Laurits Emil Taul Madsen

TY - JOUR

T1 - Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis?

T2 - A Systematic Review and Meta-analysis

AU - Taul-Madsen, Laurits

AU - Connolly, Luke

AU - Dennett, Rachel

AU - Freeman, Jenny

AU - Dalgas, Ulrik

AU - Hvid, Lars G.

PY - 2021/10

Y1 - 2021/10

N2 - Objective: The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). Data Sources: Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. Study Selection: Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. Data Extraction: Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. Data Synthesis: Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), −1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, −0.04 to 0.78]; RT: ES=0.36 [95% CI, −0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=−0.61 [95% CI, −1.10 to −0.11]; RT: ES=−0.41 [95% CI, −0.80 to −0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. Conclusions: AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus “core battery” of physical function tests to facilitate a detailed comparison of results across modalities.

AB - Objective: The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). Data Sources: Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. Study Selection: Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. Data Extraction: Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. Data Synthesis: Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), −1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, −0.04 to 0.78]; RT: ES=0.36 [95% CI, −0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=−0.61 [95% CI, −1.10 to −0.11]; RT: ES=−0.41 [95% CI, −0.80 to −0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. Conclusions: AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus “core battery” of physical function tests to facilitate a detailed comparison of results across modalities.

KW - Exercise

KW - Multiple sclerosis

KW - Rehabilitation

KW - Systematic review

KW - CLINICALLY MEANINGFUL

KW - CAPACITY

KW - FITNESS

KW - ENDURANCE

KW - WALKING ABILITY

KW - ADULTS

KW - MUSCLE STRENGTH

KW - DISABILITY

KW - QUALITY-OF-LIFE

KW - MS PATIENTS

KW - Multiple Sclerosis/physiopathology

KW - Humans

KW - Exercise/physiology

KW - Lower Extremity/physiopathology

KW - Randomized Controlled Trials as Topic

KW - Resistance Training

KW - Fatigue/physiopathology

UR - http://www.scopus.com/inward/record.url?scp=85107809139&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2021.03.026

DO - 10.1016/j.apmr.2021.03.026

M3 - Review

C2 - 33901439

AN - SCOPUS:85107809139

VL - 102

SP - 2032

EP - 2048

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 10

ER -