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The safety of exercise training in multiple sclerosis: A systematic review

      Highlights

      • We conducted a systematic review of the safety of exercise training in MS.
      • Exercise training was not associated with an increased risk of disease relapse.
      • Risk of adverse events was not higher in MS than in healthy populations.
      • This evidence should alleviate uncertainty regarding the safety of exercise training in MS.

      Abstract

      There are many reviews documenting the benefits of exercise training among persons with multiple sclerosis (MS). To date, we are unaware of a review that summarizes the risks of relapse and other adverse events (AEs) associated with exercise training, yet this is critical for informing decisions and recommendations regarding the safety of this behavior. We conducted a systematic review of relapse and other AEs reported in randomized controlled trials (RCTs) of exercise training in MS. We searched electronic databases for RCTs of exercise training in MS. We calculated the rate of relapse and AEs, and the relative risk of relapse and AEs for exercise training versus control. Twenty-six studies were reviewed that included 1295 participants. We determined that the rate of relapse was 6.3% and 4.6% for control and exercise, respectively. The rate of AEs was 1.2% and 2.0% for control and exercise, respectively. The relative risk of relapse for exercise training was 0.73, whereas the relative risk of AE for exercise training was 1.67. Exercise training was not associated with an increased risk of relapse, and risk of AEs was not higher than in healthy populations. This evidence should alleviate uncertainty regarding the safety of exercise training in MS.

