Aerobic exercise has the potential to restore function in affected adults multiple sclerosis (MS) and hypothalamic atrophy – patient populations are at increased risk for progressive physical and cognitive decline.
In a cross-sectional study, aerobic fitness was closely associated with standardized ratings of cognition and walking ability in MS patients with thalamic atrophy, but not in their non-hypothalamic peers.
The study provided preliminary evidence for “strong and selective associations between aerobic fitness, cognitive processing speed, and walking endurance in adults with MS-related hypothalamic atrophy,” the researchers wrote.
The results are “exciting as we can improve aerobic exercise training trials targeting specific groups of people with MS to increase the chances of regaining function in these patients,” first author Brian M. Sandroff, PhD, senior research scientist, Kessler Foundation, said in West Orange, NJ. Medscape Medical News.
The study was published online on June 19 in Neurology Journal.
Clinical, research implications
Historically, lesion burden and lesion activity over time have been the most important prognostic signs of MS, Sandroff explained.
However, brain atrophy, including in the thalamus, is a “particularly” important biomarker that is increasingly being evaluated in the clinic and is being included as an end point in clinical research for MS, he noted.
The researchers sought to determine whether aerobic fitness was differentially related to cognitive processing speed and walking endurance in adults with MS who did not have hypothalamic atrophy.
The study included 44 adults with MS, all of whom were able to walk. They completed a graded exercise test to assess peak oxygen uptake (VO2), a Code Number Modalities Test (SDMT) to assess cognitive ability and a 6-minute walk test (6MW) to assess walking ability. MRI scans revealed thalamic atrophy in 25 patients.
After controlling for age, the Expanded Disability Status Scale (EDSS) and global MRI measures of aerobic dystrophy and fitness (VO2) were closely associated with cognitive function (SDMT scores, s <.01) and walking ability (performance of 6mW, s <.01) in patients with hypothalamic atrophy, but not in those without hypothalamic atrophy.
“Because aerobic fitness is closely related to cognitive processing speed and walking endurance in those with hypothalamic atrophy, this may support the development of subsequent aerobic exercise training to improve cognitive processing speed and walking endurance as primary outcomes in people with MS with MS. MS. Have thalamic atrophy associated with MS,” Sandroff said.
“Because thalamic atrophy is considered a powerful biomarker of neurodegeneration for MS, such a trial would represent the first test of aerobic exercise training to restore function, particularly cognitive processing speed and walking endurance, in those with MS-related central nervous system damage. No MS rehabilitation trials targeting patients with cerebral atrophy have been conducted.”
Aerobic exercise is ‘strongly encouraged’
Accessed for comment, Eoin Flanagan, MBBCh, MD, neurologist, Mayo Clinic, Rochester, MN, notes that the thalamus is the body’s “relay station” that processes sensory signals from nerves, and brain tissue loss in this area of the brain in MS It is considered a sign of neurodegeneration.
In the study, Flanagan said, “Higher levels of fitness appeared to be protective and associated with improved cognition and gait in people with MS who experience thinning in this part of the brain.”
“Thus, the main takeaway is that aerobic exercise may be particularly beneficial in MS patients with neurodegeneration and should be strongly encouraged,” Flanagan said. Medscape Medical News.
The study was supported by an investigator-initiated grant from EMD Serono, Inc and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. Sandroff and Flanagan reported no relevant conflicts of interest.
J Neurol. Posted on June 19, 2022. Summary.