Fakorede Sodiq, Peters Joseph, Murphy Tanner, Troung Ethan, Abou Libak
Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
Kansas City University College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA.
Physiother Theory Pract. 2025 Jul 2:1-15. doi: 10.1080/09593985.2025.2518261.
Depression and anxiety are common in multiple sclerosis (MS), significantly affecting quality of life. Previous studies on exercise interventions for mental health in persons with MS (PwMS) have shown mixed results, partly due to inconsistent adherence to the Physical Activity Guidelines for Multiple Sclerosis (PAG-MS).
This study aimed to evaluate the effects of PAG-MS-compliant exercise on depression and anxiety outcomes in PwMS.
A systematic search was performed in EMBASE, PsycINFO, Web of Science, SPORTDiscuss, PubMed, Scopus, and CINAHL through October 2024 to identify randomized controlled trials (RCTs). Eligible studies involved adults with MS and focused on exercise regimens compliant with PAG-MS. Comparisons were made with non-PAG-MS exercise regimens or no exercise at all. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. Depression and anxiety outcomes were analyzed using meta-analyses, incorporating minimal clinically important difference (MCID) thresholds to determine clinical significance.
Twelve RCTs involving 458 participants we included. Depression outcomes showed significant improvement (MD: -4.46 [95% CI: -6.90, -2.01], P ˂ 0.01), exceeding the MCID threshold of 3.00 points on the Beck Depression Inventory scale. Anxiety outcomes, analyzed from two RCTs, showed non-significant improvement (SMD: -0.87 [95% CI: -2.46, 0.72], = .29). Overall, 58.33% of studies had a high risk of bias.
Interventions that meet PAG-MS demonstrate clinically meaningful improvements in depression, supporting their use as a non-pharmacological treatment strategy. However, given the limited data on anxiety outcomes, further research is needed to clarify the potential benefits in this domain.
抑郁症和焦虑症在多发性硬化症（MS）患者中很常见，严重影响生活质量。先前关于MS患者（PwMS）心理健康的运动干预研究结果不一，部分原因是对《多发性硬化症身体活动指南》（PAG-MS）的依从性不一致。
本研究旨在评估符合PAG-MS的运动对PwMS患者抑郁和焦虑结果的影响。
截至2024年10月，在EMBASE、PsycINFO、科学网、SPORTDiscuss、PubMed、Scopus和CINAHL中进行了系统检索，以识别随机对照试验（RCT）。符合条件的研究涉及成年MS患者，并侧重于符合PAG-MS的运动方案。与非PAG-MS运动方案或不运动进行比较。两名独立评审员筛选研究、提取数据并评估偏倚风险。使用荟萃分析分析抑郁和焦虑结果，并纳入最小临床重要差异（MCID）阈值以确定临床意义。
纳入了12项涉及458名参与者的RCT。抑郁结果显示有显著改善（MD：-4.46 [95% CI：-6.90，-2.01]，P ˂ 0.01），超过了贝克抑郁量表上3.00分的MCID阈值。从两项RCT分析的焦虑结果显示改善不显著（SMD：-0.87 [95% CI：-2.46，0.72]，P = 0.29）。总体而言,58.33%的研究存在高偏倚风险。
符合PAG-MS的干预措施在抑郁症方面显示出具有临床意义的改善，支持将其用作非药物治疗策略。然而，鉴于焦虑结果的数据有限，需要进一步研究以阐明该领域的潜在益处。