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      References

        • Berkovich R.
        Treatment of acute relapses in multiple sclerosis.
        Neurotherapeutics. 2013; 10: 97-105
        • Latimer-Cheung A.E.
        • Pilutti L.A.
        • Hicks A.L.
        • Martin Ginis K.A.
        • Fenuta A.
        • MacKibbon A.
        • et al.
        Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development.
        Arch Phys Med Rehabil. 2013; 94: 1800-1828
        • Latimer-Cheung A.E.
        • Martin Ginis K.A.
        • Hicks A.L.
        • Motl R.W.
        • Pilutti L.A.
        • Duggan M.
        • et al.
        Development of evidence-informed physical activity guidelines for adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2013; 94: 1829-1836
        • Ahmadi A.
        • Nikbakh M.
        • Arastoo A.A.
        • Habibi A.-H.
        The effects of a yoga intervention on balance, speed and endurance of walking, fatigue and quality of life in people with multiple sclerosis.
        J Hum Kinet. 2010; 23: 71-78
        • Bjarnadottir O.H.
        • Konradsdottir A.D.
        • Reynisdottir K.
        • Olafsson E.
        Multiple sclerosis and brief moderate exercise. A randomised study.
        Mult Scler. 2007; 13: 776-782
        • Broekmans T.
        • Roelants M.
        • Feys P.
        • Alders G.
        • Gijbels D.
        • Hanssen I.
        • et al.
        Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis.
        Mult Scler. 2011; 17: 468-477
        • Cakt B.D.
        • Nacir B.
        • Genc H.
        • Saracoglu M.
        • Karagoz A.
        • Erdem H.R.
        • et al.
        Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study.
        Am J Phys Med Rehabil. 2010; 89: 446-457
        • Carter A.M.
        • Daley A.J.
        • Kesterton S.W.
        • Woodroofe N.M.
        • Saxton J.M.
        • Sharrack B.
        Pragmatic exercise intervention in people with mild to moderate multiple sclerosis: a randomised controlled feasibility study.
        Contemp Clin Trials. 2013; 35: 40-47
        • Dalgas U.
        • Stenager E.
        • Jakobsen J.
        • Petersen T.
        • Hansen H.J.
        • Knudsen C.
        • et al.
        Resistance training improves muscle strength and functional capacity in multiple sclerosis.
        Neurology. 2009; 73: 1478-1484
        • DeBolt L.S.
        • McCubbin J.A.
        The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2004; 85: 290-297
        • Doulatabad S.N.
        • Nooreyan K.
        • Doulatabad A.N.
        • Noubandegani Z.M.
        The effects of pranayama, hatha and raja yoga on physical pain and the quality of life of women with multiple sclerosis.
        Afr J Tradit Complement. 2013; 10: 49-52
        • Garrett M.
        • Hogan N.
        • Larkin A.
        • Saunders J.
        • Jakeman P.
        • Coote S.
        Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial.
        Mult Scler J. 2013; 19: 782-789
        • Geddes E.L.
        • Costello E.
        • Raivel K.
        • Wilson R.
        The effects of a twelve-week home walking program on cardiovascular parameters and fatigue perception of individuals with multiple sclerosis: a pilot study.
        Cardiopulm Phys Ther J. 2009; 20: 5-12
        • Golzari Z.
        • Shabkhiz F.
        • Soudi S.
        • Kordi M.R.
        • Hashemi S.M.
        Combined exercise training reduces IFN-gamma and IL-17 levels in the plasma and the supernatant of peripheral blood mononuclear cells in women with multiple sclerosis.
        Int Immunopharmacol. 2010; 10: 1415-1419
        • Harvey L.
        • Davies Smith A.
        • Jones R.
        The effect of weighted leg raises on quadriceps strength, EMG parameters and functional activities in people with multiple sclerosis.
        Physiotherapy. 1999; 85: 154-161
        • Hebert J.R.
        • Corboy J.R.
        • Manago M.M.
        • Schenkman M.
        Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upright postural control: a randomized controlled trial.
        Phys Ther. 2011; 91: 1166-1183
        • Kargarfard M.
        • Etemadifar M.
        • Baker P.
        • Mehrabi M.
        • Hayatbakhsh R.
        Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis.
        Arch Phys Med Rehabil. 2012; 93: 1701-1708
        • Learmonth Y.C.
        • Paul L.
        • Miller L.
        • Mattison P.
        • McFayden A.K.
        The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study.
        Clin Rehabil. 2012; 26: 579-593
        • McCullagh R.
        • Fitzgerald A.P.
        • Murphy R.P.
        • Cooke G.
        Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.
        Clin Rehabil. 2008; 22: 206-214
        • Mostert S.
        • Kesselring J.
        Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis.
        Mult Scler. 2002; 8: 161-168
        • Negahban H.
        • Rezaie S.
        • Goharpey S.
        Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study.
        Clin Rehabil. 2013; 27: 1126-1136
        • Nilsagard Y.E.
        • Forsberg A.S.
        • von Koch L.
        Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study.
        Mult Scler. 2013; 19: 209-216
        • Oken B.S.
        • Kishiyama S.
        • Zajdel D.
        • Bourdette D.
        • Carlsen J.
        • Haas M.
        • et al.
        Randomized controlled trial of yoga and exercise in multiple sclerosis.
        Neurology. 2004; 62: 2058-2064
        • Petajan J.H.
        • Gappmaier E.
        • White A.T.
        • Spencer M.K.
        • Mino L.
        • Hicks R.W.
        Impact of aerobic training on fitness and quality of life in multiple sclerosis.
        Ann Neurol. 1996; 39: 432-441
        • Romberg A.
        • Virtanen A.
        • Ruutiainen J.
        • Aunola S.
        • Karppi S.L.
        • Vaara M.
        • et al.
        Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study.
        Neurology. 2004; 63: 2034-2038
        • Schulz K.H.
        • Gold S.M.
        • Witte J.
        • Bartsch K.
        • Lang U.E.
        • Hellweg R.
        • et al.
        Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis.
        J Neurol Sci. 2004; 225: 11-18
        • Sosnoff J.J.
        • Finlayson M.
        • McAuley E.
        • Morrison S.
        • Motl R.W.
        Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial.
        Clin Rehabil. 2014; 28: 254-263
        • Tarakci E.
        • Yeldan I.
        • Huseyinsinoglu B.E.
        • Zenginler Y.
        • Eraksoy M.
        Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial.
        Clin Rehabil. 2013; 27: 813-822
        • van den Berg M.
        • Dawes H.
        • Wade D.T.
        • Newman M.
        • Burridge J.
        • Izadi H.
        • et al.
        Treadmill training for individuals with multiple sclerosis: a pilot randomised trial.
        J Neurol Neurosurg Psychiatry. 2006; 77: 531-533
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Kjølhede T.
        • Vissing K.
        • Dalgas U.
        Multiple sclerosis and progressive resistance training: a systematic review.
        Mult Scler J. 2012; 18: 1215-1228
        • Ferguson C.
        An effect size primer: a guide for clinicians and researchers.
        Prof Psychol Res Pract. 2009; 40: 532-538
        • Camarinos J.
        • Marinko L.
        Effectiveness of manual physical therapy for painful shoulder conditions: a systematic review.
        J Man Manip Ther. 2009; 17: 206-215
        • Powell K.E.
        • Heath G.W.
        • Kresnow M.J.
        • Sacks J.J.
        • Branche C.M.
        Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics.
        Med Sci Sports Exerc. 1998; 30: 1246-1249
        • Tallner A.
        • Waschbisch A.
        • Wenny I.
        • Schwab S.
        • Hentschke C.
        • Pfeifer K.
        • et al.
        Multiple sclerosis relapses are not associated with exercise.
        Mult Scler. 2012; 18: 232-235
        • Smith R.M.
        • Adeney-Steel M.
        • Fulcher G.
        • Longley W.A.
        Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis.
        Arch Phys Med Rehabil. 2006; 87: 723-727
        • Liu C.
        • Latham N.
        Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin.
        Arch Phys Med Rehabil. 2010; 91: 1471-1473
        • Edmonds M.
        • McGuire H.
        • Price J.
        Exercise therapy for chronic fatigue syndrome.
        Cochrane Database Syst Rev. 2004; 3: CD003200
        • Kelley G.A.
        • Kelley K.S.
        Dropouts and compliance in exercise interventions targeting bone mineral density in adults: a meta-analysis of randomized controlled trials.
        J Osteoporos. 2013; 2013: 250423