Tele-exercise in multiple sclerosis: Systematic review and meta-analysis of effects on fatigue, depression, and...

Multiple sclerosis (MS) profoundly influences fatigue, depression, various physical and mental symptoms, and quality of life (QoL). Rehabilitation, including exercise training, has improved outcomes of MS, yet is often undertaken in facilities with direct supervision which present substantial barriers for accessibility and scalability. The delivery of exercise remotely via technology (tele-exercise) might overcome those barriers and improve outcomes in MS. This systematic review and meta-analysis examined the effect of tele-exercise for improving fatigue, depression, and overall health outcomes in MS patients.

We undertook a comprehensive literature search across 5 electronic databases (PubMed, Scopus, Web of Science, The Cochrane Library, clinicaltrials.gov, and EMBASE) from inception through February 2024. Three reviewers screened all randomized controlled trials (RCTs) and assessed quality, and two reviewers extracted data. The meta-analysis used standardized mean difference (SMD) with Hedges' g method, a random effects model adjusted by Hartung-Knapp, and assessed heterogeneity (I² statistic), weighted studies (inverse variance), and evaluated publication bias (Begg's funnel plot and linear regression test).

We located 13 RCTs for inclusion in the meta-analysis. Tele-exercise interventions demonstrated significant improvements across all outcomes: depression (SMD=-0.51, p < 0.001), fatigue (SMD=-0.58, p = 0.01), physical health (SMD=0.62, p = 0.001), QoL (SMD=0.38, p = 0.02), and mental health (SMD=-0.48, p = 0.001). Mind-Body Training consistently had larger effects than Combination Training.

Tele-exercise can improve fatigue, depression, mental and physical health, and overall QoL in MS patients. Further research is necessary to optimize tele-exercise protocols, assess long-term effects, and explore potential synergies with other intervention modalities such as telemedicine.