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Multiple sclerosis (MS) is an autoimmune disease in which fatigue is one of the most frequent and disabling symptoms, and it is believed to be associated with respiratory involvement. Individuals who are physically inactive for long lengths of time display greater symptomatic fatigue. The objective of this systematic review was to analyze the effectiveness of breathing exercises within rehabilitation programs in improving fatigue in patients with MS. A systematic search of electronic databases, including PubMed, Web of Science, Scopus, and PEDro, was conducted up until November 2022. Nine articles, with a total of 290 participants, were selected. The studies combined breathing exercises with other treatment techniques, such as Ai-Chi, Pilates, and upper and lower limb exercises. Four studies used the Modified Fatigue Severity scale, observing a reduction in the perception of fatigue, in favor of the experimental group. Incorporating respiratory exercises into physical exercise programs, such as Ai-Chi and Pilates, may help to reduce the perception of fatigue. However, the heterogeneity in the protocols and outcome measures makes the generalization of the results difficult. Nonetheless, further studies that include specific respiratory variables are needed to analyze whether this perceived improvement is associated with enhanced pulmonary capacity. [ABSTRACT FROM AUTHOR]