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Measurements and management of multiple sclerosis-related fatigue: an umbrella review and meta-analysis.

Hawas Y, Abdelmageed A, Abouzid M, Hamad AA, El-Moslemani M, Saeed HT et al. · Disability and rehabilitation · 2026

Researchers pooled 46 systematic reviews (covering 287 studies) on treatments for fatigue caused by multiple sclerosis, including drugs, exercise, psychological therapies, and brain stimulation. Exercise gave the most consistent benefit \u2014 aerobic training a modest reduction (SMD -0.32) with larger but less consistent effects for resistance training (-1.09) and yoga/mind-body work (-0.70) \u2014 while CBT and mindfulness gave small-to-moderate gains, vitamin D a small one (-0.18), and transcranial direct current stimulation a significant short-term effect (-1.02); the authors caution the underlying reviews were generally low quality.
Takeaway: Use structured exercise (aerobic plus resistance or yoga), ideally paired with CBT or mindfulness, to manage MS-related fatigue.
Abstract (source)

Purpose: This study

Aims: to synthesize and appraise systematic reviews with meta-analyses that assessed pharmacological, non-pharmacological, and neuromodulatory interventions for MS-related fatigue. Material and

Methods: PubMed, WOS, Scopus, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched till Nov 2025. Effect sizes are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Methodological quality was graded with AMSTAR-2. An exploratory meta-meta-analysis was also performed.

Results: Forty-six systematic reviews with meta-analyses covering 287 primary studies were included. Exercise provided the most consistent benefit: aerobic training produced a modest but reliable reduction in fatigue (SMD -0.32), while resistance exercise (-1.09) and yoga/mind-body formats (-0.70) showed larger but more heterogeneous effects. Cognitive behavioral therapy (CBT) and mindfulness/acceptance therapies yielded small to moderate improvements, while energy-conservation education showed a modest benefit. Vitamin D supplementation yielded a small effect (-0.18). Among neuromodulation approaches, transcranial direct current stimulation demonstrated a significant short-term impact (-1.02).

Conclusion: Structured exercise supported by CBT or mindfulness offers the most clinically meaningful relief from MS-related fatigue. Future RCTs should adopt longer follow-up, and use standardized outcome fatigue scales. These

Conclusions: should be interpreted considering the generally low methodological quality of the included reviews.

Systematic review / meta-analysisEndurance & Cardiovascular
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