Sage Journals: Discover world-class research

Abstract

Background:

Exercise may have beneficial effects on both well-being and walking ability in multiple sclerosis (MS). Exercise is shown to be neuroprotective in rodents and may also enhance cognitive function in humans. It may, therefore, be particularly useful for MS patients with pronounced neurodegeneration.

Objective:

To investigate the potential of standardized exercise as a therapeutic intervention for progressive MS, in a randomized-controlled pilot trial.

Methods:

Patients with progressive MS and moderate disability (Expanded Disability Status Scale (EDSS) of 4–6) were randomized to one of three exercise interventions (arm ergometry, rowing, bicycle ergometry) for 8–10 weeks or a waitlist control group. We analyzed the drop-out rate as a measure of feasibility. The primary endpoint of the study was aerobic fitness. Secondary endpoints were walking ability, cognitive function as measured by a neuropsychological test battery, depression and fatigue.

Results:

A total of 42 patients completed the trial (10.6% drop-out rate). Significant improvements were seen in aerobic fitness. In addition, exercise improved walking ability, depressive symptoms, fatigue and several domains of cognitive function.

Conclusion:

This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Larger exercise studies are needed to confirm the effect on cognition.

Trial Registration:

ISRCTN (trial number 76467492) http://isrctn.org

Keywords

Aerobic exercise clinical trial cognition depression fatigue fitness motor function multiple sclerosis progressive multiple sclerosis rehabilitation walking ability

Get full access to this article

View all access options for this article.

References

Comi

. Effects of disease modifying treatments on cognitive dysfunction in multiple sclerosis. Neurol Sci 2010; 31: S261–264.

Amato

Langdon

Montalban

. Treatment of cognitive impairment in multiple sclerosis: Position paper. J Neurol 2012; 260(6):1452–1468.

Benedict

Zivadinov

. Risk factors for and management of cognitive dysfunction in multiple sclerosis. Nat Rev Neurol 2011; 7: 332–342.

Rosti-Otajarvi

Hamalainen

. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Rev 2011: CD009131.

Mullard

. Success of immunomodulators in MS shifts discovery focus to neuroprotection. Nat Rev Drug Discov 2011; 10: 885–887.

Cotman

Berchtold

Christie

. Exercise builds brain health: Key roles of growth factor cascades and inflammation. Trends Neurosci 2007; 30: 464–472.

Smith

Blumenthal

Hoffman

. Aerobic exercise and neurocognitive performance: A meta-analytic review of randomized controlled trials. Psychosom Med 2010; 72: 239–252.

Motl

Pilutti

. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol 2012; 8(9):487–497.

Petajan

Gappmaier

White

. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996; 39: 432–441.

10.

Snook

Motl

. Effect of exercise training on walking mobility in multiple sclerosis: A meta-analysis. Neurorehabil Neural Repair 2009; 23: 108–116.

11.

Motl

Gosney

. Effect of exercise training on quality of life in multiple sclerosis: A meta-analysis. Mult Scler 2008; 14: 129–135.

12.

Rossi

Furlan

De Chiara

. Exercise attenuates the clinical, synaptic and dendritic abnormalities of experimental autoimmune encephalomyelitis. Neurobiol Dis 2009; 36: 51–59.

13.

Fox

Thompson

Baker

. Setting a research agenda for progressive multiple sclerosis: The International Collaborative on Progressive MS. Mult Scler 2012; 18: 1534–1540.

14.

Polman

Reingold

Banwell

. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol 2011; 69: 292–302.

15.

Lublin

Reingold

. Defining the clinical course of multiple sclerosis: Results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46: 907–911.

16.

Thomas

Reading

Shephard

. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sport Sci 1992; 17: 338–345.

17.

Vickers

. How to randomize. J Soc Integr Oncol 2006; 4: 194–198.

18.

Schulz

Gold

Witte

. Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis. J Neurol Sci 2004; 225: 11–18.

19.

Borg

. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381.

20.

Goldman

Marrie

Cohen

. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler 2008; 14: 383–390.

21.

Chiaravalloti

DeLuca

. Cognitive impairment in multiple sclerosis. Lancet Neurol 2008; 7: 1139–1151.

22.

Smith

. The symbol digit modalities test. Learn Dis 1968; 3: 83–91.

23.

Helmstaedter

Lendt

Lux

. Verbaler Lern- und Merkfähigkeitstest. Diagnostica 1999; 45: 205–211.

24.

Zimmermann

Fimm

. Testbatterie zur aufmerksamkeitsprüfung. Würselen: Psytest, 1994.

25.

Horn

. L-P-S leistungsprüfsystem. Göttingen: Hogrefe, 1983.

26.

Aschenbrenner

Tucha

Lange

. Regensburger wortflüssigkeitstest. Göttingen: Hogrefe, 2000.

27.

Heesen

Schulz

Fiehler

. Correlates of cognitive dysfunction in multiple sclerosis. Brain Behav Immun 2010; 24: 1148–1155.

28.

Trivedi

Rush

Ibrahim

Carmody

Biggs

Suppes

Crismon

Shores-Wilson

Toprac

Dennehy

Witte

Kashner

. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 2004;34(1):73–82.

29.

Flachenecker

Kümpfel

Kallmann

Gottschalk

Grauer

Rieckmann

Trenkwalder

Toyka

. Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler 2002; 8(6):523–6

30.

R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2012.

31.

Feinstein

DeLuca

Baune

. Cognitive and neuropsychiatric disease manifestations in MS. Mult Scler Relat Dis 2013; 2: 4–12.

32.

Oken

Kishiyama

Zajdel

. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004; 62: 2058–2064.

33.

Prakash

Patterson

Janssen

. Physical activity associated with increased resting-state functional connectivity in multiple sclerosis. J Int Neuropsychol Soc 2011; 17: 986–997.

34.

Prakash

Snook

Motl

. Aerobic fitness is associated with gray matter volume and white matter integrity in multiple sclerosis. Brain Res 2010; 1341: 41–51.

35.

Motl

Smith

Elliott

. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: A pilot study. J Neurol Phys Ther 2012; 36: 32–37.

36.

Treat-Jacobson

Bronas

Leon

. Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication. Vasc Med 2009; 14: 203–213.

37.

Tew

Nawaz

Zwierska

. Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease. Clin Sci 2009; 117: 405–413.

38.

Vollmer

Benedict

Bennett

. Exercise as prescriptive therapy in multiple sclerosis. Int J MS Care 2012; 14: 2–14.

39.

Asano

Duquette

Andersen

. Exercise barriers and preferences among women and men with multiple sclerosis. Disabil Rehabil 2013; 35: 353–361.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.14 MB

0.06 MB

0.01 MB

Effects of exercise on fitness and cognition in progressive MS: a randomized,controlled pilot trial

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Trial Registration:

Keywords

Get full access to this article

References

Supplementary Material