Exercise therapy for fatigue in multiple sclerosis

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. Primary objectives The primary objectives of this review are as follows. 1.1 To determine the immediate (i.e. postintervention; 1.1a) and long-term (i.e. follow-up; 1.1b) benefits of exercise therapy, when compared to a control group, on self-reported fatigue in people with MS; and 1.2 To specifically determine the immediate and long-term benefits of exercise therapy, when compared to a control group, on self-reported fatigue when only clinical trials are considered in which (1.2a) self-reported fatigue was the primary outcome and (1.2b) only people with MS with predefined levels of self-reported fatigue were included. Secondary objectives The following secondary objectives will be pursued; each relevant to people with MS, clinicians and academics. Safety 2.1 To determine the safety of exercise therapy, when compared to a control group, as determined by an exploratory review of reported adverse effects over the course of the intervention phase. 2.2 To confirm the safety of exercise therapy, when compared to a control group, as determined by a confirmatory review of reported MS exacerbations, falls, and overuse injuries over the course of the intervention phase. Intervention characteristics 3.1 Determine the immediate and long-term differential impact of different exercise therapy modalities on self-reported fatigue (e.g. aerobic training). 3.2 Explore the relationship between dose of exercise therapy (an agglomeration of frequency, time per session, and program duration) and the immediate and long-term benefits of exercise therapy on fatigue. 3.3 Explore the relationship between features of exercise therapy programs (e.g. progression, overload, specificity) and the immediate and long-term benefits of exercise therapy on fatigue. Participant characteristics 4.1 Determine the impact of baseline fatigue levels on the immediate and long-term benefits of exercise therapy on fatigue. 4.2 Determine the impact of baseline levels of disease severity (i.e. Expanded Disability Status Scale [EDSS]) on the immediate and long-term benefits of exercise therapy on fatigue. Study design characteristics 5.1 Determine the impact of the specific self-reported fatigue measure (e.g. Fatigue Severity Scale) on the immediate and long-term benefits of exercise therapy on fatigue. 5.2 Determine the impact of methodological quality (i.e. risk of bias) and (self-reported) pilot studies, on the immediate and long-term benefits of exercise therapy on fatigue. 5.3. Determine the impact of the type of control group on the immediate and long-term benefits of exercise therapy on fatigue.