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Safety of exercise training in multiple sclerosis: A protocol for an updated systematic review and meta-analysis

Learmonth, Y.C.ORCID: 0000-0002-4857-8480, Pilutti, L.A., Herring, M.P., Motl, R.W., Chan, B.ORCID: 0000-0001-5032-2815 and Metse, A.P.ORCID: 0000-0002-8641-1024 (2021) Safety of exercise training in multiple sclerosis: A protocol for an updated systematic review and meta-analysis. Systematic Reviews, 10 . Article number: 208.

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There has been an exponential growth in the number of clinical research studies regarding exercise training in multiple sclerosis, and literature reviews and meta-analyses have documented the many benefits of exercise training. This research further requires careful review for documenting the safety of exercise training in multiple sclerosis, as clarity on safety represents a major hurdle in the clinical prescription of exercise behaviour.


To enhance understanding of the feasibility of exercise in multiple sclerosis, we (1) provide a protocol of a systematic review and meta-analysis that summarises rates and risks of clinical relapse, adverse events (i.e., an unfavourable outcome that occurs during the intervention delivery time period), and serious adverse events (i.e., an untoward occurrence that results in death or is life threatening, requires hospitalisation, or results in disability during the intervention delivery time period), as well as retention, adherence, and compliance, from randomised controlled trials of exercise training in persons with multiple sclerosis; and (2) identify moderators of relapse, adverse events, and serious adverse event rates.


Eight field-relevant databases will be searched electronically. Studies that involve a randomised controlled trial of exercise training (with non-exercise, non-pharmacological, comparator), report on safety outcomes, and include adults with multiple sclerosis will be included. Rates and relative risks of the three primary outcomes (relapse, adverse event, and serious adverse event) will be calculated and reported each with standard error and 95% confidence interval. Random-effects meta-analysis will estimate mean population relative risk for outcomes. Potential sources of variability, including participant characteristics, features of the exercise stimulus, and comparison condition, will be examined with random-effects meta-regression with maximum likelihood estimation.


The results from this systematic review and meta-analysis will inform and guide healthcare practitioners, researchers, and policymakers on the safety of exercise training in persons with multiple sclerosis. Where possible, we will identify the impact of exercise type, exercise delivery style, participant disability level, and the prescription of exercise guidelines, on the safety of exercise training. The result will identify critical information on the safety of exercise in persons with multiple sclerosis, while also identifying gaps in research and setting priorities for future enquiries.

Item Type: Journal Article
Murdoch Affiliation(s): Psychology, Counselling, Exercise Science and Chiropractic
Centre for Healthy Ageing
Centre for Molecular Medicine and Innovative Therapeutics (CMMIT)
Health Futures Institute
Library & Information Services
Publisher: BioMed Central Ltd as part of Springer Nature
Copyright: © The Author(s). 2021
United Nations SDGs: Goal 3: Good Health and Well-Being
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