Best practice exercise for emerging depression in multiple sclerosis: A systematic review and meta-analysis

Area of Science:

• Neurology
• Exercise Science
• Psychiatry

Background:

• Multiple sclerosis (MS) is a chronic neurological condition often associated with depression.
• Depression significantly impacts the quality of life for individuals with MS.
• Understanding effective interventions for depression in MS is crucial.

Purpose of the Study:

• To evaluate the impact of instructor-led exercise on depression symptoms in adults with MS.
• To identify factors that may moderate the response to exercise interventions for depression in MS.

Main Methods:

• A systematic review and meta-analysis of studies from multiple databases (Cochrane Library, Embase, PEDro, PsycINFO, PubMed) up to April 2024.
• Included 22 studies with 785 participants diagnosed with relapsing-remitting or progressive MS.
• Assessed study quality using PEDro and TESTEX scales; calculated Hedges' g effect sizes using random and mixed-effects models.

Main Results:

• Instructor-led exercise demonstrated a significant reduction in core depression symptoms (g = 0.52, P < 0.01).
• These positive effects were not sustained after the cessation of exercise programs (g = -0.53, P ≤ 0.01).
• Both aerobic and non-aerobic exercise yielded significant improvements; individuals with better baseline ambulation showed greater benefits (P = 0.03).

Conclusions:

• Regular exercise is effective in stabilizing mood for individuals with multiple sclerosis.
• Exercise efficacy can be optimized by addressing barriers related to mobility, exercise type, delivery, and intensity.
• Consistent engagement in physical activity is key for sustained mood improvement in MS patients.