Objective
Numerous studies have demonstrated the beneficial effects of exercise on cognitive function in individuals with multiple sclerosis. However, existing research findings are inconsistent, and no study has yet identified which type of exercise yields the most favourable outcomes. This study aims to investigate the impact of exercise type on cognitive function and specific cognitive domains in individuals with multiple sclerosis.
Methods
We searched the electronic databases PubMed, Web of Science, EBSCO, Cochrane, and Scopus up to 20 June 2025 for this systematic review and network meta-analysis. The PEDro tool was employed to assess the methodological quality of the included studies. The continuous outcomes were analysed by calculating the standardised mean difference (SMD) with 95% confidence intervals (CI).
Results
This review included 35 randomised controlled trials involving 1612 participants. Several exercise interventions improved global cognitive function: multicomponent exercise programme (SMD = 0.53, 95% CI 0.16-0.89), mind-body exercise (SMD = 0.44, 95% CI 0.14-0.74), exergaming (SMD = 0.34, 95% CI 0.10-0.59), and multicomponent exercise (SMD = 0.42, 95% CI 0.03-0.81) and mind-body exercise (SMD = 0.33, 95% CI 0.01-0.66) demonstrated superior effects compared to aerobic exercise. Information processing speed: exergaming (SMD = 0.40, 95% CI 0.15, 0.65) significantly improved MS processing speed compared to usual care (UC). Furthermore, compared to aerobic exercise (SMD = 0.37, 95% CI 0.09, 0.66) and stretching exercise (SMD = 0.58, 95% CI 0.04, 1.12), exergaming demonstrated superior improvement effects. Memory: endurance training (SMD = 0.66, 95% CI 0.21, 1.12) and multicomponent exercise programme (SMD = 0.66, 95% CI 0.06, 1.27) demonstrated superior improvements in MS memory function compared to UC. Endurance training showed greater efficacy than aerobic exercise (SMD = 0.39, 95% CI 0.00, 0.78) and stretching exercise (SMD = 0.70, 95% CI 0.01, 1.40). Executive function: balance training (SMD = 0.74, 95% CI 0.00, 1.47), exergaming (SMD = 0.46, 95% CI 0.08, 0.83), and aerobic exercise (SMD = 0.42, 95% CI 0.13, 0.71) significantly improved MS executive function compared to UC.
Conclusion
A multicomponent training programme combining aerobic and resistance exercise represents the most effective intervention for enhancing global cognitive function in patients with multiple sclerosis. Furthermore, exergaming, endurance training, and balance training are most effective in improving information processing speed, memory function, and executive function in MS patients.