Petra Skeffington

Introduction: Persons with multiple sclerosis (MS) frequently experience symptoms of anxiety. There is an unmet need for effective and accessible interventions to reduce anxiety in this population.

Objectives/Aims: To conduct a systematic review and metaanalysis on the effect of exercise on anxiety in MS, exploring participant and intervention characteristics.

Methods: We searched eight databases until November 2024 for randomised controlled exercise trials with an inactive control group in adults with MS. Trial quality was assessed using the Cochrane Risk-of-Bias Tool 2.0. Intervention development was assessed based on the Medical Research Council’s (MRC) framework for developing interventions. We pooled standardised mean difference (SMD) effect sizes (Hedge’s g) and their 95% confidence intervals for continuous data in a pairwise meta-analysis.

Results: From 6096 records, 18 trials (n=709 participants) were included. Sixteen exercise interventions, demonstrated improvements in anxiety symptoms compared to inactive control, reflected as a small positive effect (SMD: 0.26, 95% CI: 0.04, 0.48). Risk of bias was high, due to self-reported measures. Few trials were pre-registered, and none focussed on anxiety as the main outcome. Authors infrequently reported detailed intervention design; only two trials reported co-design collaboration with both patient and clinician stakeholders.

Conclusion: Exercise interventions may improve symptoms of anxiety in people with MS. Studies should be designed using the MRC framework, pre-register protocols, reduce risk of bias in their outcome measurement, and assess anxiety as a primary outcome in participants with clinical levels of anxiety.