Exploring the Impact of Physical Exercise on Cognitive Function in Multiple Sclerosis: A Systematic Review and Meta-analysis.

Introduction: Cognitive impairment is a common and disabling symptom in individuals with multiple sclerosis (MS), prompting interest in interventions such as exercise training to improve cognitive function. Despite growing research in this area, the overall impact of exercise on cognitive performance in MS patients remains unclear.

Objectives: This literature review aims to investigate the effects of physical activity and exercise on cognitive function in individuals with MS.

Methods: A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane databases up to April 2024. The study focused on aerobic exercise interventions and their impact on the Symbol Digit Modalities Test (SDMT) score in MS patients. Inclusion criteria were restricted to randomized controlled trials (RCTs) examining cognitive outcomes in MS. Two independent reviewers extracted relevant data, including patient characteristics and intervention details. Data synthesis utilized random or fixed-effects models among included studies.

Results: The meta-analysis comprised 5 RCTs involving 608 patients, with the SDMT score as the primary outcome measure. Patient subgroups were analyzed based on follow-up duration and Expanded Disability Status Scale (EDSS) score (≤ 4 points or > 4 points). Significant improvements in SDMT scores were observed among MS patients engaging in aerobic exercise for 24 weeks (mean difference = 5.9, 95% CI 1.90 to 9.90; p < 0.01; I2 = 0%; Figure 1). When stratified by EDSS score, no statistically significant difference was found (mean difference = 1.7, 95% CI -1.40 to 4.80; p = 0.16; I2 = 43%; Figure 2), although patients with an EDSS score ≤ 4 points showed higher SDMT scores.

Conclusion: 

The findings support aerobic exercise as a promising intervention for managing cognitive impairment in individuals with MS, particularly with longer-term interventions. Further research is warranted to elucidate the optimal exercise parameters and long-term effects on cognitive function in this population.