Effects of Aerobic and Strengthening Exercise Combined with Behaviour Change Interventions in Fatigue Management of People with Multiple Sclerosis(pwMS).


Fatigue is one of the more debilitating symptoms as it affects the ability to carry out daily activities. Despite the increasing evidence for the effectiveness of exercise and behavioural change interventions for fatigue management in pwMS, there have been no published critical review that has investigated a combination of exercise and behavioural change interventions. This review aims to investigate the effect of aerobic and strengthening exercise combined with behavioural change interventions in fatigue management in pwMS.


A literature search was conducted in December 2018 via electronic databases. Studies included 1) pwMS aged 18 years and above; 2) intervention used combination of aerobic and strengthening exercise and behavioural change intervention (social cognitive theory, behavioural therapy or education that included increasing patient's knowledge of MS fatigue and promoting changes to lifestyle); 3) measured valid outcome measures such as MFIS, FSS, WEIMuS; 4) published after2008; 5) randomised controlled trials and non-randomised controlled trials. Studies excluded non-English articles, case studies, books, reviews and abstracts. The PEDro scale was used to evaluate the methodological quality of the studies.



Seven articles were selected for full text review; two articles were part of the same study and were combined in the results. Five studies were randomised controlled trials and one was a non-randomised controlled trial. PEDro scores ranged from 5 to 8. Of the six studies, combined exercise interventions were delivered within supervised and/or home sessions with additional face to face, newsletter/leaflets to facilitate behaviour change. The total number of participants included was 346 and the length of the interventions ranged from 10 to 40 weeks. Three studies found significant short and long term improvements in fatigue following the intervention.

Overall, the effects of exercise combined with behavioural change on fatigue in people with MS are inconclusive. Further powered randomised controlled studies are required to explore the effects of exercise and behaviour change on fatigue.Furthermore, studies could investigate the effects of differing intensities and modes of delivery of exercise and behavioural change interventions across the disability spectrum.


Physiotherapists should consider aerobic and strengthening exercise combined with behavioural change interventions to manage fatigue in pwMS.

Funding acknowledgements

This project was not funded by any organisation.

Additional notes

This work was presented at Physiotherapy UK 2019