Aerobic Exercise Could Benefit MS Management, Further Research Needed

Aerobic exercise (AE), such as stationary cycling, brought benefits to patients with multiple sclerosis (MS) across varying degrees of disability, according to a recent study published in International Journal of MS Care.¹

MS can bring about intense fatigue, weakness, and spasticity, impacting individuals’ ability to participate in various forms of exercise. Prior analyses, such as a 2021 review from BMC Neurology, have identified these manifestations as some of the more debilitating symptoms that arise from MS.² Here, Johnson et al reported that half of their patients labeled fatigue as their most incapacitating symptom, as it can stem from either disease progression or factors related to lifestyle or comorbidities. As fatigue can negatively impact someone’s mental health, quality of life, and ability to work or be present in society, the researchers concluded that fatigue management is a crucial aspect of patient care in MS.

In this same vein, a 2021 meta-analysis out of Archives of Physical Medicine and Rehabilitation identified certain exercise modalities, including resistance training, as a beneficial approach for improving

fatigue-related symptoms.³ As the authors of the present study noted, AE carries a variety of benefits for improving MS symptoms, but it remains unclear whether those with higher forms of disability can reach the favorable durations and intensities to gain these effects.¹

To investigate the practicality of an intensive AE program, Simmons et al conducted a 12-week aerobic, stationary cycling intervention that assessed the impact of forced-rate exercise (FE, which uses a motor to help propel pedaling) or voluntary exercise (VE, which features no machine assistance).

Eligible individuals scored between 2.0-6.5 on the Expanded Disability Status Scale (EDSS) and had little risk for a cardiovascular event. A total of 18 participants (11 FE, 7 VE) engaged in 2 weekly sessions that lasted an average of 42.2 minutes and had aerobic effort targets of 60%-80% of their maximum heart rate (HR). Gait and 6-Minute Walk Test (6MWT) results were recorded. The study concluded with end of treatment (EOT) testing.

The 18 who completed the study were aged 54.9 years on average, 55.6% had been diagnosed with relapsing-remitting MS and 44.4% with a progressive type of MS. The group’s EDSS scores had a median of 4.0 and the authors noted that the FE group registered slightly higher scores than those assigned to VE (4.0 vs 3.5).

Both groups achieved an aerobic effort of 60% to 80% HR throughout the 24 sessions. Outcomes related to individual gait were measured on a treadmill, and the average walking speed improved from a baseline of 0.61 m/s to 0.68 m/s by EOT (P = .01). Those assigned to the FE group exhibited a higher increase in walking speed compared with those assigned to VE, although these results did not reach statistical significance (0.1 m/s increase vs 0.03 m/s increase, respectively). Distances from the 6MWT also improved but were not significant. The authors highlighted that individuals’ gait velocity were still fairly stable in the month following the end of the study period.

In their concluding thoughts, the authors emphasized a participant who was originally assigned to the VE group. This individual had an EDSS score of 6.5, was unable to sufficiently perform in the VE group, and almost withdrew from the study. Instead, they were reassigned to the FE group where they completed the remaining sessions and reported great benefits to their home mobility and fatigue upon the study’s completion.

While the authors mentioned limitations due to the small cohort, they found that adapting AE routines—as they did for their highlighted participant—showcased the promise of AE to affect MS symptoms when specified to a patient. Further research that features larger cohorts, durations, and a higher frequency of interventions would shed more light on the impact of AE on MS management, they concluded.

References

1. Simmons SB, Skolaris A, Love R, et al. Intensive aerobic cycling is feasible and elicits improvements in gait velocity in individuals with multiple sclerosis: A preliminary study. Int J MS Care. 2024 26 (3): 119–124.

2. Johnson E, Hooshmand SJ, Hooshmand SI. Fatigue in multiple sclerosis: a comprehensive approach to evaluation and management. Pract Neurol (Fort Wash Pa). 2024;23(1):31-34,42. Accessed June 6, 2024. https://practicalneurology.com/articles/2024-jan-feb/fatigue-in-multiple-sclerosis-a-comprehensive-approach-to-evaluation-and-management

3. Torres-Costoso A, Martínez-Vizcaíno V, Reina-Gutiérrez S, et al. Effect of exercise on fatigue in multiple sclerosis: A network meta-analysis comparing different types of exercise. Arch Phys Med Rehabil. 2022;103(5):970-987.e18. doi:10.1016/j.apmr.2021.08.008