Exercise as a Therapy for Improvement of Walking Ability in Adults With Multiple Sclerosis: A Meta-Analysis

Objective: To quantify improvements in walking performance commonly observed in patients with multiple sclerosis (pwMS), a systematic literature search and meta-analysis were conducted quantifying the expected benefits of exercise on walking ability in pwMS. Data Sources: Potential studies were identified by systematic search using PubMed (1966 to March 31, 2014), EMBASE (1974 to March 31, 2014), CINAHL (1998 to March 31, 2014), SPORTDiscus (1991 to March 31, 2014), and the Cochrane Central Register of Controlled Trials (1966 to March 31, 2014). The search used key concepts of "multiple sclerosis" AND "exercise." Study Selection: Randomized controlled trials of exercise training in adult pwMS. Data Extraction: Data on patient and study characteristics, walking ability, 10-m walk test (10mWT), timed 25-foot walk test (T25FW), 2-minute walk test (2MWT), 6-minute walk test (6MWT), and timed Up and Go (TUG) were extracted and archived. Data Synthesis: Data from 13 studies were included. In pwMS who exercised, significant improvements were found in walking speed, measured by the 10mWT (mean difference [MD] reduction in walking time of -1.76s; 95% confidence interval [CI], -2.47 to -1.06; P<.001), but no change in the T25FW (MD=-.59s; 95% CI, -2.55 to 1.36; P=.55). In pwMS who exercised, significant improvements were found in walking endurance as measured by the 6MWT and 2MWT, with an increased walking distance of MD=36.46m (95% CI, 15.14-57.79; P<.001) and MD=12.51m (95% CI, 4.79-20.23; P=.001), respectively. No improvement was found for TUG (MD=-1.05s; 95% CI, -2.19 to .09; P=.07). Conclusions: Our meta-analysis suggests that exercise improves walking speed and endurance in pwMS.