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Alt Y, Wochatz M, Schraplau A, Engel T, Sharon H, Gurevich M, Menascu S, Mayer F, Kalron A. No immediate change in systemic cytokines following an eccentric muscle training session in people with multiple sclerosis. Ther Adv Neurol Disord 2024; 17:17562864241266113. [PMID: 39091997 PMCID: PMC11292683 DOI: 10.1177/17562864241266113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/12/2024] [Indexed: 08/04/2024] Open
Abstract
Background Eccentric muscle contractions elicit distinct physiological responses, including modulation of the cytokine profile. Although relevant for rehabilitation, the effect of eccentric muscle training on the immune system has never been investigated in multiple sclerosis (MS). Objectives Examine the immediate cytokine response of interleukin-4 (IL-4), IL-6, IL-10, IL-17a, interferon-gamma, and tumor necrosis factor-alpha after a moderate eccentric training session in individuals with MS. Additionally, further investigate the association between systemic cytokine levels at rest and clinical measures of mobility and lower limb functional strength. Design Observational study. Methods The first session included blood sampling for baseline cytokine measures. Subsequently, the participant completed a battery of clinical assessments related to mobility and lower limb strength, that is, the Timed-Up-and-Go Test, Five-Repetition-Sit-to-Stand-Test (5STS), Four-Square-Step-Test, and Two-Minute-Walk-Test. The second session included the eccentric exercise training session, followed by a second blood sampling to assess the acute cytokine response to the eccentric training bout. This session comprised 10 exercises concentrating on the strength of the trunk and lower extremities. Results Twenty-seven people with MS (pwMS), with a mean age of 40.1 years, participated in the study. No difference was demonstrated in the cytokine concentration values between baseline and immediately after the eccentric training session. The 5STS explained 30.3% of the variance associated with interferon-gamma, 14.8% with IL-4, and 13.8% with IL-10. Conclusion An eccentric training bout does not impact cytokine concentration in the blood and, consequently, does not boost a pro-inflammatory response, thus, it can be performed on pwMS in a rehabilitation setting.
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Affiliation(s)
- Yasmin Alt
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel
| | - Monique Wochatz
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
- Division of Therapy Science and Physiotherapy, University of Applied Sciences for Sports and Management Potsdam, Potsdam, Germany
| | - Anne Schraplau
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Hadar Sharon
- Multiple Sclerosis Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Michael Gurevich
- Multiple Sclerosis Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Frank Mayer
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Alon Kalron
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, School of Health Professions, Tel-Aviv University, POB 39040, Ramat-Aviv, Tel-Aviv 6139001, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel HaShomer, Israel
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Cook CE, Keter D, Cade WT, Winkelstein BA, Reed WR. Manual therapy and exercise effects on inflammatory cytokines: a narrative overview. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1305925. [PMID: 38745971 PMCID: PMC11091266 DOI: 10.3389/fresc.2024.1305925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024]
Abstract
Background Matching disease and treatment mechanisms is a goal of the Precision Medicine Initiative. Pro- and anti-inflammatory cytokines (e.g., Tumor Necrosis Factor-alpha, Transforming Growth Factor-beta, and Interleukin-2, 10, and 12) have gained a significant amount of interest in their potential role in persistent pain for musculoskeletal (MSK) conditions. Manual therapy (MT) and exercise are two guideline-recommended approaches for treating MSK conditions. The objective of this narrative overview was to investigate of the effects of MT and exercise on pro- and anti-inflammatory cytokines and determine the factors that lead to variability in results. Methods Two reviewers evaluated the direction and variabilities of MT and exercise literature. A red, yellow, and green light scoring system was used to define consistencies. Results Consistencies in responses were seen with acute and chronic exercise and both pro- and anti-inflammatory cytokines. Chronic exercise is associated with a consistent shift towards a more anti-inflammatory cytokine profile (Transforming Growth Factor-beta, and Interleukin-2 and 13, whereas acute bouts of intense exercise can transiently increase pro-inflammatory cytokine levels. The influence of MT on cytokines was less commonly studied and yielded more variable results. Conclusion Variability in findings is likely related to the subject and their baseline condition or disease, when measurement occurs, and the exercise intensity, duration, and an individual's overall health and fitness.
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Affiliation(s)
- Chad E. Cook
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Damian Keter
- Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - William Todd Cade
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC, United States
| | - Beth A. Winkelstein
- Departments of Bioengineering & Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Shemirani F, Pingel WR, Titcomb TJ, Salari-Moghaddam A, Arsalandeh F, Saxby SM, Snetselaar LG, Wahls TL. The effect of dietary interventions on inflammatory biomarkers among people with multiple sclerosis: A protocol for systematic review and meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0297510. [PMID: 38324543 PMCID: PMC10849228 DOI: 10.1371/journal.pone.0297510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system, characterized by demyelination and neurodegeneration, which has a profound impact on the quality of life. Dysregulated inflammatory processes are a major driver of MS progression, with many areas of research being dedicated to modulating inflammation in people with MS. Several dietary patterns have been associated with improvements in inflammatory biomarkers; although, the findings have been inconsistent. Thus, this study aims to evaluate the effects of dietary interventions on inflammatory markers in adults with MS. METHODS Electronic databases, including PubMed/MEDLINE, Web of Science, Scopus, and Cochrane/Central, will be searched. Screening, selection, and extraction of data, along with quality assessment of included studies, will be done by two separate reviewers, and any potential conflicts will be settled through discussion. Two reviewers will independently assess the risk of bias in included studies using the Cochrane Risk of Bias Tool. If plausible, the results will be synthesized and pooled for meta-analysis. The overall quality of evidence of each study will be evaluated using the NutriGRADE tool, which is a modification to the Grading Recommendations Assessment, Development, and Evaluation (GRADE) developed specifically for nutrition research. DISCUSSION Studies have demonstrated conflicting results regarding the effects of dietary interventions on serum levels of inflammatory biomarkers among people with MS. Thus, it is expected that the planned systematic review and meta-analysis will yield robust evidence on the effects of diet on inflammatory profile in the setting of MS.
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Affiliation(s)
- Farnoosh Shemirani
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Wade R Pingel
- University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | | | - Farshad Arsalandeh
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
- Community Family Medicine, Dartmouth Health, Lebanon, New Hampshire, United States of America
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
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4
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Pourfarzi F, Kamran A, Zare M, Mohammadshahi J. The effect of a web-based lifestyle intervention on nutritional status and physical activity on prevention of COVID-19: a randomized controlled trial in women's empowerment. Front Nutr 2024; 10:1172014. [PMID: 38312144 PMCID: PMC10834691 DOI: 10.3389/fnut.2023.1172014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Background Healthy dietary intake and physical activity affect the immune systems. The present study aimed to investigate the effects of a web-based lifestyle intervention on nutritional status, physical activity, and prevention of COVID-19. Methods Three hundred-three women (30-60 years old), who did not have COVID-19 in the City of Ardabil, participated in this study. Participants were randomized into an intervention (n = 152) or control group (n = 151). The intervention group received eight online educational sessions focusing on a healthy diet and physical activity via the website. There was no educational session for the control group during the intervention, but they were placed on the waiting list to receive the intervention and given access to the website and educational content after the follow-up. Outcomes were nutritional status, physical activity, immunoglobulin G (IgG), and immunoglobulin M (Ig M) antibody titers against the virus. They were evaluated at the baseline, after 4 and 12 weeks. Results Significant improvements in weight (P < 0.001), BMI (P < 0.001), total energy (P = 0.006), carbohydrate (P = 0.001), protein (P = 0.001), and fat (P < 0.001) were found for the intervention group compared to the control group during the study. MET-min/week for moderate physical activity increased during the time for the intervention and control groups (P < 0.001 and P = 0.007, respectively). MET-min/week for walking activity rose in the post-intervention and follow-up compared to that in the baseline in the groups (P < 0.001 for both groups). Total physical activity was increased during the study (P < 0.001) for both groups. The mean of serum IgG and IgM titers against the virus were increased during the study in both groups in time effect (P < 0.001). There was a significant time x group interaction for carbohydrate and fat intakes (P = 0.005 and P = 0.004, respectively). Conclusion The web-based lifestyle intervention may improve nutritional status and physical activity, and have the potential to reduce the risk of contracting a COVID-19 infection.
