Exploring the effectiveness of circuit training rehabilitation on balance, gait, and fatigue in multiple sclerosis: a systematic review and meta-analysis

Abstract

Background

People with Multiple Sclerosis (PwMS) often experience imbalance, gait dysfunction, and fatigue. Circuit Training (CT) can be viable for improving balance, gait, and fatigue in MS. To the author’s knowledge, no studies have systematically reviewed the existing literature evaluating the effectiveness of CT in PwMS.

Objectives

To investigate the effectiveness of CT in improving balance, gait, and reducing fatigue in PwMS and provide a quantitative and qualitative synthesis of Randomized Controlled Trials (RCTs).

Data sources

MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Google Scholar, and PEDro Database (Dec 2021 to May 2024).

Study selection

RCTs using CT in PwMS including balance, gait, or fatigue outcomes.

Data synthesis

Search inclusion criteria were: i) available full text, ii) CT rehabilitation, iii) balance, gait, or fatigue measured as outcomes, and iv) articles in English. Full text articles were analyzed by two screeners. If there was disagreement regarding inclusion, a further reviewer was consulted. No discrepancies were found.

Results

We identified 878 studies, 14 studies were eligible including 716 PwMS with a mean (standard deviation) age of 49.9 (10.9) years, disease duration of 10.8 (7.2) years, and Expanded Disability Status Scale score of 4.3 (0.9) points. RevMan 5.4.1 was used to run the meta-analysis. We found a significant overall effect on Berg Balance Scale (Mean Difference (MD) = 6.07 points, 95%CI:1.40,10.75; p = 0.01) and in Fatigue Severity Scale (MD = 0.98 points, 95%CI:0.30,1.66; p = 0.005) in favor of CT. We did not find a significant effect in Timed Up and Go (MD = 0.46 second, 95%CI:−0.04,0.96; p = 0.07), in Six-Minute Walk Test (MD = 17.46 m, 95%CI:−8.06,42.97; p = 0.18), and in Modified Fatigue Impact Scale (MD = 3.34 points, 95%CI:−0.41,7.09; p = 0.08) in favor of CT. We assessed methodological quality using RoB 2.0, and quality of evidence using GRADE.

Limitations

Small number of studies, all identifying having some risk of bias.

Conclusion

Circuit training can have positive effects on PwMS in terms of increasing balance, gait, and reducing fatigue. Further research is needed.

Systematic Review Registration Number

PROSPERO CRD42021286834.

Contribution of the Paper

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  Circuit training rehabilitation seems to be an effective option for the treatment of balance, gait, and fatigue in people with Multiple Sclerosis.
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  Circuit training rehabilitation comprising balance and resistance exercises may improve balance and reduce fatigue symptoms in People with Multiple Sclerosis with mild to moderate levels of disability.
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  Future studies with higher quality are recommended.