People with multiple sclerosis (MS) who take part in structured exercise programmes tend to report lower levels of fatigue, according to an umbrella review.
The strongest evidence was found for cardiorespiratory exercise.
Resistance training, which often involves weights or resistance bands, was also linked to lower self-reported fatigue, although results varied more between studies.
Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Its effects can go beyond physical tiredness, affecting cognition, employment, social participation and quality of life.
Drug treatments for MS-related fatigue have generally produced modest or inconsistent benefits, leading to growing interest in exercise as a way to reduce fatigue severity.
In recent years, numerous reviews have examined different exercise-based interventions. However, differences in exercise type and dose, participant characteristics, fatigue measures and study quality have made firm conclusions difficult.
Some reviews also included many of the same trials, raising questions about whether similar findings represented independent evidence.
To address these limitations, researchers from institutions in Spain and Colombia carried out an umbrella review using a standardised framework proposed by the American College of Sports Medicine.
Exercise programmes were grouped by their main type: cardiorespiratory or aerobic exercise, resistance training, flexibility and neuromotor or mind-body exercise, including yoga, Pilates and Tai Chi.
The team compared the effects of different exercise categories on fatigue and examined programme details including frequency, intensity, session duration, programme length and progression.
The final analysis included 35 reviews: five systematic reviews, which summarised earlier studies, and 30 meta-analyses, which combined results from multiple studies to estimate overall effects.
Aerobic or cardiorespiratory training and resistance exercise, either alone or combined, were the most commonly studied approaches.
Other interventions included high-intensity interval training, balance and motor-control exercises, yoga, Pilates, Tai Chi, mindfulness, aquatic exercise, whole-body vibration, inspiratory muscle training, dance, climbing, virtual reality and exercise-based gaming.
Exercise programmes most commonly lasted between four and 24 weeks, with sessions of 30 to 60 minutes carried out two to five times a week.
Across the fatigue measures examined, structured exercise was linked to small to moderate reductions in self-reported fatigue.
Cardiorespiratory exercise had the strongest evidence.
Across 11 pooled estimates involving a combined 4,460 participants, it was linked to a small but statistically significant reduction in self-reported fatigue.
Resistance training was also linked to improvement.
Across 11 pooled estimates involving a combined 2,254 participants, resistance exercise was associated with a moderate, statistically significant reduction in self-reported fatigue.
However, results for resistance training varied substantially, and the predicted range of effects included the possibility of no benefit in some settings.
Aquatic exercise, high-intensity interval training, mindfulness, yoga, balance training and technology-assisted approaches such as virtual reality and exercise-based gaming were linked to reduced fatigue in some analyses.
However, these findings were based on a small number of estimates, varied substantially between studies or came from reviews with methodological limitations.
Overall, the findings suggest structured exercise is associated with small to moderate reductions in self-reported MS fatigue, with cardiorespiratory exercise and resistance training showing the strongest evidence.
However, the evidence does not establish a single best type or dose of exercise.
“Exercise prescriptions should remain individualised and integrated within multidisciplinary care, with careful monitoring of patient response and tolerability,” the researchers concluded.
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