Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis.

Yvonne C Learmonth, Matthew P Herring, Daniel I Russell, Lara A Pilutti, Sandra Day, Claudia H Marck, Bryan Chan, Alexandra P Metse, Robert W Motl

Journal: Multiple sclerosis (Houndmills, Basingstoke, England) 2023;29(13):1604-1631

PMID: 37880997

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Plain Language Summary

Exercise training represents a rehabilitation-based approach for reversing multiple sclerosis (MS) dysfunction and managing symptoms and should be promoted among persons with MS throughout the disease trajectory. The aim of this study was to quantify the rate of relapse, adverse events (AE) and serious adverse events (SAE) in randomised controlled trials of exercise training in persons with MS. This study was a systematic review and meta-analysis of forty-six exercise interventions. Results showed that in exercise trials with individuals diagnosed with MS, where safety measures were documented, aerobic, strength, or neuromotor exercises conducted under both supervised and unsupervised conditions were deemed safe for those with MS. This conclusion was drawn from two key observations: (1) there were no instances of serious adverse effects reported during exercise sessions, and (2) participants engaging in exercise interventions did not exhibit higher risks of relapse, AE or SAE compared to control participants. Authors concluded that exercise training may be promoted as safe and beneficial to persons with MS.

Abstract

BACKGROUND

A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013.

OBJECTIVE

We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE).

METHODS

Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study's internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR.

RESULTS

Forty-six interventions from 40 RCTs ( = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), -value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), = 0.82), 1.40 ((0.90, 2.19), = 0.14) and 1.05 ((0.62, 1.80), = 0.85), respectively. No significant heterogeneity is observed for any outcome.

CONCLUSION

In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.

Address: School of Allied Health (Exercise Science), Murdoch University, Murdoch, WA, Australia.; Perron Institute for Neurological and Translational Science, Perth, WA, Australia.; Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia.; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia.; Physical Activity for Health Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.; Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.; Discipline of Psychology, Murdoch University, Murdoch, WA, Australia.; Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.; Disability and Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.; Murdoch University Library, Murdoch, WA, Australia.; Discipline of Libraries, Archives, Records and Information Science, School of Media, Creative Arts and Social Inquiry, Faculty of Humanities, Curtin University, Perth, WA, Australia.; Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, QLD, Australia.; School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Australia, Newcastle, NSW, Australia.; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.

DOI: 10.1177/13524585231204459