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Affiliation(s)
- Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aziz Kamran
- Health Education and Promotion, School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Maryam Zare
- Department of Nutrition, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Jafar Mohammadshahi
- Infectious Disease, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Moslemi Z, Toledo-Aldana EA, Baldwin B, Donkers SJ, Eng JJ, Mondal P, de Zepetnek JOT, Buttigieg J, Levin MC, Mang CS. Task-oriented exercise effects on walking and corticospinal excitability in multiple sclerosis: protocol for a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:175. [PMID: 38129896 PMCID: PMC10734154 DOI: 10.1186/s13102-023-00790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a degenerative disease of the central nervous system (CNS) that disrupts walking function and results in other debilitating symptoms. This study compares the effects of 'task-oriented exercise' against 'generalized resistance and aerobic exercise' and a 'stretching control' on walking and CNS function in people with MS (PwMS). We hypothesize that task-oriented exercise will enhance walking speed and related neural changes to a greater extent than other exercise approaches. METHODS This study is a single-blinded, three-arm randomized controlled trial conducted in Saskatchewan, Canada. Eligible participants are those older than 18 years of age with a diagnosis of MS and an expanded Patient-Determined Disease Steps (PDDS) score between 3 ('gait disability') and 6 ('bilateral support'). Exercise interventions are delivered for 12 weeks (3 × 60-min per week) in-person under the supervision of a qualified exercise professional. Interventions differ in exercise approach, such that task-oriented exercise involves weight-bearing, walking-specific activities, while generalized resistance and aerobic exercise uses seated machine-based resistance training of major upper and lower body muscle groups and recumbent cycling, and the stretching control exercise involves seated flexibility and relaxation activities. Participants are allocated to interventions using blocked randomization that stratifies by PDDS (mild: 3-4; moderate: 5-6). Assessments are conducted at baseline, post-intervention, and at a six-week retention time point. The primary and secondary outcome measures are the Timed 25-Foot Walk Test and corticospinal excitability for the tibialis anterior muscles determined using transcranial magnetic stimulation (TMS), respectively. Tertiary outcomes include assessments of balance, additional TMS measures, blood biomarkers of neural health and inflammation, and measures of cardiorespiratory and musculoskeletal fitness. DISCUSSION A paradigm shift in MS healthcare towards the use of "exercise as medicine" was recently proposed to improve outcomes and alleviate the economic burden of MS. Findings will support this shift by informing the development of specialized exercise programming that targets walking and changes in corticospinal excitability in PwMS. TRIAL REGISTRATION ClinicalTrials.gov, NCT05496881, Registered August 11, 2022. https://classic. CLINICALTRIALS gov/ct2/show/NCT05496881 . Protocol amendment number: 01; Issue date: August 1, 2023; Primary reason for amendment: Expand eligibility to include people with all forms of MS rather than progressive forms of MS only.
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Affiliation(s)
- Zahra Moslemi
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Eduardo A Toledo-Aldana
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Bruce Baldwin
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Sarah J Donkers
- School of Rehabilitation Sciences, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Janice J Eng
- Centre for Aging SMART at Vancouver Coastal Health, Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Prosanta Mondal
- Clinical Research Support Unit, University of Saskatchewan, 3200 Health Science E-wing, Saskatoon, SK, S7N 5B5, Canada
| | - Julia O Totosy de Zepetnek
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Josef Buttigieg
- Department of Biology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Michael C Levin
- Department of Neurology and Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada.
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Liao T, Xiong L, Wang X, Yang S, Liang Z. Mitochondrial disorders as a mechanism for the development of obese Sarcopenia. Diabetol Metab Syndr 2023; 15:224. [PMID: 37926816 PMCID: PMC10626707 DOI: 10.1186/s13098-023-01192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
Obese sarcopenia is a severe and prevalent disease in an aging society. Compared to sarcopenia alone, the development and advanced stage of obesity sarcopenia is faster and more severe. Diagnosis of the cause of adipocyte accumulation is also more complicated; however, no effective pharmacological treatment is available. Chronic inflammation is one of the causes of sarcopenia, and obese patients, who are more likely to develop chronic inflammation, may simultaneously suffer from obesity and sarcopenia. Mitochondrial metabolic disorders have been more easily observed in the tissue cells of patients with obesity and sarcopenia. Mitochondrial metabolic disorders include abnormal mtDNA release, mitochondrial autophagy, and dynamic mitochondrial disorders. Therefore, this review will reveal the mechanism of development of obesity myasthenia gravis from the perspective of mitochondria and discuss the currently existing small-molecule drugs.
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Affiliation(s)
- Tingfeng Liao
- School of Medicine, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
| | - Lijiao Xiong
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
| | - Xiaohao Wang
- School of Medicine, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
| | - Shu Yang
- School of Medicine, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China.
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
| | - Zhen Liang
- School of Medicine, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China.
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
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Ramari C, Awadia Z, Bansi J, Casey B, Feys P, Pilutti LA, Sandroff BM, Paul L. The MoxFo initiative - outcomes: Outcome measures in studies of exercise training in multiple sclerosis; scoping review of reviews and classification according to the ICF framework. Mult Scler 2023; 29:1578-1594. [PMID: 37880966 DOI: 10.1177/13524585231204451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The number of published studies of exercise training in multiple sclerosis (MS) has grown exponentially with increasing numbers of outcomes capturing exercise effects. This has complicated the selection of relevant indicators and interpretation of intervention effects. OBJECTIVES The Outcomes subgroup of the MoXFo initiative aimed to (1) identify outcome measures and biomarkers in studies of exercise training in MS; (2) systematically map retrieved outcomes to International Classification of Functioning, Disability and Health (ICF) categories; (3) identify gaps where relevant ICF categories have been omitted. METHODS Electronic databases and registers were searched from 2010 to July 2020 to identify systematic reviews or meta-analyses of controlled trials of exercise training on any outcome in MS. Retrieved outcomes/biomarkers were mapped to the corresponding ICF category. RESULTS Eighty-one review articles reporting 235 different outcomes were included. The outcomes corresponded to 15 chapters and 45 categories within the ICF. Outcomes mapped primarily to body function (30 categories) and activities and participation (9 categories) components. Few outcomes mapped to body structures (2 categories) or environmental factors (1 category). CONCLUSION This sets the stage to develop a resource for researchers/clinicians that will aid in the selection of appropriate outcomes/biomarkers when examining exercise effects in MS.
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Affiliation(s)
- Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC), Hasselt, Belgium
| | - Zain Awadia
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Jens Bansi
- Physical Activity for Health (PAfH) Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC), Hasselt, Belgium
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ, USA
| | - Lorna Paul
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Schlagheck ML, Bansi J, Wenzel C, Kuzdas-Sallaberger M, Kiesl D, Gonzenbach R, Zimmer P. Complexity and pitfalls in maximal exercise testing for persons with multiple sclerosis. Eur J Neurol 2023; 30:2726-2735. [PMID: 37209371 DOI: 10.1111/ene.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND PURPOSE Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS who attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET) and (ii) to provide insight into participant characteristics that limit maximal exercise performance. METHODS This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n = 380 inpatient pwMS (mean age = 48 ± 11 years, 66% female). Chi-squared or Fisher's exact tests were conducted to compare differences in the distribution of criteria achieved. Participants' characteristics were examined as potential predictors using binary logistic regression. RESULTS Only 60% of the overall sample attained a respiratory exchange ratio ≥ 1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six percent met at least two of three criteria. Disability status, gender, disease course, and body mass index were associated with the attainment of maximal effort. CONCLUSIONS Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimize CPET protocols in restrictive groups of pwMS.
