Physical activity improves cardiovascular fitness and reduces cardiovascular risk factors in adults with multiple sclerosis: A systematic review and meta-analysis

Background: Physical activity is known to be vital for cardiovascular health in the general population, but there is no comprehensive review on the effectiveness of physical activity to modify cardiovascular risk in multiple sclerosis (MS). This systematic review and meta-analysis aims to synthesize the evidence regarding the effectiveness of physical activity programs on modifying traditional cardiovascular risk factors in adults with MS.

Methods: Six electronic databases (PubMed, Scopus, Web of Science, CINAHL, Embase, and SPORTDiscuss) provided literature from inception until August 2024. Randomized clinical trials examining physical activity interventions vs control (no intervention/alternative physical activity modality) and targeting cardiovascular risk factors in adults with MS were included. Study screening and quality was assessed using the Cochrane risk of bias tool were conducted by two independent reviewers. Meta-analysis was conducted using RevMan 5.3.

Results: Thirty studies were included in the qualitative synthesis and 21 were included in the meta-analysis involving 1,052 participants. Significant improvements in cardiovascular fitness indicators such as VO2 peak, mean difference [MD] = 166.77; 95 % CI: 62.77 to 272.77; P = 0.002, and HR peak [MD] = 3.02; 95 % CI: 1.16 to 4.87; P = 0.001, and peak power output [MD] = 24.28; 95 % CI: 5.73 to 42.83; P = 0.01 were observed. Physical activity was also effective at reducing traditional cardiovascular disease (CVD) risk factors of triglycerides [MD] = -13.64; 95 % CI:9.36 to -17.92; P < 0.00001 and LDL-cholesterol [MD] = -6.61; 95 % CI:8.82 to -4.40; P < 0.00001 and total cholesterol [MD] = -8.35; 95 % CI:15.26 to -1.45; P = 0.02 and resulted in a significant decrease in body fat percentage [MD] = -1.56; 95 % CI:2.36 to -0.76; P = 0.0001.

Conclusions: Physical activity appears beneficial in improving cardiovascular fitness and managing some traditional CVD risk factors in adults with MS. Tailored interventions such as Pilates, aerobic exercise, and combined aerobic and resistance training warrant further investigation due to their positive outcomes.