Advertisement

The effect of therapeutic exercise on depressive symptoms in people with multiple sclerosis – A systematic review

Published:November 08, 2022DOI:https://doi.org/10.1016/j.msard.2022.104407

      Highlights

      • Depression is around 25 – 50% in people with MS.
      • Therapeutic exercise reduces depressive symptoms.
      • Robotic gait training and aerobic exercise are highly recommend.

      Abstract

      Background

      The prevalence of depressive symptoms in people with Multiple Sclerosis (MS) is around 25 – 50% and affects their daily life and general quality of life. Several studies investigating therapeutic exercise have shown highly beneficial effects in preventing or reducing depressive symptoms. The present systematic review was conducted to investigate randomized controlled trials on the effectiveness of therapeutic exercise programs on depressive symptoms in people with MS.

      Methods

      A search was performed in PubMed, Scopus, APA Psychnet and ResearchGate. The keywords used were: therapeutic exercise, physiotherapy, physiotherapy, physical therapy, rehabilitation, depression, depressive disorders and multiple sclerosis. In addition, specific inclusion and exclusion criteria were set and the study selection process was conducted by two separate reviewers. The quality of the final studies included in the systematic review was assessed using the PEDro scale.

      Results

      Out of the total of 934 studies initially identified, 9 studies were finally included. The results showed that physiotherapy interventions, through aerobic exercise, robotic-assisted gait training with or without virtual reality, aerobic exercise combined with Pilates, interval training, video-games and finally clinical Pilates, improve patients' depression and in many cases with much better results compared to classic physiotherapy type interventions.

