Aerobic Exercise Provides Benefits for Gait and Fatigue in Multiple Sclerosis

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Using the Modified Fatigue Impact Scale, patients either forced to exercise or who volunteered saw significant improvements over a 12-week period.

Susan M. Linder, DPT, PhD, research scientist, Cleveland Clinic

Susan M. Linder, DPT, PhD

Data from a 12-week trial assessing high-intensity aerobic cycling exercise in patients with multiple sclerosis (MS) demonstrated improvements in walking speed and capacity, as well as significant reductions in physical fatigue. Above all, investigators concluded that this approach may be a viable rehabilitation method to manage MS-related walking limitations and mitigate fatigue.

The study featured 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 no-intervention observation period, followed by 2 exercise sessions per week for 12 weeks. Across all participants, walking speed increased significantly from 0.61 to 0.68 m/s (P = .01), along with modest improvements in 6-minute walk test (6MWT), from 341.7 to 352.0 m.

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

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

READ MORE: Arterial Stiffness Associated With Processing Speed in Multiple Sclerosis

In addition to benefitting fatigue, aerobic exercise has helped patients with MS in numerous other ways. Nearly a decade ago, the first evidence for aerobic exercise to increase hippocampal volume and connectivity and improve memory in MS was first published. Using a 30-minute sessions 3 times per week for 3 months, aerobic exercise resulted in 16.5% increase in hippocampal volume and 53.7% increase in memory. Non-aerobic exercise resulted in relatively no change 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 patients with MS. In a cohort of 86 individuals with mildly to severely impaired MS, percentage brain volume change did not change over the 24-week intervention period (mean change, +0.12%; 95% CI, –0.27 to 0.51; P = .55). In contrast, cardiorespiratory fitness (+3.5 mL O2/min/kg; 95% CI, 2.0-5.1; P <.01) and annualized relapse rate (0.00 [95% CI, 0.00-0.07]; vs +0.45 [95% CI, 0.28-0.61]; P <.01) improved in the exercise group.3

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REFERENCES
1. Fricker TM, Chew K, Harris D, et al. Aerobic cycling improves gait velocity and reduces physical fatigue in persons with multiple sclerosis. Presented at: 2023 CMSC Annual Meeting; May 31-June 3; Aurora, CO. Abstract REH18
2. Leavitt VM, Cirnigliaro C, Cohen A, et al. Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary findings. 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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