The effect of exercise interventions on symptoms of anxiety in persons with multiple sclerosis: a systematic review and meta-analysis.

Introduction: Persons with multiple sclerosis (MS) frequently experience symptoms of anxiety. There is a large unmet need for effective and accessible interventions.

Objectives: To assess the effect of exercise on symptoms of anxiety in persons with MS, consider characteristics associated with effectiveness, and evaluate intervention design reporting.

Methods: This systematic review and meta-analysis included randomised controlled exercise trials in persons with MS. MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL, Scopus, Web of Science and PEDro were searched up to November 2024. The primary outcome was the post-intervention difference in anxiety symptoms between intervention and inactive control groups. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. We pooled standardised mean differences using a restricted maximum likelihood random-effects model.

Results: This systematic review of 18 randomised controlled trials identified a small positive effect of exercise on anxiety symptoms in persons with MS (SMD: 0.26, 95% CI: 0.04, 0.48) with moderate heterogeneity between trials (I: 37.94%, τ: 0.0962). All trials had a high risk of bias, as they relied on self-reported anxiety measures in unblinded participants. Few trials were pre-registered, and none focused on anxiety as the primary outcome. Authors infrequently reported intervention designs incorporating stakeholder engagement, expert engagement, and evidence-based and/or behavioural frameworks.

Conclusions: Exercise can reduce symptoms of anxiety in persons with MS. This is a promising result, given that exercise is beneficial for general health and is a safe and accessible treatment option.