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Volume 10, Issue 1 (Spring 2023)                   J Prevent Med 2023, 10(1): 20-35 | Back to browse issues page

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Akbari H, Abedi A, Ghofrani M, Seyedahmadi M. Effect of Regular Physical Activity on BDNF and IL-17 Factors in Patients With Multiple Sclerosis: A Meta-analysis Study. J Prevent Med 2023; 10 (1) :20-35
URL: http://jpm.hums.ac.ir/article-1-670-en.html
Effect of Regular Physical Activity on BDNF and IL-17 Factors in Patients With Multiple Sclerosis: A Meta-analysis Study
Hadi Akbari * 1, Ali Abedi2 , Mohsen Ghofrani2 , Mohammad Seyedahmadi3
1- Department of Sport Sciences, Faculty of Literature and Humanities, University of Zabol, Zabol, Iran.
2- Department of Sport Sciences, Faculty of Educational Sciences and Psychology, University of Sistan & Baluchestan, Zahedan, Iran.
3- Department of Sport Sciences, Faculty of Humanities, Velayat University, Iranshar, Iran.
Keywords: Physical activity, Cytokines, Interleukin-17, Brain-derived neurotrophic factor, Multiple sclerosis
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Introduction
One of the progressive chronic neurological diseases with high prevalence is multiple sclerosis (MS). Although the pathological cause of MS is still unknown, it is probably a multifactorial disease caused by the interaction of heredity and several environmental factors. The clinical courses of MS follow four distinct patterns: Relapsing-remitting, primary progressive, secondary progressive, and progressive-relapsing (very rare). The relapsing-remitting type accounts for about 65-89% of MS cases. The level of disability in people with MS is usually assessed by the expanded disability status scale (EDSS) and is graded according to the level of neurological damage from 0 (normal brain function) to 10 (death due to MS).
The balance of cytokines especially brain-derived neurotrophic factor (BDNF) and interleukin-17 (IL-17), is related to MS disease and undergoes changes in such a way that the inflammatory/anti-inflammatory balance of the body leads to an increase in inflammation. Many interventions, including regular physical activity, have been proposed to control the course of MS. This study aims to conduct a meta-analysis of studies on the effectiveness of regular physical activity on BDNF and IL-17 levels in MS patients.

Methods
Articles were searched in international databases including Scopus, ScienceDirect, PubMed and Web of Science and national databases including SID, Magiran and IranDoc for studies published until April 2021 using the keywords multiple sclerosis, MS, exercise, physical activity, inflammatory and anti-inflammatory factors, training, and cytokines. All found articles were entered into the EndNote software and duplicate articles were removed. After removing duplicates, all titles and abstracts were examined to find articles related to the research goal. The studies that were conducted only on MS patients (regardless of gender and age of the patients), examined the effect of regular physical activity in MS patients, evaluated IL-17 and BDNF factors, published in English or Persian, and had available full texts were included. The exclusion criterion was the use of other methods and interventions (medicine or supplementation during the training period). Initial search yielded 1353 articles. After removing duplicates, 408 articles were screened based on the title and abstract, and 138 studies remained. Based on the entry and exit criteria, 30 complete articles were finally selected. Data collection, analysis and interpretation of findings were based on the PRISMA technique. Results related to IL-17 and BDNF in studies were extracted. The Mean±SD of the scores for the samples were also recorded and the significance of the difference between the means was investigated. For the accuracy in selecting and refining the quality assessment of the studies, the Physiotherapy Evidence Database (PEDro) was used. Comprehensive meta-analysis (CMA) software, version 3 was used for meta-analysis. 

Results
After following the procedures for meta-analysis studies, 9 articles out of 30 articles (6 articles for BDNF and 3 studies for IL-17) were subjected to quantitative analysis. Of the three studies that investigated the effect of regular physical activity on IL-17, one study reported a decrease, one study reported no change, and one study reported an increase in IL-17 level at baseline. The meta-analysis results showed that regular physical activity did not significantly increase the difference between the control and experimental groups in IL-17 (I2=11.171%, P=0.324). Of the six studies that investigated the effect of regular physical activity on BDNF, two studies reported an increase and four studies reported a decrease in BDNF level at baseline. The meta-analysis results of these studies showed that there was no significant difference in the mean BDNF level between the experimental and control groups in these studies (I2=0.00%, P=0.466). As a result, the meta-analysis results showed that regular physical activity could not cause significant changes in people with MS.

Discussion
The results of this meta-analysis study showed that inflammatory responses in MS patients are probably not significantly reduced by regular physical activity. Regular physical activity can be used as a complementary treatment to regulate the behavior of the immune system in MS patients. The effect of regular physical activity in these patients is not only determined by the basic changes in the serum or plasma levels of cytokines; despite of non-significant change in the levels of cytokines, the disability status and clinical results of patients can be improved. No studies have been found that report a negative effect of exercise or that regular physical activity leads to increased inflammation or disease severity. To better understand and quantify the role of regular physical activity on some inflammatory and anti-inflammatory factors in MS patients, methodological weaknesses (e.g. small samples size, using only women as samples, non-uniformity of sampling time, heterogeneity of the study population, incompatibility of the intensity and type of exercises with the patient’s disability level, and using inappropriate kits in terms of accuracy and sensitivity) should be solved and studies with larger sample size and longer duration are needed.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research. 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Literature Search: Hadi Akbari, Ali Abedi and Mohammad Seyedahmadi; Meta-analysis: Mohammad Seyedahmadi; Resources: Hadi Akbari, Ali Abedi; Data curation: Hadi Akbari, Ali Abedi and Mohammad Seyedahmadi; Writing–original draft preparation: Hadi Akbari and Ali Abedi; Review & editing: All authors.

Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Review | Subject: General
Received: 2022/10/24 | Accepted: 2022/11/23 | Published: 2023/07/1
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