Aerobic Exercise for MS Positively Affects Motor-related Tract and Nuclei Microstructural Integrity

Although data from the EMSES study failed to reveal a reduction in relapse rates or global brain atrophy, half of the important motor-related tracts and nuclei observed displayed higher structural integrity in exercise patients.

Ulrik Dalgas, PhD, MSc, associate professor of public health, Aarhus University

Ulrik Dalgas, PhD, MSc

Data from the randomized, controlled Early Multiple Sclerosis Exercise, or EMSES, study suggest that early supervised aerobic exercise does positively affect the microstructural integrity of important motor-related tracts and nuclei in patients with multiple sclerosis (MS).1

Notably, though, the supervised exercise regimen did not reduce relapse rates or global brain atrophy—the study’s primary outcome measures—but the investigators, including Ulrik Dalgas, PhD, MSc, associate professor of public health, Aarhus University, noted that “exercise is a promising nonpharmacological approach,” and to this point, the window of opportunity for intervention that is suspected to exist early in the disease course has been mostly uninvestigated. Particularly, they wrote, “Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis.”

All told, the data from MRI findings showed that microstructural integrity was higher in 50% (4 of 8) a priori defined motor-related tracts and nuclei—the thalamus, corticospinal tract, globus pallidus, and cingulate gyrus—in the exercise group (n = 84) compared with the population-based Danish MS Registry control group (n = 850) at 48 weeks.

No between-group differences were observed for the relapse rate (incidence-rate-ratio exercise relative to control, 0.49; 95% CI, 0.15-1.66; P = .25) nor for global brain atrophy rate (incidence-rate-ratio exercise relative to control, –0.04%; 95% CI, –0.48 to 0.40; P = .87). Additionally, Dalgas and colleagues wrote that no differences were observed on the secondary measures of lesion load, but aerobic fitness did increase in favor of the exercise group.

Nonpharmacologic, and particularly exercise-based, interventions for MS have been investigated somewhat frequently in recent years, much of which has been suggestive of at least some benefit for patients. In addition to Dalgas et al’s work, a study presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, February 24-26, in West Palm Beach, Florida, by Kathy Zackowski, PhD, OTR, senior director of patient management, care, and rehabilitation research, National Multiple Sclerosis Society, showed that the integration of functional electrical stimulation (FES) cycling into clinical practice for secondary progressive MS was a promising form of exercise for those with more severe disability.2

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Although Zackowski et al noted their findings require further study, the data showed that the mean change in Timed 25-Foot Walk scores was –0.89 seconds (SD, 0.97) in the FES-assisted group and +0.15 seconds (SD, 1.19) in the comparator passive cycling group (P = .11), while the mean differences in Timed Up and Go test times were –2.01 s (SD, 2.68) in the FES assisted group and –0.88 s (SD, 0.50) in the passive group (P = .31). The difference in 2-Minute Walk Test distance averaged a gain of 16.71 m (SD, 23.57) for the FES assisted group and of 4.42 m (SD, 10.35) for the passive group (P = .26).2

More data published in the fall of 2022 from Motl et al showed that the benefits of exercise in MS might also extend to those patients who have restless legs syndrome (RLS). Their data suggest that RLS severity may be reduced in patients with MS through physical activity, particularly light physical activity (LPA) and evening steps shortly before bed. Notably, higher morning and overall LPA were associated with worse sleep quality in their findings.3

Using Spearman rho correlations, Motl et al repored that more time spent in evening LPA (ρ = –0.42), more evening steps (ρ = ­–0.51), and more overall daily steps (ρ = –0.40) had moderate-to-strong associations with lower RLS severity. Additionally, regarding total weekly physical activity, more time spent in morning LPA (ρ = 0.34) and overall daily LPA (ρ = 0.33) had moderate associations with higher scores on Pittsburgh Sleep Quality Index, or worse sleep quality.3

1. Riemenschneider M, Hvid LG, Ringgaard S, et al. Investigating the potential disease-modifying and neuroprotective efficacy of exercise therapy early in the disease course of multiple sclerosis: The Early Multiple Sclerosis Exercise Study (EMSES). Mult Scler. 2022;28(10):1620-1629. doi:10.1177/13524585221079200.
2. Simpson A, Cassard SD, Keller J, et al. The effects of functional electrical stimulation cycling in people with secondary progressive multiple sclerosis. Presented at ACTRIMS Forum 2022; February 24-26; West Palm Beach, FL and Virtual. Poster P110.
3. Cederberg KL, Jeng B, Sasaki JE, et al. Does physical activity timing differentially correlate with symptoms of restless legs syndrome in adults with multiple sclerosis? Sleep Med. 2022;100:120-127. doi:10.1016/j.sleep.2022.08.001
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