Effects Of Aquatic-based Exercise On Perceived-fatigue In People With Multiple Sclerosis: A Systematic Review And Meta-analysis

Abstract

Multiple sclerosis (MS) is a chronic, immune-mediated and neurodegenerative disease of the central nervous system. Since signs and symptoms associated with MS extend to several dimensions, people with MS (PwMS) can experience symptoms at both physical and cognitive dimensions. Among them, perceived fatigue is one of the most disabling symptoms, affecting the majority of the MS population. Hydrotherapy is a novel therapeutic option to improve the perceived-fatigue in PwMS, PURPOSE: To analyze the effects of aquatic-based exercise on perceived-fatigue in PwMS using a meta-analytic procedures and systematic review. METHODS: Clinical trials comparing aquatic exercise to no exercise treatments were searched on four scientific databases up to June 2019. The standard mean differences (SMD +) was calculated for the outcome perceived-fatigue. Firstly, general fatigue was evaluated, from which three sub-dimensions were also assessed (physical, psychosocial, and cognitive). The methodological quality of the included studies was assessed employing the PEDro scale. RESULTS: A total of 148 articles were initially identified, from which only 5 fulfilled all the inclusion criteria, other than inclusion of a control group and an experimental group, and a hydrotherapy program. General fatigue, assessed mainly through the Modified Fatigue Impact Scale, showed a significant decrease (SMD+ = -2.15 [95% CI = -3.44 to -0.87]; p<0.01; I2=91%). Regarding fatigue sub-dimensions, physical fatigue achieved a significant improvement in the experimental group compared to the controls (SMD+ = -2.15 [95% CI = -3.72 to -0.58]; p<0.01; p<0.01; I2=92%). Psychosocial fatigue (SMD+ = -1.13 [95% CI = -1.86 to -0.40; p<0.01; I2=76%) and cognitive fatigue were also significantly improved compared to the control group (SMD+ = -0.57 [95% CI = -0.88 to -0.25]; p<0.01; I2=0%). CONCLUSIONS: Aquatic-based exercise significantly decreases all dimensions of perceived-fatigue in PwMS. Based on these findings, it would be useful for future studies to address the dose-response characterization of aquatic-based exercise programs (i.e. intensity, volume, frequency, training length, etc.) in order to optimize the physical exercise interventions for PwMS.