Objective

The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS).

Data Sources

Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020.

Study Selection

Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue.

Data Extraction

Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale.

Data Synthesis

Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), −1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, −0.04 to 0.78]; RT: ES=0.36 [95% CI, −0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=−0.61 [95% CI, −1.10 to −0.11]; RT: ES=−0.41 [95% CI, −0.80 to −0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive.

Conclusions

AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus “core battery” of physical function tests to facilitate a detailed comparison of results across modalities.

中文翻译：

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有氧或阻力训练是改善多发性硬化症患者下肢身体机能和感知疲劳的最有效运动方式吗？系统评价和荟萃分析

客观的

本系统评价的目的是调查有氧训练 (AT) 或阻力训练 (RT) 是否在改善多发性硬化症 (PwMS) 患者的下肢身体机能和感知疲劳方面最有效。

数据源

2020 年 4 月以电子方式检索了九个数据库（MEDLINE、EMBASE、护理和专职健康累积索引、专职和补充医学数据库、物理治疗证据数据库、SPORTDiscus、PsycINFO、Web of Science 和 Scopus）。

研究选择

纳入的研究是随机对照试验 (RCT)，涉及 PwMS 参与 2 种运动干预中的一种：AT 或 RT。研究必须包括至少 1 项客观或自我报告的下肢身体功能和/或感知疲劳的结果。

数据提取

使用定制的电子表格提取数据，其中包括有关患者特征、干预和结果的详细信息。纳入研究的方法学质量由 2 名评价员使用运动评分量表的研究质量评估工具进行独立评估。

数据综合

27 篇文章报告了来自 22 个 RCTS（AT=14，RT=8）的数据，包括 966 个 PwMS。发现这 2 种方式在改善短距离步行测试方面同样有效（AT：效果大小 [ES]=0.33 [95% 置信区间 (CI)，-1.49 至 2.06]；RT：ES=0.27 [95% CI] , 0.07-0.47]) 和长距离步行测试性能（AT：ES=0.37 [95% CI，-0.04 至 0.78]；RT：ES=0.36 [95% CI，-0.35 至 1.08]），以及减少感知疲劳（AT：ES=-0.61 [95% CI，-1.10 至 -0.11]；RT：ES=-0.41 [95% CI，-0.80 至 -0.02]）。其他功能性移动测试的结果以及自我报告的步行表现是稀疏和不确定的。

结论

AT 和 RT 在改善 PwMS 中的下肢身体功能和感知疲劳方面似乎同样高效。因此，临床医生可以使用任何一种方式来针对这些结果中的损伤。从未来的角度来看，有必要进行头对头的运动方式研究。进一步鼓励未来的 MS 运动研究采用物理功能测试的共识“核心电池组”，以促进跨模式结果的详细比较。