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Affiliation(s)
- Marit L Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Jens Bansi
- Department of Neurology, Kliniken Valens, Rehabilitation Centre Valens, Valens, Switzerland
- Department of Health, OST-Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Charlotte Wenzel
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | | | - David Kiesl
- University Clinic for Hematology and Internal Oncology, Kepler University Hospital Linz, Johannes Kepler University Linz, Linz, Austria
| | - Roman Gonzenbach
- Department of Neurology, Kliniken Valens, Rehabilitation Centre Valens, Valens, Switzerland
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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Effects of Tele-Pilates and Tele-Yoga on Biochemicals, Physical, and Psychological Parameters of Females with Multiple Sclerosis. J Clin Med 2023; 12:jcm12041585. [PMID: 36836119 PMCID: PMC9966519 DOI: 10.3390/jcm12041585] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the serum levels of prolactin and cortisol and selected physical and psychological factors. METHODS Forty-five females with relapsing remitting multiple sclerosis, based on age (18-65), expanded disability status scale (0-5.5), and body mass index (20-32), were randomly assigned to tele-Pilates, tele-yoga, or control groups (n = 15). Serum blood samples and validated questionnaires were collected before and after interventions. RESULTS Following online interventions, there was a significant increase in the serum levels of prolactin (p = 0.004) and a significant decrease in cortisol (p = 0.04) in the time × group interaction factors. In addition, significant improvements were observed in depression (p = 0.001), physical activity levels (p < 0.001), QoL (p ≤ 0.001), and the speed of walking (p < 0.001). CONCLUSION Our findings suggest that tele-yoga and tele-Pilates training could be introduced as patient-friendly, non-pharmacological, add-on therapeutic methods for increasing prolactin and decreasing cortisol serum levels and achieving clinically relevant improvements in depression, walking speed, physical activity level, and QoL in female MS patients.
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Gravesteijn AS, Beckerman H, Willemse EA, Hulst HE, de Jong BA, Teunissen CE, de Groot V. Brain-derived neurotrophic factor, neurofilament light and glial fibrillary acidic protein do not change in response to aerobic training in people with MS-related fatigue - a secondary analysis of a randomized controlled trial. Mult Scler Relat Disord 2023; 70:104489. [PMID: 36621163 DOI: 10.1016/j.msard.2022.104489] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuroinflammation and neurodegeneration are pathological hallmarks of multiple sclerosis (MS). Brain-derived neurotrophic factor (BDNF), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) are blood-based biomarkers for neurogenesis, axonal damage and astrocyte reactivity, respectively. We hypothesize that exercise has a neuroprotective effect on MS reflected by normalization of BDNF, NfL and GFAP levels. OBJECTIVES To investigate the neuroprotective effect of aerobic training (AT) compared to a control intervention on blood-based biomarkers (i.e. BDNF, NfL, GFAP) in people with MS (pwMS). METHODS In the TREFAMS-AT (Treating Fatigue in Multiple Sclerosis - Aerobic Training) study, 89 pwMS were randomly allocated to either a 16-week AT intervention or a control intervention (3 visits to a MS nurse). In this secondary analysis, blood-based biomarker concentrations were measured in 55 patients using Simoa technology. Changes in pre- and post-intervention concentrations were compared and between-group differences were assessed using analysis of covariance (ANCOVA). Confounding effects of age, sex, MS-related disability assessed using the Expanded Disability Status Scale (EDSS), MS duration, use of disease-modifying medication, and Body Mass Index were considered. RESULTS Blood samples were available for 30 AT and 25 control group participants (mean age 45.6 years, 71% female, median disease duration 8 years, median EDSS score 2.5). Within-group changes in both study groups were small and non-significant, with the exception of BDNF in the control group (median (interquartile range) -2.1 (-4.7; 0)). No between-group differences were found for any biomarker: BDNF (β = 0.11, 95%CI (-3.78 to 4.00)), NfL (β = -0.04, 95%CI (-0.26 to 0.18)), and GFAP (β = -0.01, 95%CI (-0.16 to 0.15)), adjusted for confounders. CONCLUSION Aerobic exercise therapy did not result in statistically significant changes in the tested neuro-specific blood-based biomarkers in people with MS. TRIAL REGISTRATION this study is registered under number ISRCTN69520623 (https://www.isrctn.com/ISRCTN695206).
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Affiliation(s)
- Arianne S Gravesteijn
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam.
| | - Heleen Beckerman
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam.
| | - Eline Aj Willemse
- MS Center Amsterdam, Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam; Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4031 Basel, Switzerland.
| | - Hanneke E Hulst
- MS Center Amsterdam, Anatomy and Neuroscience, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, PO Box 9500, 2300 RA Leiden, The Netherlands.
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam.
| | - Charlotte E Teunissen
- MS Center Amsterdam, Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam.
| | - Vincent de Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, PO Box 7057, 1007 MB Amsterdam.
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11
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Bonnechère B. Integrating Rehabilomics into the Multi-Omics Approach in the Management of Multiple Sclerosis: The Way for Precision Medicine? Genes (Basel) 2022; 14:63. [PMID: 36672802 PMCID: PMC9858788 DOI: 10.3390/genes14010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Over recent years, significant improvements have been made in the understanding of (epi)genetics and neuropathophysiological mechanisms driving the different forms of multiple sclerosis (MS). For example, the role and importance of the bidirectional communications between the brain and the gut-also referred to as the gut-brain axis-in the pathogenesis of MS is receiving increasing interest in recent years and is probably one of the most promising areas of research for the management of people with MS. However, despite these important advances, it must be noted that these data are not-yet-used in rehabilitation. Neurorehabilitation is a cornerstone of MS patient management, and there are many techniques available to clinicians and patients, including technology-supported rehabilitation. In this paper, we will discuss how new findings on the gut microbiome could help us to better understand how rehabilitation can improve motor and cognitive functions. We will also see how the data gathered during the rehabilitation can help to get a better diagnosis of the patients. Finally, we will discuss how these new techniques can better guide rehabilitation to lead to precision rehabilitation and ultimately increase the quality of patient care.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
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12
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Smith M, Williams G, Jordan M, Willson A, Barker R. The feasibility of a flexible exercise participation programme (FEPP) for individuals with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 28:e1988. [PMID: 36536530 DOI: 10.1002/pri.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with multiple sclerosis (MS) want health advice regarding participation in their choice of exercise. To address this need, a flexible exercise participation programme (FEPP) was developed, underpinned by the MS aerobic exercise guidelines and supported by a physiotherapist using behaviour change techniques. The aim of this study was to investigate the feasibility of the FEPP for individuals with minimal disability from MS. METHODS A feasibility study utilising a single group pre/post-intervention design was conducted. The 12-week FEPP was completed by 10 individuals with MS (EDSS 0-3.5). Exercise progression in duration, intensity or frequency of exercise (in line with MS exercise guidelines) was guided by a self-perceived weekly energy level score, and weekly telephone coaching sessions using behavioural change techniques. Trial feasibility was assessed via measures of process (recruitment and retention), resources/management (communication time; data entry) and scientific feasibility (safety; compliance). Secondary FEPP feasibility outcomes included the Goal Attainment Scale (GAS) T-score, exercise participation (weekly exercise diary), high-level mobility (HiMAT), vitality (Subjective Vitality Scale), biomarkers for inflammation (cytokines levels [IL2, IL4, IL6, IL10, TNF and IFNγ]), and acceptability (participant survey). RESULTS Process: In total, 11 (85%) of 13 eligible participants enroled at baseline with 10 (91%) completing the study. Resources/management: Coaching sessions included a baseline interview-mean 39 min (SD: 6.6) and telephone coaching-mean 10 min (SD: 3.8) per week. Outcome measure data collection time-mean 44 min (SD: 2.1). Scientific feasibility: Two participants experienced a fall during their exercise participation. Self-reported compliance was high (99%). GAS T-scores increased significantly, indicating achievement of exercise participation goals. Secondary outcomes showed trends towards improvement. DISCUSSION The FEPP was feasible, safe and highly acceptable for use with individuals with MS and warrants a larger trial to explore effectiveness.
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gavin Williams
- Discipline of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Margaret Jordan
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Annie Willson
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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13
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Suzuki K, Hekmatikar AHA, Jalalian S, Abbasi S, Ahmadi E, Kazemi A, Ruhee RT, Khoramipour K. The Potential of Exerkines in Women's COVID-19: A New Idea for a Better and More Accurate Understanding of the Mechanisms behind Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315645. [PMID: 36497720 PMCID: PMC9737724 DOI: 10.3390/ijerph192315645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 05/31/2023]
Abstract
The benefits of physical exercise are well-known, but there are still many questions regarding COVID-19. Chow et al.'s 2022 study, titled Exerkines and Disease, showed that a special focus on exerkines can help to better understand the underlying mechanisms of physical exercise and disease. Exerkines are a group of promising molecules that may underlie the beneficial effects of physical exercise in diseases. The idea of exerkines is to understand the effects of physical exercise on diseases better. Exerkines have a high potential for the treatment of diseases and, considering that, there is still no study of the importance of exerkines on the most dangerous disease in the world in recent years, COVID-19. This raises the fundamental question of whether exerkines have the potential to manage COVID-19. Most of the studies focused on the general changes in physical exercise in patients with COVID-19, both during the illness and after discharge from the hospital, and did not investigate the basic differences. A unique look at the management of COVID-19 by exerkines, especially in obese and overweight women who experience high severity of COVID-19 and whose recovery period is long after discharge from the hospital, can help to understand the basic mechanisms. In this review, we explore the potential of exerkines in COVID-19 by practicing physical exercise to provide compelling practice recommendations with new insights.
