Can exercise therapy started soon after diagnosis affect the course of multiple sclerosis?

Previous studies of exercise therapy have included people at least 3 years after diagnosis. Danish researchers argue that there may be a "window of opportunity" in the early stages of MS, when exercise therapy might have the potential to modify the course of MS, similar to the benefits seen with early disease modifying drug treatment. The test this theory they evaluated exercise therapy started soon after diagnosis.

They recruited 84 people who had been diagnosed with MS for less than 2 years. Half of the group took part in supervised high-intensity aerobic exercise training over a 48-week period in addition to their routine care which included taking disease modifying drugs. The other half took part in health education sessions on top of routine care.

There was no difference in relapse rate and overall brain volume loss between the two groups. The exercise group improved their aerobic fitness by 21%, greater than the 10% improvement generally considered to represent a meaningful change. There were also improvements in the microscopic structure of four out of eight areas of the brain important for the control of movement.

The researchers conclude that the results do not show a direct disease modifying effect of exercise therapy but suggest that a study with more participants followed for a longer period might be required to show improvements in relapse rates and brain volume loss.

The positive effects of high intensity training on four out of eight regions of the brain associated with movement control may indicate improvements in neuroprotection or demyelination/remyelination processes.

Exercise therapy, which covers a range of different approaches such as endurance, resistance or aerobic training, has been extensively studied in MS and has been shown to increase general physical fitness and improve MS symptoms. However, these studies evaluated exercise therapy once someone's MS is well-established. In this study, researchers have investigated whether the benefits of early treatment, which are well-established for disease modifying drugs, could also be applied to exercise therapy.

Researchers in Denmark recruited 84 people who had been diagnosed with MS less than 2 years ago. Half of the group took part in supervised high-intensity aerobic exercise training over a 48-week period in addition to their routine care which included taking disease modifying drugs. The other half took part in health education sessions on top of routine care. Relapse rate and brain tissue loss assessed by MRI were the main measures of the study. The microscopic structures of several regions of the brain involved in the control of movement were also examined using advanced MRI techniques. Aerobic fitness level and participation in exercise were measured before and after the study. Read a detailed description of the study design here.

Compared to the health education group, the exercise group increased aerobic fitness by 21%, greater than the 10% improvement generally considered to represent a real change. There were also improvements in the microscopic structure of four out of eight areas of the brain associated with movement.

There was no difference between the two groups in relapse rate, brain tissue loss or number of lesions seen in MRI scans. Both exercise and health education groups increased their participation in exercise, although this was slightly greater in the exercise group.

Studies of exercise therapy typically include people at least 3 years after diagnosis, at the point where their MS is already well-established. Starting a disease modifying drug early in the course of relapsing MS results in fewer relapses and fewer new lesions, and ultimately less long-term disability. This group of researchers wanted to test whether the same is true for exercise, arguing that we may have overlooked a “window of opportunity” in the early stages of MS, when exercise therapy might have the potential to modify the course of MS.

The study did not show an effect of exercise on the number of relapses and overall brain volume loss. The researchers suggest that the study may have had too few participants and that 48 weeks may not have been long enough to show effects on these measures; clinical trials of disease modifying drugs typically recruit hundreds of participants and run for two years. So, a larger study which continues for a longer time might show improvements in relapse rates and brain volume loss.

The study did find that the programme of exercise training resulted in a significant improvement in aerobic fitness which will have a beneficial effect on symptoms and well-being of the exercise group, and reduce the risk of the risk of developing other conditions such as cardiovascular disease.

In addition, the positive effects of high intensity training on the microscopic structures of four out of eight regions of the brain associated with movement control indicate improvements in brain and spinal cord structures and possibly on demyelination/remyelination processes.

Riemenschneider M, et al.
Investigating the potential disease-modifying and neuroprotective efficacy of exercise therapy early in the disease course of multiple sclerosis: The Early Multiple Sclerosis Exercise Study (EMSES).
Mult Scler. 2022 Mar 16:13524585221079200. [Epub ahead of print]

Exercise can be something energetic or something more leisurely. There is no right or wrong exercise. However, the nature of MS may mean that you have to be more aware of your limits. If you have concerns about doing certain activities, talk to a health professional (eg your neurologist, GP, MS nurse, physiotherapist or occupational therapist) beforehand. You have to learn to listen to your own body and to be honest with what it is telling you. As recovery time can be longer for someone with MS, be prepared to stop before your body tells you that you've reached your limit.

Find out more about how exercise can help people with MS, how to get started with exercise, and how to choose the right exercise to suit your needs and abilities.