Exercise training improves depressive symptoms in people with multiple sclerosis: results of a meta-analysis.

OBJECTIVE There is a high prevalence, yet under-treatment of depressive disorder and symptoms by conventional therapy in people with multiple sclerosis (MS). We conducted a meta-analysis examining the overall effect of exercise training on depressive symptoms in MS. METHODS We searched PubMed for randomized controlled trials (RCT) of exercise training and depression as an outcome in samples with MS. There were 13 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g. RESULTS The weighted mean ES was small, but statistically significant (Hedge's g=0.36, SE=0.09, 95% CI=0.18-0.54, z=3.92, p<.001) indicating the exercise training resulted in an improvement in depressive symptoms compared to control. The overall effect was not heterogeneous (Q=16.46, df=12, p=0.17, I2=27.08); and post-hoc, exploratory analyses only identified depression symptom scale as a potential moderator variable (p=0.04). CONCLUSION The cumulative evidence indicates that exercise training can yield a small, yet statistically significant and reliable reduction in depressive symptoms for people with MS.

[1]  S. Patten,et al.  Major depression in multiple sclerosis , 2003, Neurology.

[2]  Michael A. Andrykowski,et al.  Short Form of the Profile of Mood States (POMS-SF): Psychometric Information. , 1995 .

[3]  S. Kishiyama,et al.  Randomized controlled trial of yoga and exercise in multiple sclerosis , 2004, Neurology.

[4]  W. E. Craighead,et al.  Exercise and Pharmacotherapy in Patients With Major Depression: One-Year Follow-Up of the SMILE Study , 2011, Psychosomatic medicine.

[5]  H. Erdem,et al.  Cycling Progressive Resistance Training for People with Multiple Sclerosis: A Randomized Controlled Study , 2010, American journal of physical medicine & rehabilitation.

[6]  S. Broadley,et al.  Comparing endurance- and resistance-exercise training in people with multiple sclerosis: a randomized pilot study , 2011, Clinical rehabilitation.

[7]  L. Paul,et al.  The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study , 2012, Clinical rehabilitation.

[8]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[9]  Deborah M. Miller,et al.  Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS , 2014, Neurology.

[10]  D. Mohr,et al.  Treatment of depression for patients with multiple sclerosis in neurology clinics , 2006, Multiple sclerosis.

[11]  U. Dalgas,et al.  Multiple sclerosis and progressive resistance training: a systematic review , 2012, Multiple sclerosis.

[12]  A. Rush,et al.  The Inventory of Depressive Symptomatology (IDS): psychometric properties , 1996, Psychological Medicine.

[13]  J. González‐Gallego,et al.  Effects of Resistance Training in Multiple Sclerosis , 2009, International journal of sports medicine.

[14]  Anthony Feinstein,et al.  Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients , 2009, Multiple sclerosis.

[15]  D. Landers,et al.  The Antidepressive Effects of Exercise , 2009, Sports medicine.

[16]  H. J. Hansen,et al.  Fatigue, mood and quality of life improve in MS patients after progressive resistance training , 2010, Multiple sclerosis.

[17]  J. Ruutiainen,et al.  Long–term exercise improves functional impairment but not quality of life in multiple sclerosis , 2005, Journal of Neurology.

[18]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .

[19]  M. Kopp,et al.  Effects of psychological group therapy in patients with multiple sclerosis , 2003, Acta neurologica Scandinavica.

[20]  J. Corboy,et al.  Effects of Vestibular Rehabilitation on Multiple Sclerosis–Related Fatigue and Upright Postural Control: A Randomized Controlled Trial , 2011, Physical Therapy.

[21]  T. Ingemann-Hansen,et al.  Review: Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training , 2008, Multiple sclerosis.

[22]  A. Hicks,et al.  Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: a pilot study. , 2011, Archives of physical medicine and rehabilitation.

[23]  Jerson Laks,et al.  Physical Exercise and Clinically Depressed Patients: A Systematic Review and Meta-Analysis , 2013, Neuropsychobiology.

[24]  J. Tippin,et al.  Depressed mood in multiple sclerosis: relationship to capacity-demanding memory and attentional functioning. , 1999, Neuropsychology.

[25]  Catherine Sherrington,et al.  Reliability of the PEDro scale for rating quality of randomized controlled trials. , 2003, Physical therapy.

[26]  Karl-Heinz Schulz,et al.  Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis , 2004, Journal of the Neurological Sciences.

[27]  J. Oger,et al.  Depression and multiple sclerosis , 1996, Neurology.

[28]  A. Mulasso,et al.  The role of Fatigue in the associations between Exercise and Psychological Health in Multiple Sclerosis: Direct and Indirect Effects , 2013 .

[29]  R. Joffe,et al.  Mood disorder and multiple sclerosis. , 1987, Archives of neurology.

