Abstract
Background: Anxiety is a common symptom experienced by people with multiple sclerosis (MS). Exercise is a safe intervention that improves many MS symptoms. Exercise interventions are complex and require careful evidence-based design that includes stakeholder input. Recent randomised controlled exercise trials show promise to reduce anxiety, but evidence syntheses are lacking.
Objective: We aimed to assess the effectiveness of exercise interventions for anxiety in people with MS compared to no exercise. We also aimed to assess the effect of intervention type for anxiety and to evaluate the reporting of intervention design processes (pre-registered with Prospero: CRD42024611185).
Methods: We systematically reviewed randomised controlled trials of exercise interventions that included an anxiety outcome. We searched MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL, Scopus, Web of Science and PEDro to November 2024. Two independent reviewers screened abstracts and full text articles against eligibility criteria and extracted data. We pooled the estimates of the effect of exercise on anxiety compared to no exercise and assessed if the effect differed by intervention type.
Results: We included 18 trials (23 interventions) and found a small effect of exercise on anxiety (standardised mean difference: 0.26, 95% CI: 0.04, 0.48). There was low-moderate heterogeneity (I-squared: 37.94%, tau-squared: 0.096) which was not explained by intervention type (tau-squared from meta-regression: 0.118). Anxiety was not a primary outcome in any trial.
Conclusion: Exercise can reduce anxiety in people with MS, making this a safe and feasible treatment option for anxiety symptom management and promoting wellbeing in people with MS. Future exercise interventions should prioritise anxiety as a primary outcome and implement and report evidence-based intervention co-design.