. The Grading of Recommendations, Assessment, Development and Evaluation was used to evaluate the quality of the evidence. The review protocol was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42023387305).
Twenty-two randomized clinical trials with 920 participants were included in the review; 17 studies were included in the meta-analysis. Findings indicated that interventions meeting physical activity guidelines for at least 4 weeks significantly reduced fatigue severity (standardized mean difference = -1.46; 95% CI = -2.11 to -0.81) and fatigue impact measured with the modified Fatigue Impact Scale (mean difference = -11.88; 95% CI = -20.57 to -3.19) and Fatigue Impact Scale (mean difference = -21.08; 95% CI = -31.01 to -11.15). All findings were clinically relevant, with effect sizes exceeding the established minimal clinically important differences for the fatigue measures. Some methodological concerns were noted, and the evidence level ranged from very low to moderate.
Evidence suggests that engaging in physical activity for at least 150 minutes per week or 2 sessions of 10 to 30 minutes of moderate-intensity aerobic training plus 2 sessions of resistance training per week results in clinically significant reductions in fatigue severity and impact necessary to improve the quality of life of persons with multiple sclerosis.
Fatigue is a highly prevalent symptom associated with poor outcomes, including falls, activity restrictions, pain, cognitive problems, functional limitations, and mortality risk among persons with multiple sclerosis. Our study suggests that adhering to physical activity guidelines developed for persons with multiple sclerosis clinically reduces the severity and impact of fatigue. This regimen includes engaging in physical activity for at least 150 minutes per week or participating in 2 sessions of 10 to 30 minutes of moderate-intensity aerobic training plus 2 sessions of resistance training per week.
定期进行体育活动是针对多发性硬化症患者推荐的行为目标。本综述旨在确定符合多发性硬化症患者体育活动指南的干预措施对疲劳指标的影响，并将达到这些指南的效应量大小与疲劳指标的最小临床重要差异进行比较。
检索了从创刊至2024年10月的PubMed、Embase、Web of Science、SPORTDiscus、Scopus、护理及相关健康文献累积索引（CINAHL）和PsycINFO。仅纳入明确符合体育活动指南并评估疲劳的随机临床试验。两名独立评审员筛选纳入的文章，并使用Cochrane随机试验偏倚风险工具评估纳入试验的偏倚风险。对研究结果进行了总结，并进行了荟萃分析。疲劳指标包括疲劳严重程度量表、疲劳影响量表和改良疲劳影响量表。采用推荐分级、评估、制定和评价方法来评估证据质量。该综述方案已在国际系统评价前瞻性注册库（PROSPERO）数据库中预先注册（注册号：CRD42023387305）。
该综述纳入了22项有920名参与者的随机临床试验；荟萃分析纳入了17项研究。结果表明，符合体育活动指南至少4周的干预措施显著降低了疲劳严重程度（标准化平均差=-1.46；95%置信区间=-2.11至-0.81），以及用改良疲劳影响量表测量的疲劳影响（平均差=-11.88；95%置信区间=-20.57至-3.19）和疲劳影响量表（平均差=-21.08；95%置信区间=-31.01至-11.15）。所有结果均具有临床相关性，效应量超过了既定的疲劳指标最小临床重要差异。注意到了一些方法学问题，证据水平从极低到中等不等。
有证据表明，每周进行至少150分钟的体育活动，或每周进行2次10至30分钟的中等强度有氧训练加2次阻力训练，可使疲劳严重程度和影响在临床上显著降低，这对于改善多发性硬化症患者的生活质量是必要的。
疲劳是一种非常普遍的症状，与包括跌倒、活动受限、疼痛、认知问题、功能限制和多发性硬化症患者的死亡风险在内的不良后果相关。我们的研究表明，遵循为多发性硬化症患者制定的体育活动指南在临床上可降低疲劳的严重程度和影响。该方案包括每周进行至少150分钟的体育活动，或参加每周2次10至30分钟的中等强度有氧训练加2次阻力训练。
