MS: Exercise Impacts on MRI
Multiple sclerosis (MS) is a chronic condition that affects the optic nerves, spinal cord, and brain. Symptoms of MS include body tingling, numbness, weakness, and poor vision. Other uncommon symptoms include cognitive problems, urinary issues, and muscle stiffness. The problem with most cases of MS is it’s very hard to predict how it will progress. Some people only have mild symptoms such as blurred vision and numbness, while others experience severe issues such as vision loss, paralysis, and mobility problems.
MS is incurable despite many disease-modifying drugs (DMDs) that are currently available today. Most of these drugs only limit the disease by controlling the inflammatory process. There is not enough data on how they can directly target neurodegeneration which usually happens during the critical phase of MS, but can also happen at an early stage.
How Aerobic Exercise May Decelerate Neurodegeneration
Physical exercise is widely known to improve physical performance, mental status, and overall well-being. Exercise affects our body’s mechanism at the cellular level which is why it’s so beneficial for people suffering from this neurodegenerative disease. Aerobic exercise can also improve the production of neurotransmitters and hormones. Patients with multiple sclerosis are affected by their condition which is why they are less physically active. However, exercise is considered safe for most cases and can even be effective in controlling various symptoms of MS. Because exercise can reduce fatigue and improve mobility, it can also improve the quality of life of patients with multiple sclerosis.
Previous studies on the effects of physical exercise have only mostly focused on the outcomes of physical fitness, balance, cognition, walking mobility, fatigue, and depressive symptoms. There is also not enough data on the effects of exercise on MRI biomarkers, lesions, and brain structure, apart from a few case studies with randomized control trials.
The Study
This research aims to understand the effects of aerobic exercise on people with multiple sclerosis who are currently under fingolimod treatment.
This study also aims to investigate the effect of physical activity in the form of aerobic exercise on neurodegeneration and neuroinflammation by quantifying magnetic resonance imaging (MRI) biomarkers including patient-reported outcome measures of disease activity and progression in persons with MS.
Study Design
Two groups of patients with multiple sclerosis diagnosis were included in this study. The first one was an intervention group who undertook 12 weeks of exercise training. The second group was the controlled group who continued their usual lifestyle. Evaluation of study participants consisted of a comprehensive set of clinical assessment, MRI, patient recorded outcomes, blood sampling, and cognitive testing.
Patients
The study screened a total of 88 patients. 60 out of 80 were excluded because they met the exclusion criteria or declined to participate. 28 patients were randomized and included. A total of zero patients were involved in prior regular exercise and none required physiotherapy during the study. Two female patients required pulsed intravenous corticosteroid therapy during the intervention period due to disease relapse. However, after the issues were resolved, they continued with the study.
Methods
The study trials were done from February to June 2016, whereas the intervention was done from March 1 to March 31, 2016. The subjects were assessed one month before the start of the intervention and after the intervention ended. The intervention included organizing the aerobic exercise group by a certified aerobic trainer. The participants did aerobic exercises twice each week for 12 weeks. The exercises lasted up to 60 minutes. There were short 1-2 min breaks each session.
The exercise intensity was assessed using Polar heart rate monitors with 24alife Live session software and by the subjective physical sensations as measured by the Borg Rating of Perceived Exertion (RPE) Scale. The subjects’ heart rates and percentage of heart rate reserve were shown on a screen using the software and observed by the participant and trainer. The primary goal of the exercise was to train the patients at a moderate intensity level or 60 -70% of an individual’s heart rate using an age-predicted maximal heart rate, which is equivalent to a somewhat hard rating on the Borg RPE Scale.
For the cognitive testing, the researchers used the standard battery of neuropsychological tests to evaluate the psychomotor speed and attention of the participants. The researchers used bloodwork analysis, magnetic resonance imaging, and other clinical assessments before and after the 12-week period. The study is pursued in accordance with the CONSORT 2010 statement and CONSORT Extension for Randomized Trials of Non-pharmacological Treatment.
Limitations of the Study
This study has several limitations. First, the results may be limited only by the participants who were willing to participate in the 12-week trial. The study is very small in sample size which increases the risk of type II error. Another limitation is the study duration which is short and doesn’t allow research to find any key changes.
Results
Overall, the effects of aerobic exercise on the patient’s brain and grey matter atrophy was minor. The effect on volume in the brain substructure was heterogeneous. The immediate effect resulting in an increased cardiorespiratory fitness was assessed using a step test. Nine out of fourteen were not able to do the measurements because of organizational reasons.
Putaminal and posterior cingulate volumes decreased, parahippocampal gyrus volume increased, thalamus and amygdala volume remained the same, and active lesion load and count decreased. However, apart from weak improvements in walking speed and brain-derived neurotrophic factor levels, there was no effect of aerobic exercise on other clinical, cognitive or patient-reported outcomes.
Conclusion
Results suggest that aerobic exercise can positively affect brain regions in people with MS by decreasing the level of degeneration and inflammatory activity. However, there’s a negative impact on the volume of the substructures of the brain with unclear implications. The researchers recommend that further studies should be performed to evaluate whether rehabilitation could really slow down the rate of disability. Future studies should have larger samples and longer duration to confirm or refute the findings shown in this study.
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