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Affiliation(s)
- Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
| | - Amir Hossein Ahmadi Hekmatikar
- Department of Physical Education and Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran 10600, Iran
| | - Shadi Jalalian
- Department of Physical Education and Sport Sciences, Science and Research Branch, Islamic Azad University, Tehran 10600, Iran
| | - Shaghayegh Abbasi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 10600, Iran
| | - Elmira Ahmadi
- Department of Physical Education and Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran 10600, Iran
| | - Abdolreza Kazemi
- Department of Sports Science, Faculty of Literature and Humanities, Vali-e-Asr University, Rafsanjan 7718897111, Iran
| | | | - Kayvan Khoramipour
- Neuroscience Research Center, Institute of Neuropharmacology, Department of Physiology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman 7616914115, Iran
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14
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Gilio L, Fresegna D, Gentile A, Guadalupi L, Sanna K, De Vito F, Balletta S, Caioli S, Rizzo FR, Musella A, Iezzi E, Moscatelli A, Galifi G, Fantozzi R, Bellantonio P, Furlan R, Finardi A, Vanni V, Dolcetti E, Bruno A, Buttari F, Mandolesi G, Centonze D, Stampanoni Bassi M. Preventive exercise attenuates IL-2-driven mood disorders in multiple sclerosis. Neurobiol Dis 2022; 172:105817. [PMID: 35835361 DOI: 10.1016/j.nbd.2022.105817] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Elevated levels of specific proinflammatory molecules in the cerebrospinal fluid (CSF) have been associated with disability progression, enhanced neurodegeneration and higher incidence of mood disorders in people with multiple sclerosis (MS). Studies in animal models of MS suggest that preventive exercise may play an immunomodulatory activity, with beneficial effects on both motor deficits and behavioral alterations. Here we explored the impact of lifestyle physical activity on clinical presentation and associated central inflammation in a large group of newly diagnosed patients with MS. Furthermore, we addressed the causal link between exercise-mediated immunomodulation and mood symptoms in the animal setting. METHODS A cross-sectional study was conducted on 235 relapsing-remitting MS patients at the time of the diagnosis. Patients were divided into 3 groups ("sedentary", "lifestyle physical activity" and "exercise") according to the level of physical activity in the six months preceding the evaluation. Patients underwent clinical, neuropsychological and psychiatric evaluation, magnetic resonance imaging and lumbar puncture for diagnostic purposes. The CSF levels of proinflammatory and anti-inflammatory cytokines were analyzed and compared with a group of 80 individuals with non-inflammatory and non-degenerative diseases. Behavioral and electrophysiological studies were carried out in control mice receiving intracerebral injection of IL-2 or vehicle. Behavior was also assessed in mice with experimental autoimmune encephalomyelitis (EAE), animal model of MS, reared in standard (sedentary group) or running wheel-equipped (exercise group) cages. RESULTS In exercising MS patients, depression and anxiety were reduced compared to sedentary patients. The CSF levels of the interleukin-2 and 6 (IL-2, IL-6) were increased in MS patients compared with control individuals. In MS subjects exercise was associated with normalized CSF levels of IL-2. In EAE mice exercise started before disease onset reduced both behavioral alterations and striatal IL-2 expression. Notably, a causal role of IL-2 in mood disorders was shown. IL-2 administration in control healthy mice induced anxious- and depressive-like behaviors and impaired type-1 cannabinoid (CB1) receptor-mediated neurotransmission at GABAergic synapses, mimicking EAE-induced synaptic dysfunction. CONCLUSIONS Our results indicate an immunomodulatory effect of exercise in MS patients, associated with reduced CSF expression of IL-2, which might result in reduced mood disorders. These data suggest that exercise in the early stages may act as a disease-modifying therapy in MS although further longitudinal studies are needed to clarify this issue.
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Affiliation(s)
- Luana Gilio
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Diego Fresegna
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Livia Guadalupi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Krizia Sanna
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Sara Balletta
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Silvia Caioli
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alessandro Moscatelli
- Department of Systems Medicine, Tor Vergata University, Rome, Italy; Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | | | | | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Vanni
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Antonio Bruno
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Fabio Buttari
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Diego Centonze
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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15
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Cytokine Profile in Patients with Multiple Sclerosis Following Exercise: A Systematic Review of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138151. [PMID: 35805808 PMCID: PMC9266041 DOI: 10.3390/ijerph19138151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) is one of the most prevalent causes of nontraumatic neurological impairment in young adults. This review aims to determine the impact of exercise on cytokine and adipokine profile levels as inflammatory markers in MS patients across various exercise paradigms. We used specific keywords in PubMed, Web of Science, The Cochrane Library, and Scopus to find randomized clinical trials addressing the effects of physical activity and exercise training on inflammatory markers levels in MS patients. The majority of the research showed no considerable changes in IL-6 levels, while three studies reported declining levels after the intervention. Approximately half of the trials observed a change in TNF-α and IL-10 levels after exercise interventions, while the other half showed no meaningful changes. Other markers such as IL-17, IL-4, IL-12, adipokines, and BDNF showed fluctuations in levels. We found no universal agreement on the effects of different exercise training protocols on the serum level of inflammatory markers in patients with MS. More research is needed to fully identify the effects of exercise on cytokines in MS patients.
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16
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Motl RW, Sandroff BM. Physical exercise in multiple sclerosis is not just a symptomatic therapy: It has a disease-modifying effect-Yes. Mult Scler 2022; 28:859-861. [PMID: 35293819 DOI: 10.1177/13524585211061651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Kurgan N, Islam H, Matusiak JBL, Baranowski BJ, Stoikos J, Fajardo VA, MacPherson REK, Gurd BJ, Klentrou P. Subcutaneous adipose tissue sclerostin is reduced and Wnt signaling is enhanced following 4-weeks of sprint interval training in young men with obesity. Physiol Rep 2022; 10:e15232. [PMID: 35312183 PMCID: PMC8935536 DOI: 10.14814/phy2.15232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 06/01/2023] Open
Abstract
Sclerostin is a Wnt/β-catenin antagonist, mainly secreted by osteocytes, and most known for its role in reducing bone formation. Studies in rodents suggest sclerostin can also regulate adipose tissue mass and metabolism, representing bone-adipose tissue crosstalk. Exercise training has been shown to reduce plasma sclerostin levels; but the effects of exercise on sclerostin and Wnt/β-catenin signaling specifically within adipose tissue has yet to be examined. The purpose of this study was to examine subcutaneous WAT (scWAT) sclerostin content and Wnt signaling in response to exercise training in young men with obesity. To this end, 7 male participants (BMI = 35 ± 4; 25 ± 4 years) underwent 4 weeks of sprint interval training (SIT) involving 4 weekly sessions consisting of a 5-min warmup, followed by 8 × 20 s intervals at 170% of work rate at VO2peak , separated by 10 s of rest. Serum and scWAT were sampled at rest both pre- and post-SIT. Despite no changes in serum sclerostin levels, we found a significant decrease in adipose sclerostin content (-37%, p = 0.04), an increase in total β-catenin (+52%, p = 0.03), and no changes in GSK3β serine 9 phosphorylation. There were also concomitant reductions in serum TNF-α (-0.36 pg/ml, p = 0.03) and IL-6 (-1.44 pg/ml, p = 0.05) as well as an increase in VO2peak (+5%, p = 0.03) and scWAT COXIV protein content (+95%, p = 0.04). In conclusion, scWAT sclerostin content was reduced and β-catenin content was increased following SIT in young men with excess adiposity, suggesting a role of sclerostin in regulating human adipose tissue in response to exercise training.
