Effect of Mind Body Exercises on Fatigue, Balance, and Quality of Life in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Purpose: Mind-body exercises (MBEs) such as Yoga and Pilates, which are increasingly used in the rehabilitation of patients with MS (pwMS), are moderate aerobic exercises that include stretching and relaxation in skeletal muscle, physical coordination training, breathing, movement control, and attention regulation. This study aims to investigate the effects of MBEs on fatigue, balance, and health-related quality of life (HRQoL) in pwMS. Methods: PubMed, Science Direct, Web of Science, and Ulakbim databases were searched. Search, selection, and data extraction from the studies were performed by two independent reviewers. The random effects model for meta-analysis, reporting effect sizes as Standardized Mean Difference (SMD) was used in this meta-analysis. Results: This meta-analysis included 19 randomized controlled clinical trials with 791 participants in total. No statistically significant difference was detected between MBEs and physical exercise in terms of fatigue (SMD: 0.14, 95% CI=–0.07, 0.34, I2=0%) and balance (SMD: 0.51, 95% CI=0.00, 1.02, I2=73%) in pwMS. MBEs are more effective compared to no exercise for improving fatigue (SMD: 0.82, 95% CI = –1.23, –0.41, I2=71%) and balance (SMD: 1.36, 95% CI = 0.39, 2.32, I2=88%) but not physical (SMD: 0.04, 95% CI = –0.42, 0.34, I2=0%) or mental HRQoL (SMD: 0.04, 95% CI = –0.42, 0.34, I2=0%) in pwMS. Conclusion: This meta-analysis concluded that MBEs may be considered a feasible alternative to physical exercise for managing fatigue and balance in pwMS. MBEs showed greater benefits compared to no exercise. MBEs did not provide any additional benefit on HRQoL.