Efficacy of High-Intensity Aerobic Exercise on Brain MRI Measures in Multiple Sclerosis. (12th January 2021)

• Record Type: Journal Article
• Authors: Langeskov-Christensen, Martin; Grøndahl Hvid, Lars; Nygaard, Mikkel Karl Emil; Ringgaard, Steffen; Boye Jensen, Henrik; Hvilsted Nielsen, Helle; Petersen, Thor; Stenager, Egon; Fristed Eskildsen, Simon; Dalgas, Ulrik
• Is Part Of: Neurology. Volume 96:Number 2(2021)
• Publication Date: 2021-01-12
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000011241
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To determine whether 24 weeks of high-intensity progressive aerobic exercise (PAE) affects brain MRI measures in people with multiple sclerosis (MS). Methods: We conducted a randomized, controlled, phase 2 trial (with a crossover follow-up) including an exercise group (supervised PAE followed by self-guided physical activity) and a waitlist group (habitual lifestyle followed by supervised PAE). Mildly to severely impaired patients with MS aged 18–65 years were randomized (1:1). The primary outcome was percentage brain volume change (PBVC) after 24 weeks, analyzed using the intention-to-treat principle. Results: Eighty-six participants were recruited. PBVC did not change over the intervention period (mean between-group change +0.12%, 95% confidence interval [CI] −0.27 to 0.51, p = 0.55). In contrast, cardiorespiratory fitness (+3.5 mL O2 /min/kg, 2.0 to 5.1, p < 0.01) and annualized relapse rate (0.00, 0.00–0.07 vs +0.45, 0.28 to 0.61, p < 0.01) improved in the exercise group. Conclusion: These findings do not support a neuroprotective effect of PAE in terms of total brain atrophy in people with MS and it did not lead to a statistically significant difference in gray matter parenchymal fraction. PAE led to improvements in cardiorespiratory fitness and a lower relapse rate. While these exploratory findings cautiously support PAE as a potential adjunct disease-modifying treatment in MS, further investigations are warranted. Clinicaltrials.gov identifier: NCT02661555. Classification of evidence: This study provides Level I evidence that 24 weeks of high-intensity PAE did not elicit disease-modifying effects in PBVC in people with MS. Exploratory analyses showed that PAE may reduce relapse rate.