BACKGROUND Despite many benefits of the physical activity on physical and mental health of patients with Multiple Sclerosis (MS), the activity level in these patients is still very limited, and they continue to suffer from impairment in functioning ability. The main aim of this study is thus to closely examine exercise's effect on fatigue of patients with MS worldwide, with particular interest on Iran based on a comprehensive systematic review and meta-analysis. METHODS The studies used in this systematic review were selected from the articles published from 1996 to 2019, in national and international databases including SID, Magiran, Iranmedex, Irandoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (ISI). These databases were thoroughly searched, and the relevant ones were selected based on some plausible keywords to the aim of this study. Heterogeneity index between studies was determined using Cochran's test and I2. Due to heterogeneity in studies, the random effects model was used to estimate standardized mean difference. RESULTS From the systematic review, a meta-analysis was performed on 31 articles which were fulfilled the inclusion criteria. The sample including of 714 subjects was selected from the intervention group, and almost the same sample size of 720 individuals were selected in the control group. Based on the results derived from this meta-analysis, the standardized mean difference between the intervention group before and after the intervention was respectively estimated to be 23.8 ± 6.2 and 16.9 ± 3.2, which indicates that the physical exercise reduces fatigue in patients with MS. CONCLUSION The results of this study extracted from a detailed meta-analysis reveal and confirm that physical exercise significantly reduces fatigue in patients with MS. As a results, a regular exercise program is strongly recommended to be part of a rehabilitation program for these patients.

中文翻译：

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体育锻炼对多发性硬化症患者疲劳症状的影响：系统评价和荟萃分析。

背景技术尽管体育锻炼对多发性硬化症（MS）患者的身心健康有许多益处，但是这些患者的活动水平仍然非常有限，并且他们继续遭受功能障碍。因此，本研究的主要目的是仔细研究运动对全世界MS患者疲劳的影响，特别是基于全面的系统评价和荟萃分析，伊朗对MS尤其感兴趣。方法本系统综述中使用的研究选自1996年至2019年在国家和国际数据库中发表的文章，包括SID，Magiran，Iranmedex，Irandoc，Google Scholar，Cochrane，Embase，ScienceDirect，Scopus，PubMed和Web of Science（ ISI）。对这些数据库进行了彻底的搜索，并根据一些合理的关键词选择了相关的关键词。使用Cochran检验和I2确定研究之间的异质性指数。由于研究的异质性，随机效应模型用于估计标准化均值差。结果通过系统评价，对符合纳入标准的31篇文章进行了荟萃分析。从干预组中选择了包括714名受试者的样本，在对照组中选择了720名个体几乎相同的样本量。根据这项荟萃分析得出的结果，干预组在干预前后的标准均差分别为23.8±6.2和16.9±3.2，这表明体育锻炼可减轻MS患者的疲劳。结论从详细的荟萃分析中提取的这项研究结果揭示并证实体育锻炼显着降低了MS患者的疲劳程度。结果，强烈建议定期运动计划作为这些患者康复计划的一部分。