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Affiliation(s)
- Nigel Kurgan
- Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
- Centre for Bone and Muscle HealthBrock UniversitySt. CatharinesOntarioCanada
| | - Hashim Islam
- School of Health and Exercise SciencesUniversity of British Columbia OkanaganKelownaBritish ColumbiaCanada
| | | | - Bradley J. Baranowski
- Centre for Bone and Muscle HealthBrock UniversitySt. CatharinesOntarioCanada
- Department of Health SciencesBrock UniversitySt. CatharinesOntarioCanada
| | - Joshua Stoikos
- Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
- Centre for Bone and Muscle HealthBrock UniversitySt. CatharinesOntarioCanada
| | - Val A. Fajardo
- Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
- Centre for Bone and Muscle HealthBrock UniversitySt. CatharinesOntarioCanada
| | | | - Brendon J. Gurd
- Department of KinesiologyQueens UniversityKingstonOntarioCanada
| | - Panagiota Klentrou
- Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
- Centre for Bone and Muscle HealthBrock UniversitySt. CatharinesOntarioCanada
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18
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Ercan Z, Bilek F, Demir CF. The effect of aerobic exercise on Neurofilament light chain and glial Fibrillary acidic protein level in patients with relapsing remitting type multiple sclerosis. Mult Scler Relat Disord 2021; 55:103219. [PMID: 34433118 DOI: 10.1016/j.msard.2021.103219] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
Background Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system in which disease activity can be monitored with some biomarkers. The aim of our study was to investigate serum Glial Fibrillary Acidic Protein (GFAP) and Neurofilament Light Chain (NFL) in relapsing-remitting MS (RRMS) patients after the aerobic exercise. Methods A total of 38 participants with RRMS (Expanded Disability Status Scale: 1.0 - 4.5) were randomized to a study group (3 × /week for 8 weeks at 60 - 70 % of maximal aerobic capacity (VO2max) + home exercises) and a control group (were given home exercises programme 3 times a week for 8 week). Serum NFL and GFAP levels were analyzed using enzyme-linked immunosorbent analysis method before and at the end of 8 weeks. Results: NFL and GFAP levels were statistically lower in the study group at the end of the study than before the study. In the control group, no significant changes were observed in serum NFL and GFAP levels. ΔNFL levels were significantly higher in the study group than control group. Conclusion It was shown, for the first time that serum GFAP and NFL levels (%10 and % 32, respectively) in RRMS patients decreased after aerobic exercise. Our study is important in terms of investigating the effects of aerobic exercise in individuals with RRMS and elucidating the underlying measurable biomarkers. The significant reduction of NFL and GFAP, which have an important role in the pathology associated with nervous system damage in MS, with aerobic exercise may be promising in understanding the regulation of disease activity in MS patients.
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Affiliation(s)
- Zubeyde Ercan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey.
| | - Furkan Bilek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey.
| | - Caner Feyzi Demir
- Department of Neurology, Faculty of Medical, Fırat University, Elazığ, Turkey.
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19
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Mokhtarzade M, Molanouri Shamsi M, Abolhasani M, Bakhshi B, Sahraian MA, Quinn LS, Negaresh R. Home-based exercise training influences gut bacterial levels in multiple sclerosis. Complement Ther Clin Pract 2021; 45:101463. [PMID: 34348201 DOI: 10.1016/j.ctcp.2021.101463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/20/2021] [Accepted: 07/28/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multiple sclerosis is associated with gut microbiome alterations. The current study aimed to investigate the effect of home-based exercise on gut bacteria in people with multiple sclerosis (MS). We also examined the association of exercise-induced gut bacterial modulation with circulating levels of inflammatory and anti-inflammatory cytokines. MATERIALS AND METHODS Forty-two people with MS (female/male: 31/11, expanded disability scale status <5) participated in this study and were divided into two groups: 6 months of home-based exercise (5 sessions per week) and controls. Before and after the intervention, the following parameters were assessed: gut microbiota, including faecalibacterium prausnitzii, akkermansia muciniphila, prevotella and bacteroides counts; cytokine levels including interleukin (IL)-10 and tumor necrosis factor-alpha (TNF-α); and psychosocial factors including anxiety, depression, and fatigue. RESULTS Home-based exercise significantly increased prevotella counts, and decreased akkermansia muciniphila counts (p < 0.05); however, there were no significant effects on faecalibacterium prausnitzii and bacteroides counts (p > 0.05). There were no significant effects of home-based exercise on circulating cytokine levels (p > 0.05). Moreover, home-based exercise was associated with significant improvements in anxiety and depression (p < 0.05); however, fatigue revealed no significant change (p > 0.05). Akkermansia muciniphila, prevotella and bacteroides count changes in response to the intervention were correlated with changes in IL-10 (r = -0.052, r = 0.67, and r = -0.55, respectively). CONCLUSION In general, our data revealed the effect of exercise on gut bacteria, especially prevotella, and akkermansia muciniphila counts, which can probably have a beneficial effect on MS disease pathology and course; however, the lack of changes in cytokines following exercise suggests the possible role of mechanisms other than modulation of circulating IL-10 and TNF- α levels.
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Affiliation(s)
- Motahare Mokhtarzade
- Department of Physical Education and Sport Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Maryam Abolhasani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bita Bakhshi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - LeBris S Quinn
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, University of Washington, Seattle, WA, 98108, USA
| | - Raoof Negaresh
- Department of Physical Education and Sport Sciences, Tarbiat Modares University, Tehran, Iran
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20
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Negaresh R, Gharakhanlou R, Sahraian MA, Abolhasani M, Motl RW, Zimmer P. Physical activity may contribute to brain health in multiple sclerosis: An MR volumetric and spectroscopy study. J Neuroimaging 2021; 31:714-723. [PMID: 33955618 DOI: 10.1111/jon.12869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Physical activity may represent a disease-modifying therapy in persons with multiple sclerosis (pwMS). To date, there is limited research regarding mechanisms based on brain imaging for understanding the beneficial effects of physical activity in pwMS. This study examined the relationship between physical activity levels and thalamic and hippocampal volumes and brain metabolism in pwMS. METHODS The sample of 52 pwMS (37.3 ± 9.6 years of age; 35 females, 17 males) underwent a combination of volumetric magnetic resonance imaging and magnetic resonance spectroscopy. Current and lifetime physical activity were assessed using actigraphy and the adapted version of the Historical Activity Questionnaire, respectively. RESULTS Positive associations were observed between both actigraphy and self-reported levels of moderate-to-vigorous physical activity (MVPA) and thalamic and hippocampal volumes. Regarding brain metabolism, actigraphy and self-reported levels of MVPA were positively associated with higher hippocampal and thalamic levels of N-acetylaspartate/creatine ratio (NAA/Cr: marker of neural integrity and cell energy state). CONCLUSIONS This study provides novel evidence for a positive association between physical activity and thalamic and hippocampal volume and metabolism in pwMS. These findings support the hypothesis that physical activity, particularly MVPA, may serve as a disease-modifying treatment by improving brain health in pwMS.
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Affiliation(s)
- Raoof Negaresh
- Department of Sport Physiology, Tarbiat Modares University, Tehran, Iran
| | - Reza Gharakhanlou
- Department of Sport Physiology, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philipp Zimmer
- Division for Performance and Health (Sports Medicine), Department of Sport and Sport Science, TU Dortmund University, Dortmund, Germany
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21
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Hvid LG, Harwood DL, Eskildsen SF, Dalgas U. A Critical Systematic Review of Current Evidence on the Effects of Physical Exercise on Whole/Regional Grey Matter Brain Volume in Populations at Risk of Neurodegeneration. Sports Med 2021; 51:1651-1671. [PMID: 33861414 DOI: 10.1007/s40279-021-01453-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the intriguing potential of physical exercise being able to preserve or even restore brain volume (grey matter volume in particular)-a tissue essential for both cognitive and physical function-no reviews have so far synthesized the existing knowledge from randomized controlled trials investigating exercise-induced changes of the brain's grey matter volume in populations at risk of neurodegeneration. Our objective was to critically review the existing evidence regarding this topic. METHODS A systematic search was carried out in MEDLINE and EMBASE databases primo April 2020, to identify randomized controlled trials evaluating the effects of aerobic training, resistance training or concurrent training on brain grey volume changes (by MRI) in adult clinical or healthy elderly populations. RESULTS A total of 20 articles (from 19 RCTs) evaluating 3-12 months of aerobic, resistance, or concurrent training were identified and included, involving a total of 1662 participants (populations: healthy older adults, older adults with mild cognitive impairment or Alzheimer's disease, adults with schizophrenia or multiple sclerosis or major depression). While few studies indicated a positive effect-although modest-of physical exercise on certain regions of brain grey matter volume, the majority of study findings were neutral (i.e., no effects/small effect sizes) and quite divergent across populations. Meta-analyses showed that different exercise modalities failed to elicit any substantial effects on whole brain grey volume and hippocampus volume, although with rather large confidence interval width (i.e., variability). CONCLUSION Altogether, the current evidence on the effects of physical exercise on whole/regional grey matter brain volume appear sparse and inconclusive, and does not support that physical exercise is as potent as previously proposed when it comes to affecting brain grey matter volume.
