Study: Exercise Combats Multiple Sclerosis Brain Atrophy

Exercise can increase cortical thickness - a key measure of improvement for patients with multiple sclerosis (MS).

For all of its spoken benefits in overall health and fitness, exercise training’s affect on one’s brain is often overlooked, according to Daniel M. Corcos, PhD, professor of physical therapy and human movement sciences at Northwestern University's Feinberg School of Medicine. In an interview with MD Magazine, he said there is “compelling evidence” that resistance and endurance exercise is good for the brain, and thus, good for MS patients.

“It either improves cognition, or if it doesn’t improve it, it stops the rate at which it declines,” Corcos said. “As one ages, they tend to have a decline in cognition. Anything we can do to hold whatever cognitive faculties we have at stable, is good.”

Researchers, co-led by Ulrik Dalgas (pictured), a professor in the Department of Public Health at Aarhus University, Denmark, re-evaluated previous work that showed progressive resistance training’s (PRT) counteraction to brain atrophy in MS patients.

In a 24-week randomized, controlled cross-over trial, 35 relapsing-remitting MS (RRMS) patients were split near evenly into a training (n=18) and waitlist (17) group. The training group patients underwent 24 weeks of PRT, followed by self-guided physical activity. The waitlist group conducted 24 weeks of a habitual lifestyle, followed by PRT.

To evaluate exercise’s efficacy on brain atrophy, patients underwent magnetic resonance imaging (MRI) reviews and series of clinical MS progression measures. MRI imaging gauged lesion load, global brain volume, percentage brain volume change (PBVC), and cortical thickness.

According to the study, training group patients’ cortical thickness and MS Functional Composite score — used to review disease progression — had improved at trial’s end.

Although little differentiation between Expanded Disability Status Scale, lesion load and global volumes did not indicate much difference between groups, Dalgas said the apparent increase in cortical thickness induced by exercise is significant, and warrants further study. He and colleagues are currently in the middle of a much larger study which he hopes will help researchers better understand the mechanism by which the neuroprotection occurs in correlation with resistance training.

“Our original idea was that changes in the immune system would explain the improvements, but we did not see this,” he said. “Now we are looking at different neurotrophic factors.”

The study is the first to suggest that exercise might protect the nervous system against MS, Dalgas said. It also put to rest a once-common belief that exercise could harm patients with MS.

“Exercise often worsens symptoms, but today we know that the exacerbation is temporary and will disappear within 30 to 60 minutes after exercise cessation,” Dalgas said. “Furthermore, a period of regular training will often reduce or even remove the exacerbation.”

Aside from limiting brain atrophy, exercise can also impact a patient’s ability to walk, lessen fatigue, and aid muscle strength and aerobic capacity.

Dalgas said there may be rare instances where exercise might be detrimental to specific patients, but he said the evidence is now clear that the vast majority of patients will see a significant benefit from exercise.

Resistance training may not be the only applicable exercise form for MS patients. In an MD Magazine Peer Exchange last year, Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center, advocated for aerobic exercise, yoga, and even tai chi in MS care.

Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai, similarly advocated for swimming training in the same discussion as Coyle.

That’s not to say exercise can be a sufficient treatment for the disease. Dalgas said drugs must still play the lead role in RRMS treatment. Exercise, he said, should be thought of as a valuable supplement to medication.

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