Aerobic exercise offers benefits for gait and fatigue in multiple sclerosis

Data from a 12-week study evaluating high-intensity aerobic cycling exercise in multiple sclerosis (MS) patients demonstrated improvements in walking speed and ability, as well as significant reductions in physical fatigue. Most importantly, the researchers concluded that this approach may be a valuable rehabilitation method for managing MS-related walking limitations and mitigating fatigue.

The study involved 18 individuals with MS who were randomly assigned to either forced exercise (FE; n = 11) or voluntary exercise (VE; n = 7) for a 4-week observation period without intervention, followed from 2 exercise sessions per week for 12 weeks. In all participants, walking speed significantly increased from 0.61 to 0.68 m/s (P = .01), along with modest improvements in the 6-minute walk test (6MWT), from 341.7 to 352.0 m.

These data were presented by senior investigator Susan M. Linder, research scientist, Cleveland Clinic, at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 through June 3 in Aurora, Colorado. In the study, those assigned to the FE group exercised on a custom-designed cycle to increase pedaling rate, while those in the VE group exercised on an identical semi-recumbent cycle ergometer at self-selected cadence without assistance. Each session lasted 45 minutes, with a total of 24 sessions.

In addition to the 6MWT, participants completed biomechanical analysis of gait, Modified Fatigue Impact Scale (MFIS), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and Neuro-QoL. Using paired t-tests, self-reported fatigue on the MFIS physical subscale decreased significantly from 14.07 to 10.53 (P = .005) in grouped groups. Of note, the researchers found no changes in the PROMIS-29 physical subscale, Neuro-Qol fatigue, or Neuro-QoL lower extremity function domains.

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In addition to promoting fatigue, aerobic exercise has helped MS patients in a number of other ways. Nearly a decade ago, the first evidence of aerobic exercise to increase hippocampal volume and connectivity and improve memory in MS was first published. Using 30-minute sessions 3 times a week for 3 months, aerobic exercise resulted in a 16.5% increase in hippocampal volume and a 53.7% increase in memory. Non-aerobic exercise resulted in relatively no changes in hippocampal volume (2.8%) or memory (0.0%) and no changes in hippocampal functional connectivity.2

In a 2021 study of high-intensity aerobic exercise, findings did not support a neuroprotective effect in terms of brain atrophy in MS patients. In a cohort of 86 individuals with mild to severe MS, the percent change in brain volume did not change during the 24-week intervention period (mean change, +0.12%; 95% CI, 0.27 to 0 .51; P = .55). Conversely, cardiorespiratory fitness (+3.5 mL O2/min/kg; 95% CI, 2.0-5.1; P <.01) and annualized recurrence rate (0.00 [95% CI, 0.00-0.07]; against +0.45 [95% CI, 0.28-0.61]; P <.01) improved in the exercise group.3

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1. Fricker TM, Chew K, Harris D, et al. Aerobic cycling improves gait speed and reduces physical fatigue in people with multiple sclerosis. Presented at: 2023 CMSC Annual Meeting; May 31-June 3; Aurora, CO. REH18 extract
2. Leavitt VM, Cirnigliaro C, Cohen A, et al. Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary results. Neurocase. 2014;6:695-697. doi:10.1080/13554794.2013.841951
3. Langeskov-Christensen M, Hvid LG, Nygaard MKE, et al. Efficacy of high-intensity aerobic exercise on brain MRI measures in multiple sclerosis. Neurology. 2021;96(2). doi:10.1212/WNL.000000000000011241

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