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Affiliation(s)
- Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Dylan L Harwood
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Simon F Eskildsen
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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22
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Lozinski BM, de Almeida LGN, Silva C, Dong Y, Brown D, Chopra S, Yong VW, Dufour A. Exercise rapidly alters proteomes in mice following spinal cord demyelination. Sci Rep 2021; 11:7239. [PMID: 33790323 PMCID: PMC8012633 DOI: 10.1038/s41598-021-86593-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/16/2021] [Indexed: 02/01/2023] Open
Abstract
Exercise affords broad benefits for people with multiple sclerosis (PwMS) including less fatigue, depression, and improved cognition. In animal models of multiple sclerosis (MS), exercise has been shown to improve remyelination, decrease blood-brain barrier permeability and reduce leukocyte infiltration. Despite these benefits many PwMS refrain from engaging in physical activity. This barrier to participation in exercise may be overcome by uncovering and describing the mechanisms by which exercise promotes beneficial changes in the central nervous system (CNS). Here, we show that acute bouts of exercise in mice profoundly alters the proteome in demyelinating lesions. Following lysolecithin induced demyelination of the ventral spinal cord, mice were given immediate access to a running wheel for 4 days. Lesioned spinal cords and peripheral blood serum were then subjected to tandem mass tag labeling shotgun proteomics workflow to identify alteration in protein levels. We identified 86 significantly upregulated and 85 downregulated proteins in the lesioned spinal cord as well as 14 significantly upregulated and 11 downregulated proteins in the serum following acute exercise. Altered pathways following exercise in demyelinated mice include oxidative stress response, metabolism and transmission across chemical synapses. Similar acute bout of exercise in naïve mice also changed several proteins in the serum and spinal cord, including those for metabolism and anti-oxidant responses. Improving our understanding of the mechanisms and duration of activity required to influence the injured CNS should motivate PwMS and other conditions to embrace exercise as part of their therapy to manage CNS disability.
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Affiliation(s)
- Brian Mark Lozinski
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Luiz Gustavo Nogueira de Almeida
- Department of Biochemistry and Molecular Biology, University of Calgary, Alberta, Canada
- HRIC 3C64, Department of Physiology and Pharmacology, University of Calgary, 3330 Hospital Drive Calgary, Alberta, T2N 4N1, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Claudia Silva
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Yifei Dong
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Dennis Brown
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Sameeksha Chopra
- Department of Biochemistry and Molecular Biology, University of Calgary, Alberta, Canada
- HRIC 3C64, Department of Physiology and Pharmacology, University of Calgary, 3330 Hospital Drive Calgary, Alberta, T2N 4N1, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - V Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Antoine Dufour
- Department of Biochemistry and Molecular Biology, University of Calgary, Alberta, Canada.
- HRIC 3C64, Department of Physiology and Pharmacology, University of Calgary, 3330 Hospital Drive Calgary, Alberta, T2N 4N1, Canada.
- The Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada.
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23
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Khalafi M, Alamdari KA, Symonds ME, Nobari H, Carlos-Vivas J. Impact of acute exercise on immediate and following early post-exercise FGF-21 concentration in adults: systematic review and meta-analysis. Hormones (Athens) 2021; 20:23-33. [PMID: 33151509 DOI: 10.1007/s42000-020-00245-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE/OBJECTIVE The aim of this study was to quantify circulating fibroblast growth factor 21 (FGF-21) changes during and immediately after acute exercise and, based on body weight, to identify the subgroups exhibiting the largest response. METHODS The PubMed, Web of Science, and Cochrane Library electronic databases were searched up to December 2019 for studies published in English peer-reviewed journals. Studies that evaluated the effects of acute exercise on FGF-21 concentrations immediately after and 1 and 3 h post-exercise in adults were included. Random effects models were used for analyses, with data reported as standardized mean difference (SMD) and 95% confidence interval, and the risk of heterogeneity was evaluated. Subgroup analysis of subjects with normal weight and obesity/overweight was performed. RESULTS A total of seven studies involving 125 participants (age 35.95 (21-64) years and BMI 25.89 (21.30-35.46) kg/m2) were included. Overall, acute exercise increased FGF-21 (d = 0.18; 95% CI 0.01 to 0.35, p = 0.02) and this remained for 1 h post-exercise FGF-21 (d = 0.59; 95% CI 0.33 to 0.86, p = 0.001). Three hours after exercise, FGF-21 was restored to near baseline values (d = - 0.05; 95% CI - 0.34 to 0.22, p = 0.68). Acute exercise raised FGF-21 concentrations in normal weight participants (d = 0.57, p = 0.001) and tended to increase in overweight and obese participants (d = 0.79, p = 0.05) 1 h post-exercise. CONCLUSION Acute exercise increases circulating FGF-21, irrespective of body weight.
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Affiliation(s)
- Mousa Khalafi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, 4199613776, Iran.
| | - Karim Azali Alamdari
- Department of Sport Sciences, Azarbaijan Shahid Madani University, Tabriz, 5375171379, Iran.
| | - Michael E Symonds
- The Early Life Research Unit, Division of Child Health, Obstetrics and Gynaecology, and Nottingham Digestive Disease Centre and Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Hadi Nobari
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Jorge Carlos-Vivas
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003, Caceres, Spain
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24
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Grazioli E, Nigro E, Cerulli C, Borriello G, Mancini A, Tranchita E, Polito R, Parisi A, Buono P, Daniele A. Case Report: Concurrent Resistance and Aerobic Training Regulate Adiponectin Expression and Disease Severity in Multiple Sclerosis: A Case Study. Front Neurosci 2021; 14:567302. [PMID: 33414700 PMCID: PMC7783198 DOI: 10.3389/fnins.2020.567302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022] Open
Abstract
Adapted exercise is an effective non-pharmacological tool to improve functional, cognitive, and psychological parameters in multiple sclerosis (MS), in association with increased quality of life (QoL) and decreased disease severity. Adipose tissue, through the production of different adipokines, is involved in regulating energy metabolism and inflammation. Adiponectin, increased in MS, circulates as oligomers of low (LMW), medium (MMW), and high molecular weight (HMW), the latter mediating the main biological effects. The aim of study was to evaluate the effects of 4 months training at moderate intensity [65% heart rate reserve (HRR)] on BMI, adiponectin, and QoL in a volunteer with secondary progressive MS. The parameters were evaluated before (T0), after 4 months training (T1), and 6 months after the end of training (T2); total serum adiponectin and its oligomeric profile were evaluated. We found a reduction in BMI (−0.9%) and FAT (−2.6%), an improvement in perceived QoL and a reduced expression of total adiponectin and HMW oligomers together with decreased MS disability level at T1 measured by EDSS. Despite the limitations of a case study, this represent a starting point to understand the influence of exercise in MS and the relationship with adiponectin expression.
