A study published in the January 2005 issue of Cochrane Database System Reviews by M.B. Rietberg and colleagues assessed the effectiveness of exercise therapy for patients with MS in terms of activities of daily living and health-related quality of life. According to the authors, no intervention has proven effective in modifying long-term disease prognosis in MS, but exercise therapy is considered to be an important part of symptomatic and supportive treatment for these patients.

Rietberg and colleagues conducted automated searches on several databases and identified additional studies and reference sources by manually searching published articles and abstracts. They included in the analysis all randomized controlled trials (RCTs) that reported on exercise therapy for adults with MS, not presently experiencing an exacerbation, and had outcomes that included measures of either activity limitation or health-related quality of life, or both.

Two reviewers then reviewed the studies to extract data and methodological quality of the included trials independently of each other. Disagreements were resolved by discussion. The results were analyzed using a best-evidence synthesis based on methodological quality.

The authors found nine highmethodological-quality RCTs (260 participants) that met the inclusion criteria. Six trials focused on comparison of exercise therapy versus no exercise therapy and three trials compared two interventions that both met the definition of exercise therapy. Best evidence synthesis showed strong evidence in favor of exercise therapy compared to no exercise therapy in terms of muscle power function, exercise tolerance functions, and mobility-related activities. Moderate evidence was found for improving mood. No evidence was observed for exercise therapy on fatigue and perception of handicap when compared to no exercise therapy. Finally, no evidence was found that specific exercise therapy programs were more successful in improving activities and participation than other exercise treatments. No evidence of deleterious effects of exercise therapy was described in the studies included in the analysis.

According to the authors, the review suggests that exercise therapy can be beneficial for patients with MS not experiencing an exacerbation. However, they point out that there is an urgent need for consensus on a core set of outcome measures to be used in exercise trials. Furthermore, these studies should experimentally control for ‘dose’ of treatment, type of MS and should include sufficient contrast between experimental and control groups. (Available from: www.pubmed.gov, PMID:15674920).

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