Efficacy of high-intensity aerobic exercise on brain MRI measures in multiple sclerosis

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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 MS patients 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% 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 REGISTRATION: 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.

Original languageEnglish
Pages (from-to)e203-e213
Number of pages11
Publication statusPublished - Jan 2021

    Research areas

  • Adult, Brain/diagnostic imaging, Cross-Over Studies, Denmark/epidemiology, Exercise/physiology, Female, Follow-Up Studies, High-Intensity Interval Training/methods, Humans, Magnetic Resonance Imaging/methods, Male, Middle Aged, Multiple Sclerosis/diagnostic imaging, Treatment Outcome

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ID: 201994474