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Affiliation(s)
- Elisa Grazioli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Ersilia Nigro
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Claudia Cerulli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Giovanna Borriello
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
| | - Annamaria Mancini
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Eliana Tranchita
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Rita Polito
- CEINGE Advanced Biotechnologies, Naples, Italy
| | - Attilio Parisi
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Pasqualina Buono
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Aurora Daniele
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
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25
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Silva BA, Miglietta EA, Ferrari CC. Training the brain: could it improve multiple sclerosis treatment? Rev Neurosci 2020; 31:779-792. [PMID: 32712593 DOI: 10.1515/revneuro-2020-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022]
Abstract
Multiple sclerosis (MS) is a neurological disease characterized by neuroinflammation, demyelination and axonal degeneration along with loss of function in the central nervous system. For many years, research in MS has focused on the efficacy of pharmacological treatments. However, during the last years, many publications have been dedicated to the study of the efficacy of non-pharmacological strategies, such as physical exercise and cognitive training. Beneficial effects of the combination of both strategies on cognitive function have been described in both ageing adults and patients with neurodegenerative diseases, such as MS. The analysis of combining both physical and cognitive stimulation can be summarized by the environmental enrichment (EE) experiments, which are more suitable for animal models. EE refers to housing conditions consisting of exercise and cognitive and social stimulation. In this review, we will summarize the available studies that describe the influence of EE in both MS patients and MS animal models.
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Affiliation(s)
- Berenice Anabel Silva
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Esteban Alberto Miglietta
- Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
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26
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Effect of combined exercise training on pentraxins and pro- inflammatory cytokines in people with multiple sclerosis as a function of disability status. Cytokine 2020; 134:155196. [DOI: 10.1016/j.cyto.2020.155196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/25/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
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27
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Impact of Exercise on Immunometabolism in Multiple Sclerosis. J Clin Med 2020; 9:jcm9093038. [PMID: 32967206 PMCID: PMC7564219 DOI: 10.3390/jcm9093038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Multiple Sclerosis (MS) is a chronic, autoimmune condition characterized by demyelinating lesions and axonal degradation. Even though the cause of MS is heterogeneous, it is known that peripheral immune invasion in the central nervous system (CNS) drives pathology at least in the most common form of MS, relapse-remitting MS (RRMS). The more progressive forms’ mechanisms of action remain more elusive yet an innate immune dysfunction combined with neurodegeneration are likely drivers. Recently, increasing studies have focused on the influence of metabolism in regulating immune cell function. In this regard, exercise has long been known to regulate metabolism, and has emerged as a promising therapy for management of autoimmune disorders. Hence, in this review, we inspect the role of key immunometabolic pathways specifically dysregulated in MS and highlight potential therapeutic benefits of exercise in modulating those pathways to harness an anti-inflammatory state. Finally, we touch upon current challenges and future directions for the field of exercise and immunometabolism in MS.
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28
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Effect of a Combined Program of Strength and Dual Cognitive-Motor Tasks in Multiple Sclerosis Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176397. [PMID: 32887411 PMCID: PMC7503584 DOI: 10.3390/ijerph17176397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
This study investigated the effects of a 24-week combined training program (CTP) based on strength exercises and cognitive–motor tasks performed concurrently in participants with multiple sclerosis. A randomized, controlled intervention study was carried out. In total, 31 subjects with a confirmed diagnosis of multiple sclerosis (14 men and 17 women) were stratified and randomized into an intervention group (17 subjects) and a control group (14 subjects). The intervention group completed three weekly training sessions for 24 weeks, while the control group pursued their normal daily activities. In this program, cognitive–motor tasks were completed at once (dual tasking). A 3D photogrammetry connected to a selective attention system designed for dual tasking while walking was used. Ground reaction forces were measured using two force plates, one for sit-to-stand testing, while the other was used for static force measurement. Postural equilibrium was examined using a stabilometric plate based for Romberg test assessment. The 24-week training program for multiple sclerosis patients improved their static peak force by 11% (p < 0 .05), their rate of force development by 36% (p < 0.05), and their balance (p < 0.05). Performance in daily activities such as walking or sitting-to-standing improved significantly in multiple sclerosis participants. CTP training was effective in reducing the dual-task costs of step length (48%) and walking velocity (54%), as compared to a matched control group.
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29
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Exercise improves neurotrophins in multiple sclerosis independent of disability status. Mult Scler Relat Disord 2020; 43:102143. [DOI: 10.1016/j.msard.2020.102143] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
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30
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Thompson AK, Sinkjær T. Can Operant Conditioning of EMG-Evoked Responses Help to Target Corticospinal Plasticity for Improving Motor Function in People With Multiple Sclerosis? Front Neurol 2020; 11:552. [PMID: 32765389 PMCID: PMC7381136 DOI: 10.3389/fneur.2020.00552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
Corticospinal pathway and its function are essential in motor control and motor rehabilitation. Multiple sclerosis (MS) causes damage to the brain and descending connections, and often diminishes corticospinal function. In people with MS, neural plasticity is available, although it does not necessarily remain stable over the course of disease progress. Thus, inducing plasticity to the corticospinal pathway so as to improve its function may lead to motor control improvements, which impact one's mobility, health, and wellness. In order to harness plasticity in people with MS, over the past two decades, non-invasive brain stimulation techniques have been examined for addressing common symptoms, such as cognitive deficits, fatigue, and spasticity. While these methods appear promising, when it comes to motor rehabilitation, just inducing plasticity or having a capacity for it does not guarantee generation of better motor functions. Targeting plasticity to a key pathway, such as the corticospinal pathway, could change what limits one's motor control and improve function. One of such neural training methods is operant conditioning of the motor-evoked potential that aims to train the behavior of the corticospinal-motoneuron pathway. Through up-conditioning training, the person learns to produce the rewarded neuronal behavior/state of increased corticospinal excitability, and through iterative training, the rewarded behavior/state becomes one's habitual, daily motor behavior. This minireview introduces operant conditioning approach for people with MS. Guiding beneficial CNS plasticity on top of continuous disease progress may help to prolong the duration of maintained motor function and quality of life in people living with MS.
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Affiliation(s)
- Aiko K Thompson
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Thomas Sinkjær
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Lundbeck Foundation, Copenhagen, Denmark
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31
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Moura SRG, Corrêa HL, Neves RVP, Santos CAR, Neto LSS, Silva VL, Souza MK, Deus LA, Reis AL, Simões HG, Beal FLR, Moraes MR, Navalta JW, Prestes J, Gadelha AB, Rosa TDS. Effects of resistance training on hepcidin levels and iron bioavailability in older individuals with end-stage renal disease: A randomized controlled trial. Exp Gerontol 2020; 139:111017. [PMID: 32634551 DOI: 10.1016/j.exger.2020.111017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/24/2023]
Abstract
Anemia is an inherent complication of older individuals with end-stage renal disease (ESRD) that is associated with inflammation which in turn is an important factor in the activation of hepcidin that contributes to the decrease in serum iron. Athough resistance training (RT) seems to reduce inflammation in ESRD, its influence on hepcidin and iron availability in hemodialysis patients is unclear. Therefore, the aim of this study was to exemine the effects of RT in on inflammatory profile, hepcidin, and iron status in older individuals with ESRD. End-stage renal disease patients (N: 157, age: 66.8 ± 3.6; body mass: 73 ± 15 body mass index:27 ± 3), were assigned to control (CTL n: 76) and exercise groups (RT n: 81). RT consisted of 24 weeks/3 days per week of a moderate intensity. There was an increase in the bioavailability of iron (ΔRT: 22.2; ΔCTL: -1 μg/dL, p < 0.0001), a decrease in hepcidin levels (ΔRT: -7.9; ΔCTL: 0.2 ng/mL, p < 0.0001),and an improvement of the inflammatory profile. These novel findings show that RT is a potential coadjuvant to reduce iron deficiency by decreasing the levels of hepcidin and pro-inflammatory markers in older patients undergoing hemodialysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - James W Navalta
- University of Nevada, Las Vegas, Department of Kinesiology and Nutrition Sciences, Las Vegas, NV, USA
| | - Jonato Prestes
- Catholic University of Brasilia, Federal District, Brazil
| | - André Bonadias Gadelha
- Catholic University of Brasilia, Federal District, Brazil; Federal Institute of Education, Science and Technology Goiano, Goiás, Brazil
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32
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Rooney S, Albalawi H, Paul L. Exercise in the management of multiple sclerosis relapses: current evidence and future perspectives. Neurodegener Dis Manag 2020; 10:103-115. [PMID: 32352357 DOI: 10.2217/nmt-2019-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Relapses are a common feature of multiple sclerosis; however, recovery from relapses is often incomplete, with up to half of people experiencing residual disabilities postrelapse. Therefore, treatments are required to promote recovery of function and reduce the extent of residual disabilities postrelapse. Accordingly, this Perspective article explores the role of exercise in relapse management. Current evidence from two studies suggests that exercise in combination with steroid therapy improves disability and quality of life postrelapse, and may be more beneficial in promoting relapse recovery than steroid therapy alone. However, given the small number of studies and methodological limitations, further studies are required to understand the effects of exercise in relapse management and the mechanism through which exercise influences relapse recovery.
