The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis

Background: A large body of evidence has tested the effect of exercise interventions on mental health and healthrelated quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). Objective: To determine the effect of exercise interventions on mental health and HRQoL in PwMS. Methods: We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS >= 18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. Results: Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d =1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). Conclusion: Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS >= 65 years or with higher level of impairments.