Network meta-analysis of six exercise modalities in females with multiple sclerosis shows improvements in fatigue, quality of life, balance, depression, and mental health.
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Key Takeaway
Consider regular physical activity for females with multiple sclerosis; yoga may offer superior benefits for psychological well-being.
This network meta-analysis assessed the efficacy of six distinct training programs or exercise modalities, including Yoga, resistance exercise (RE), aerobic exercise (AE), cognitive exercise (CE), cognitive training (CT), mind-body exercise (MBE), and resistance training (RT), in females with multiple sclerosis. The analysis compared these interventions against control groups to evaluate impacts on fatigue, total quality of life, balance, physical quality of life, depression, and mental health quality of life. The study included a sample size of 579 participants, though the setting and follow-up duration were not reported.
All exercise modalities demonstrated statistically significant efficacy compared to control groups for the evaluated secondary outcomes. Pairwise comparisons between different exercise categories revealed minimal differences overall. However, SUCRA rankings indicated specific leaders for each domain: Yoga ranked highest for depression (74.6) and mental health (79.5), while aerobic exercise (AE) led for balance (89.7). Resistance exercise (RE) and aerobic exercise (AE) also ranked high for total quality of life. MBE ranked highest for physical quality of life (82.0).
Safety and tolerability data, including adverse events, discontinuations, and serious adverse events, were not reported in the study. Key limitations include the lack of reported effect sizes, absolute numbers, p-values, or confidence intervals, as well as the absence of reported study settings and follow-up periods. The practice relevance suggests that regular physical activity boosts physical function and psychological status outcomes, with yoga identified as the most effective way to improve psychological well-being among the modalities assessed.
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View Original Abstract ↓
BACKGROUND: As a therapeutic approach, physical activity can serve as a rehabilitation method for females with multiple sclerosis. However, the optimal exercise type remains unclear. This study aims to evaluate the effects of six distinct training programs on the physical function and psychological state of females with multiple sclerosis, thereby providing foundational guidance for rehabilitation treatment in this population.
METHOD: In September 2025, a comprehensive literature search was conducted across seven major databases (Embase, PubMed, Web of Science, Cochrane Library, Wanfang, CNKI, and CQVIP) to identify randomized controlled trials to study how physical activity interventions affect the physical function and psychological status in females with multiple sclerosis. These studies were subsequently analyzed through a frequency-based network meta-analysis framework.
RESULTS: We conducted a systematic review analyzing 16 studies involving 579 participants. Among the six exercise modalities tested in the intervention groups, all demonstrated statistically significant efficacy compared to the control groups. However, pairwise comparisons between different exercise categories revealed minimal differences. Using the surface under the cumulative ranking curve (SUCRA) metric, researchers evaluated and ranked the impact of these interventions on both physical function and psychological status in females multiple sclerosis, FATIGUE: Yoga (SUCRA=81) > RE (SUCRA=77) > AE (SUCRA=67.6) > CE (SUCRA=56.0) > CT (SUCRA=30.8) > MBE (SUCRA=25.7) > RT(SUCRA=11.9); QoL-total: RE (SUCRA=69.7) > AE (SUCRA=63.5) > Yoga (SUCRA=63.0) > RT (SUCRA=3.9); BALANCE: AE (SUCRA=89.7) > Yoga (SUCRA=66.9) > MBE (SUCRA=55.0) > RE (SUCRA=36.7) > RT (SUCRA=1.7); Qol-ph: MBE(SUCRA=82.0) > Yoga (SUCRA=78.7) > AE (SUCRA=45.1) > CE (SUCRA=35.8) > RT (SUCRA= 8.5); DEPRESS: Yoga (SUCRA=74.6) > AE (SUCRA=66.3) > CT (SUCRA=53.0) > CE (SUCRA=49.9) > MBE (SUCRA=45.6) > RT (SUCRA=10.6), Qol-mh: Yoga (SUCRA=79.5) > MBE (SUCRA=68.5) > CE (SUCRA=53.9) > AE (SUCRA=46.4) > RT (SUCRA=1.8).
CONCLUSIONS: For females with multiple sclerosis, regular physical activity boosts physical function and psychological status outcomes. Among these activities, yoga is the most effective way to improve their psychological well-being.
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