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Affiliation(s)
- Scott Rooney
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom, G4 0BA
| | - Hani Albalawi
- College of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia, 47713
| | - Lorna Paul
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom, G4 0BA
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33
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Smith M, Williams G, Barker R. Finding the right balance with participation in exercise and sport for individuals with multiple sclerosis: protocol for a pre and post intervention feasibility study. BMJ Open 2020; 10:e035378. [PMID: 32193273 PMCID: PMC7150603 DOI: 10.1136/bmjopen-2019-035378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Individuals with minimal disability from multiple sclerosis (MS) requested advice on finding the right balance, between too much and too little exercise, when participating in their choice of sport or exercise. To optimise exercise participation during the early stages of the disease, a flexible exercise participation programme (FEPP) has been developed. The FEPP is novel because it provides guidance and support for individuals with MS to participate and progress in their preferred sport or exercise. The primary objective was to assess the feasibility of the FEPP. The secondary objective was to assess the feasibility of a larger trial to demonstrate the efficacy of the FEPP. METHODS AND ANALYSIS A stage I feasibility study of the FEPP, using a single group preintervention/post-intervention design, will be conducted with 16 participants with minimal disability from MS (Expanded Disability Status Scale level of 0-3.5). The 12-week FEPP will guide participants to independently participate in their preferred sport or exercise at a location of their choice. Exercise progression will be guided by individual energy levels and a weekly telephone coaching session with a physiotherapist. Participation in exercise or sport will be recorded in parallel with assessment of disease biomarkers (plasma cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor (TNF)), subjective vitality and high-level mobility. Acceptability of the FEPP will be assessed using a sequential explanatory mixed methods design where the findings of a participant survey will inform the interview guide for a series of focus groups.Feasibility of a larger trial will be assessed via process, resources, management and scientific metrics. Progression to a larger trial will depend on the achievement of specified minimum success criteria. ETHICS AND DISSEMINATION Ethical approval has been obtained for this study from the James Cook University Human Research Ethics Committee (H7956). Dissemination of findings is planned via peer-reviewed journals, conference presentations and media releases. The protocol date was 21 December 2019, V.1. TRIAL REGISTRATION NUMBER The trial is registered with Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000076976.
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gavin Williams
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
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Exercise as Medicine in Multiple Sclerosis—Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives. Curr Neurol Neurosci Rep 2019; 19:88. [DOI: 10.1007/s11910-019-1002-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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35
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Fasczewski KS, Cook HM, Campbell KE, Anderes B. I ride for MS: The impact of bike MS participation on motivation for physical activity in individuals with multiple sclerosis. Disabil Health J 2019; 13:100853. [PMID: 31679952 DOI: 10.1016/j.dhjo.2019.100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurodegenerative disease that results in deficits in physical and cognitive functioning. Research supports the use of physical activity (PA) to aid in MS symptom management and slow disease progression, however individuals diagnosed with MS are generally physically inactive. Social support has been shown to increase PA behavior in group exercise settings. Events such as Bike MS, a charity bicycle ride where individuals raise money for MS, could increase motivation for participation and therefore may be an ideal setting to introduce PA to individuals diagnosed with MS. OBJECTIVE /Hypothesis: The objective of the current research was to explore motives for participation in a Bike MS event in individuals diagnosed with MS and their family members, and examine if their Bike MS participation has translated to long-term PA behavior change and positive quality of life outcomes. METHODS A descriptive qualitative approach using semi-structured focus group, individual, and phone interviews, combined with observational field notes, was used to explore the experiences of seven individuals diagnosed with MS and four family members from two regional self-help groups who all actively participated in a Bike MS event. RESULTS Participants reported important social bonds, raising awareness for the cause, fundraising, long-term physical benefits, and overall increased quality of life as motives for participation. All participants reported long-term PA participation as a result of Bike MS participation. CONCLUSION Results support using Bike MS to increase long-term PA participation in individuals with MS, resulting in positive quality of life outcomes.
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Affiliation(s)
- Kimberly S Fasczewski
- Appalachian State University, Department of Health and Exercise Science, Boone, NC, USA.
| | - Hannah M Cook
- Appalachian State University, Department of Health and Exercise Science, Boone, NC, USA
| | - Katie E Campbell
- Appalachian State University, Department of Health and Exercise Science, Boone, NC, USA
| | - Blair Anderes
- Appalachian State University, Department of Health and Exercise Science, Boone, NC, USA
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Guo LY, Lozinski B, Yong VW. Exercise in multiple sclerosis and its models: Focus on the central nervous system outcomes. J Neurosci Res 2019; 98:509-523. [DOI: 10.1002/jnr.24524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Ling Yi Guo
- Department of Physiology and Pharmacology Western University London Ontario Canada
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
| | - Brian Lozinski
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
| | - Voon Wee Yong
- Hotchkiss Brain InstituteUniversity of Calgary Calgary Alberta Canada
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
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Acute effects of aerobic intensities on the cytokine response in women with mild multiple sclerosis. Mult Scler Relat Disord 2019; 31:82-86. [DOI: 10.1016/j.msard.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/17/2019] [Accepted: 03/31/2019] [Indexed: 12/18/2022]
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Mokhtarzade M, Agha-Alinejad H, Motl RW, Negaresh R, Baker JS, Zimmer P. Weight control and physical exercise in people with multiple sclerosis: Current knowledge and future perspectives. Complement Ther Med 2019; 43:240-246. [DOI: 10.1016/j.ctim.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/07/2019] [Indexed: 01/24/2023] Open
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Negaresh R, Motl RW, Zimmer P, Mokhtarzade M, Baker JS. Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: a systematic review of intervention studies. Eur J Neurol 2019; 26:711-721. [DOI: 10.1111/ene.13929] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/21/2019] [Indexed: 12/23/2022]
Affiliation(s)
- R. Negaresh
- Department of Physical Education and Sport Sciences Faculty of Humanities Tarbiat Modares University Tehran Iran
| | - R. W. Motl
- Department of Physical Therapy University of Alabama at Birmingham Birmingham AL USA
| | - P. Zimmer
- Department for Molecular and Cellular Sports Medicine German Sport University Cologne Cologne
- Division of Physical Activity, Prevention and Cancer German Cancer Research Center Heidelberg Germany
| | - M. Mokhtarzade
- Department of Physical Education and Sport Sciences Faculty of Humanities Tarbiat Modares University Tehran Iran
| | - J. S. Baker
- Applied Physiology Research Laboratory School of Health and Life Sciences University of the West of Scotland, Lanarkshire Campus Paisley UK
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Prolonged cortical silent period is related to poor fitness and fatigue, but not tumor necrosis factor, in Multiple Sclerosis. Clin Neurophysiol 2019; 130:474-483. [PMID: 30771724 DOI: 10.1016/j.clinph.2018.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Poor fitness among people with Multiple Sclerosis (MS) aggravates disease symptoms. Whether low fitness levels accompany brain functioning changes is unknown. METHODS MS patients (n = 82) completed a graded maximal exercise test, blood was drawn, and transcranial magnetic stimulation determined resting and active motor thresholds, motor evoked potential latency, and cortical silent period (CSP). RESULTS Sixty-two percent of participants had fitness levels ranked below 10th percentile. Fitness was not associated with disability measured using the Expanded Disability Status Scale (EDSS). Regression analyses revealed that, cardiorespiratory fitness, when controlling for disease demographics, contributed 23.7% (p < 0.001) to the model explaining variance in CSP. Regression analysis using cardiorespiratory fitness and CSP as predictors showed that CSP alone explained 19.9% of variance in subjective fatigue (p = 0.002). Tumor necrosis factor was not associated with any variable. CONCLUSION Low fitness was associated with longer CSP in MS. Longer CSP was, in turn, related to greater MS fatigue. SIGNIFICANCE MS patients had extremely low levels of cardiorespiratory fitness. Poor fitness predicted longer CSP, a marker of greater intracortical inhibition, which was linked to MS fatigue. Future research should examine whether aerobic training could shorten CSP and potentially lessen inhibition of cortical networks.
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