This systematic review and meta-analysis examines the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with multiple sclerosis (MS). The study included 40 randomized controlled trials (RCTs) involving a total of 56 exercise groups and 40 control groups, with a combined sample size of 1,300 and 827 participants, respectively. The meta-analysis found that exercise significantly improved balance (Berg Balance Scale and Timed Up and Go test), walking ability (Multiple Sclerosis Walking Scale-12), walking endurance (6-Minute Walk Test), fatigue (Fatigue Severity Scale and Modified Fatigue Impact Scale), and quality of life (Multiple Sclerosis Quality of Life-54). Subgroup analyses revealed that younger age was associated with greater improvements in fatigue, and resistance exercise and aerobic exercise were the most effective interventions for improving fatigue and quality of life, respectively. The study concludes that exercise has beneficial effects on various aspects of MS, with resistance and aerobic exercises being the most effective interventions.This systematic review and meta-analysis examines the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with multiple sclerosis (MS). The study included 40 randomized controlled trials (RCTs) involving a total of 56 exercise groups and 40 control groups, with a combined sample size of 1,300 and 827 participants, respectively. The meta-analysis found that exercise significantly improved balance (Berg Balance Scale and Timed Up and Go test), walking ability (Multiple Sclerosis Walking Scale-12), walking endurance (6-Minute Walk Test), fatigue (Fatigue Severity Scale and Modified Fatigue Impact Scale), and quality of life (Multiple Sclerosis Quality of Life-54). Subgroup analyses revealed that younger age was associated with greater improvements in fatigue, and resistance exercise and aerobic exercise were the most effective interventions for improving fatigue and quality of life, respectively. The study concludes that exercise has beneficial effects on various aspects of MS, with resistance and aerobic exercises being the most effective interventions.