The effect of exercise on dynamic balance and walking endurance in patients with relapsing remitting Multiple Sclerosis: A systematic review and meta-analysis

Background: Multiple Sclerosis (MS) affects 2-3 million people worldwide, with relapsing remitting MS (RRMS) accounting for 75% of new cases. Exercise has been proposed to alleviate symptoms and enhance quality of life. This meta-analysis aims to evaluate the effect of exercise on dynamic balance and walking endurance in RRMS patients.

Methodology: A comprehensive PubMed search identified exercise interventions that specifically measured walking endurance via the 6-minute walk test (6MWT) and dynamic balance through the timed up-and-go (TUG) test. Mean and standard deviation values at baseline and post-intervention were extracted for analysis. For subgroup comparisons, interventions were classified as either lower or higher intensity.

Results: Thirteen intervention groups were analysed. The 6MWT results showed a statistically significant improvement in distance covered post-intervention (MD, 29.11; 95% CI, 8.36–49.86; p = 0.006). In subgroup analysis, lower-intensity interventions produced a significant benefit (MD, 29.35; 95% CI, 5.21–53.49; p = 0.02), whereas higher-intensity interventions exhibited a trend (MD, 28.44; 95% CI, -12.18–69.05; p = 0.17). The TUG test demonstrated a significant reduction in test completion time (MD, -1.4; 95% CI, -1.69 to -1.10; p < 0.00001), with both lower- (MD, -2.00; 95% CI, -2.60 to -1.40; p < 0.00001) and higher intensity (MD, -1.20; 95% CI, -1.54 to -0.87; p < 0.00001) subgroups showing statistically significant improvements.

Conclusions: The results of this research reinforce the existing evidence that exercise significantly improves walking endurance and dynamic balance in RRMS patients. These findings support the recommendation for early, regular exercise as a non-pharmacological intervention.