      Conclusion

      The effect of therapeutic exercise has a positive impact on the depressive symptoms of people with MS. However, future research in this field is necessary to find the most proven curative forms to reduce depressive symptoms and improve the daily life of these patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ahmadi A.
        • Arastoo A.A.
        • Nikbakht M.
        • Zahednejad S.
        • Rajabpour M.
        Comparison of the effect of 8 weeks aerobic and yoga training on ambulatory function, fatigue and mood status in MS patients.
        Iran Red Crescent. Med. J. 2013; 15: 449-454
        • Bilek F.
        • Cetisli-Korkmaz N.
        • Ercan Z.
        • Deniz G.
        • Demir C.F.
        Aerobic exercise increases irisin serum levels and improves depression and fatigue in patients with relapsing remitting multiple sclerosis: a randomized controlled trial.
        Mult. Scler. Relat. Disord. 2022; 61103742
        • Bombardier C.H.
        • Ehde D.M.
        • Gibbons L.E.
        • Wadhwani R.
        • Sullivan M.D.
        • Rosenberg D.E.
        • Kraft G.H.
        Telephone-based physical activity counseling for major depression in people with multiple sclerosis.
        J. Consult. Clin. Psychol. 2013; 81: 89-99
        • Cakt B.D.
        • Nacir B.
        • Genç H.
        • Saraçoğlu M.
        • Karagöz A.
        • Erdem H.R.
        • Ergün U.
        Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study.
        Am. J. Phys. Med. Rehabil. 2010; 89: 446-457
        • Calabro R.S.
        • Russo M.
        • Naro A.
        • De Luca R.
        • Leo A.
        • Tomasello P.
        • Molonia F.
        • Dettola V.
        • Bramanti A.
        • Bramanti P.
        Robotic gait training in multiple sclerosis rehabilitation: can virtual reality make the difference? Findings from a randomized controlled trial.
        J. Neurol. Sci. 2017; 15: 25-30
        • Cantuti-Castelvetri L.
        • Fitzner D.
        • Bosch-Queralt M.
        • Weil M.T.
        • Su M.
        • Sen P.
        • Ruhwedel T.
        • Mitkovski M.
        • Trendelenburg G.
        • Lütjohann D.
        • Möbius W.
        • Simons M.
        Defective cholesterol clearance limits remyelination in the aged central nervous system.
        Science. 2018; 359: 684-688
        • Compston A.
        • Coles A.
        Multiple sclerosis.
        Lancet. 2008; 372: 1502-1517
        • Cotsapas C.
        • Mitrovic M.
        • Hafler D.
        Multiple sclerosis.
        Handb. Clin. Neurol. 2018; 148: 723-730
        • Dalgas U.
        • Stenager E.
        • Jakobsen J.
        • Petersen T.
        • Hansen H.J.
        • Knudsen C.
        • Overgaard K.
        • Ingemann-Hansen T.
        Fatigue, mood and quality of life improve in MS patients after progressive resistance training.
        Mult. Scler. 2010; 16: 480-490
        • Feinstein A.
        • Magalhaes S.
        • Richard J.F.
        • Audet B.
        • Moore C.
        The link between multiple sclerosis and depression.
        Nat. Rev. Neurol. 2014; 10: 507-517
        • Feinstein A.
        • Rector N.
        • Motl R.
        Exercising away the blues: can it help multiple sclerosis-related depression?.
        Mult. Scler. 2013; 19: 1815-1819
        • Grazioli E.
        • Tranchita E.
        • Borriello G.
        • Cerulli C.
        • Minganti C.
        • Parisi A.
        The Effects of Concurrent Resistance and Aerobic Exercise Training on Functional Status in Patients with Multiple Sclerosis.
        Curr. Sports Med. Rep. 2019; 18: 452-457
        • Hadjimichael O.
        • Kerns R.D.
        • Rizzo M.A.
        • Cutter G.
        • Vollmer T.
        Persistent pain and uncomfortable sensations in persons with multiple sclerosis.
        Pain. 2007; 127: 35-41
        • Jones C.D.
        • Motl R.
        • Sandroff B.M.
        Depression in multiple sclerosis: is one approach for its management enough?.
        Mult. Scler. Relat. Disord. 2021; 51102904
        • Kara B.
        • Küçük F.
        • Poyraz E.C.
        • Tomruk M.S.
        • İdıman E.
        Different types of exercise in Multiple Sclerosis: aerobic exercise or Pilates, a single-blind clinical study.
        J. Back Musculoskelet Rehabil. 2017; 30: 565-573
        • Krupp L.B.
        Fatigue in multiple sclerosis: definition, pathophysiology and treatment.
        CNS Drugs. 2003; 17: 225-234
        • Kucuk F.
        • Kara B.
        • Coskuner P.
        • Idiman E.
        Improvements in cognition, quality of life, and physical performance with clinical pilates in multiple sclerosis: a randomized controlled trial.
        J. Phys. Ther. Sci. 2016; : 761-768
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys. Ther. 2003; 83: 713-721
        • Moore P.
        • Hirst C.
        • Harding K.E.
        • Clarkson H.
        • Pickersgill T.P.
        • Robertson N.P.
        Multiple sclerosis relapses and depression.
        J. Psychosom. Res. 2012; 73: 272-276
        • Motl R.W.
        • Pilutti L.A.
        The benefits of exercise training in multiple sclerosis.
        Nat. Rev. Neurol. 2012; 8: 487-497
        • Negaresh R.
        • Motl R.
        • Mokhtarzade M.
        • Ranjbar R.
        • Majdinasab N.
        • Khodadoost M.
        • Zimmer P.
        • Baker S.J.
        • Patel D.
        Effect of Short-Term Interval Exercise Training on Fatigue, Depression, and Fitness in Normal Weight vs. Overweight Person With Multiple Sclerosis.
        End-to-end J. 2019; 15: 134-141
        • Ozdogar T.A.
        • Ertekin O.
        • Kahraman T.
        • Yigit P.
        • Ozakbas S.
        Effect of video-based exergaming on arm and cognitive function in persons with multiple sclerosis: a randomized controlled trial.
        Mult. Scler. Relat. Disord. 2020; 40101966
        • Ozkul C.
        • Guclu-Gunduz A.
        • Eldemir A.
        • Apaydin Y.
        • Yazici G.
        • Irkec C.
        Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: a single-blinded randomized controlled trial.
        Mult. Scler. Relat. Disord. 2020; 45102419
        • Ozsoy-Unubol T.
        • Ata E.
        • Cavlak M.
        • Demir S.
        • Candan S.
        • Yilmaz F.
        Effects of Robot-Assisted Gait Training in Patients With Multiple Sclerosis: a Single-Blinded Randomized Controlled Study.
        Am. J. Phys. Med. Rehabil. 2022; 101: 768-774
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • Boutron I.
        • Hoffmann T.C.
        • Mulrow C.D.
        • Shamseer L.
        • Tetzlaff J.M.
        • Akl E.A.
        • Brennan S.E.
        • Chou R.
        • Glanville J.
        • Grimshaw J.M.
        • Hróbjartsson A.
        • Lalu M.M.
        • Li T.
        • Loder E.W.
        • Mayo-Wilson E.
        • McDonald S.
        • McGuinness L.A.
        • Stewart L.A.
        • Thomas J.
        • Tricco A.C.
        • Welch V.A.
        • Whiting P.
        • Moher D.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: 71
        • Patten S.B.
        • Marrie R.A.
        • Carta M.G.
        Depression in multiple sclerosis.
        International Rev. Psychiatry. 2017; 29: 463-472
        • Rizzo M.A.
        • Hadjimichael O.C.
        • Preiningerova J.
        • Vollmer T.L.
        Prevalence and treatment of spasticity reported by multiple sclerosis patients.
        Mult. Scler. 2004; 10: 589-595
        • Russo M.
        • Dattola V.
        • De Cola M.C.
        • Logiudice L.A.
        • Porcari B.
        • Cannavo A.
        • Sciarrone F.
        • De Luca R.
        • Molonia F.
        • Sessa E.
        • Bramanti P.
        • Calabro S.R.
        The role of robotic gait training coupled with virtual reality in boosting the rehabilitative outcomes in patients with multiple sclerosis.
        Int. J. Rehabil. Res. 2018; 41: 166-172
        • Solaro C.
        • Gamberini G.
        • Masuccio F.G.
        Depression in Multiple Sclerosis: epidemiology, Aetiology, Diagnosis and Treatment.
        CNS Drugs. 2018; 32: 117-133
        • Straudi S.
        • Fanciullacci C.
        • Martinuzzi C.
        • Pavarelli C.
        • Rossi B.
        • Chisari C.
        • Basaglia N.
        The effects of robot-assisted gait training in progressive multiple sclerosis: a randomized controlled trial.
        Mult. Scler. 2015; 22: 373-384
        • Straudi S.
        • Manfredini F.
        • Lamberti N.
        • Martinuzzi C.
        • Maietti E.
        • Basaglia N.
        Robot-assisted gait training is not superior to intensive overground walking in multiple sclerosis with severe disability (the RAGTIME study): a randomized controlled trial.
        Multiple Sclerosis J. 2019; 26: 716-724
        • Winkelmann A.
        • Engel C.
        • Apel A.
        • Zettl U.K.
        Cognitive impairment in multiple sclerosis.
        J. Neurol. 2007; 254: II35-II42
      1. World Health Organization. Depression. [Online]. Available at the following address: https://www.who.int/health-topics/depression#tab=tab_1 [accessed 10 May 2022].

        • Yamout B.I.
        • Alroughani R.
        Multiple Sclerosis.
        Semin. Neurol. 2018; 38: 212-225