[30]  U. Dalgas,et al.  The effect of exercise therapy on fatigue in multiple sclerosis , 2011, Multiple sclerosis.

[31]  A Mauro,et al.  Depression is the main determinant of quality of life in multiple sclerosis: A classification-regression (CART) study , 2006, Disability and rehabilitation.

[32]  B M J Uitdehaag,et al.  Exercise Therapy for Multiple Sclerosis , 2022 .

[33]  N. Mills,et al.  Mindfulness of movement as a coping strategy in multiple sclerosis. A pilot study. , 2000, General hospital psychiatry.

[34]  R. Motl,et al.  Exercising away the blues: can it help multiple sclerosis-related depression? , 2013, Multiple sclerosis.

[35]  Robert W Motl,et al.  Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. , 2013, Archives of physical medicine and rehabilitation.

[36]  Debbie A Lawlor,et al.  The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials , 2001, BMJ : British Medical Journal.

[37]  V. Conn.  Depressive Symptom Outcomes of Physical Activity Interventions: Meta-analysis Findings , 2010, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[38]  I. Lamers,et al.  Endurance training is feasible in severely disabled patients with progressive multiple sclerosis , 2014, Multiple sclerosis.

[39]  A. O’Cathain,et al.  The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: A qualitative study of people with multiple sclerosis , 2010, Psychology & health.

[40]  T. T. Haug,et al.  The validity of the Hospital Anxiety and Depression Scale. An updated literature review. , 2002, Journal of psychosomatic research.

[41]  E. McAuley,et al.  Patterns and predictors of naturally occurring change in depressive symptoms over a 30-month period in multiple sclerosis , 2014, Multiple sclerosis.

[42]  R Bakshi,et al.  Fatigue in multiple sclerosis and its relationship to depression and neurologic disability , 2000, Multiple sclerosis.

[43]  A. Ahmadi,et al.  Comparison of the Effect of 8 weeks Aerobic and Yoga Training on Ambulatory Function, Fatigue and Mood Status in MS Patients , 2013, Iranian Red Crescent medical journal.

[44]  R G Newcombe,et al.  Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis , 2001, Journal of neurology, neurosurgery, and psychiatry.

[45]  Steven J. Petruzzello,et al.  Effects of Exercise Training on Fatigue in Multiple Sclerosis: A Meta-Analysis , 2013, Psychosomatic medicine.

[46]  A. John,et al.  A Large-Scale Study of Anxiety and Depression in People with Multiple Sclerosis: A Survey via the Web Portal of the UK MS Register , 2012, PloS one.

[47]  H. Dawes,et al.  Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities , 2011, Multiple sclerosis.

[48]  P. Doraiswamy,et al.  Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder , 2007, Psychosomatic medicine.

[49]  S. Jazbec,et al.  Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis , 2010, Clinical Neurology and Neurosurgery.

[50]  J. De Keyser,et al.  Pharmacologic treatment of depression in multiple sclerosis. , 2011, The Cochrane database of systematic reviews.

[51]  Jessica L. Gosney,et al.  Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis , 2008, Multiple sclerosis.

[52]  P Bech,et al.  The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. , 2001, Journal of affective disorders.

[53]  J. Petajan,et al.  Impact of aerobic training on fitness and quality of life in multiple sclerosis , 1996, Annals of neurology.

[54]  M. Arroyo-Morales,et al.  Hydrotherapy for the Treatment of Pain in People with Multiple Sclerosis: A Randomized Controlled Trial , 2011, Evidence-based complementary and alternative medicine : eCAM.

[55]  M. Stoové,et al.  Can aerobic exercise training affect health-related quality of life for people with multiple sclerosis? , 2001 .

[56]  C. Dettmers,et al.  Endurance exercise improves walking distance in MS patients with fatigue , 2009, Acta neurologica Scandinavica.

[57]  K. Krishnan,et al.  Effects of exercise training on older patients with major depression. , 1999, Archives of internal medicine.

[58]  G. Ketels,et al.  Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial , 2014, Multiple sclerosis.

[59]  L. Hedges,et al.  Introduction to Meta‐Analysis , 2009, International Coaching Psychology Review.

[60]  M. Piepoli,et al.  Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients With Multiple Sclerosis: A Randomized Crossover Controlled Study , 2007, Physical Therapy.

[61]  H. Vet,et al.  The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. , 1998, Journal of clinical epidemiology.

[62]  A. Meriç,et al.  Comparing routine neurorehabilitation programme with callisthenic exercises in multiple sclerosis. , 2011, NeuroRehabilitation.

[63]  L. Radloff.  The CES-D Scale , 1977 .

[64]  R. Motl,et al.  The benefits of exercise training in multiple sclerosis , 2012, Nature Reviews Neurology.

[65]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[66]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.