Effects of meeting exercise guidelines on depression and anxiety in multiple sclerosis - a systematic review and meta-analysis.

Seven of the twelve included studies had a high risk of bias, particularly in randomization and missing outcome data, which reduces the reliability of the pooled results. The number of studies analyzing anxiety was very small (only two), leading to imprecise estimates and inconclusive findings. Most participants had relapsing-remitting MS (RRMS), so the findings may not generalize to those with secondary or primary progressive MS. Control groups varied widely (waitlist vs. active non-exercise), making it difficult to isolate the specific effect of meeting PAG-MS guidelines compared to other interventions. The MCID for some tools was estimated rather than established, introducing uncertainty into the assessment of clinical significance.

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Do not interpret the null result for anxiety as evidence that exercise is ineffective for anxiety. The finding was based on only two studies with high heterogeneity and no prescreening for elevated anxiety levels, so the true effect remains unknown.