PeerJ Reviewer Match - Exercise with NIBS for fatigue

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Effects of exercise combined with non-invasive brain stimulation on fatigue and psychological status among patients with multiple sclerosis: A meta-analysis of randomised controlled trials

Abstract

Background. Multiple sclerosis (MS) stands as the foremost cause of non-traumatic neurological disability around the world. This review employed a meta-analysis approach to assess the effects of exercise with non-invasive brain stimulation (NIBS) on anxiety, fatigue, and depression in patients with MS.

Methodology. Four databases were searched for randomized controlled trials (RCTs) from January 2005 to November 2025. Eligible studies were RCTs comparing exercise with NIBS (SG) with exercise with sham stimulation (CG) in MS patients, with pre- and post-intervention assessment of fatigue, anxiety, or depression.

Results. The findings from the meta-analysis indicated that SG experienced a more pronounced reduction in fatigue than CG [SMD = -1.11 (95% CI, -1.45, -0.78), P < 0.05, I ² = 0%]. Subgroup analysis also revealed that tDCS [SMD = -1.23 (95% CI, -1.62, -0.84), P < 0.05, I ² = 0%] and iTBS [SMD = -0.76 (95% CI, -1.44, -0.07), P = 0.03, I ² = 0%] interventions considerably enhanced fatigue. Likewise, two articles examined the impact of SG and CG on anxiety and depression in patients experiencing MS (Figure 4). Although SG notably lowered anxiety [SMD = -1.16 (95% CI, -1.73, -0.58), P < 0.05, I ² = 0%], it had no impact on depression [SMD = -3.61 (95% CI, -10.51, 3.29), P = 0.31, I ² = 95%] compared to CG.

Conclusions. This review demonstrated that exercise with NIBS could alleviate fatigue and anxiety in patients experiencing MS. Collectively, the exercise with NIBS intervention could represent a potentially more time-efficient non-pharmacological approach for managing MS.

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