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)

Morten Riemenschneider*, Lars G. Hvid, Steffen Ringgaard, Mikkel Karl Emil Nygaard, Simon Fristed Eskildsen, Tobias Gaemelke, Melinda Magyari, Henrik Boye Jensen, Helle Hvilsted Nielsen, Matthias Kant, Masoud Falah, Thor Petersen, Egon Stenager, Ulrik Dalgas

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Abstrakt

Background: Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis (MS). Exercise is a promising non-pharmacological approach, and an uninvestigated ‘window of opportunity’ exists early in the disease course. Objective: To investigate the effect of early exercise on relapse rate, global brain atrophy and secondary magnetic resonance imaging (MRI) outcomes. Methods: This randomized controlled trial (n = 84, disease duration <2 years) included 48 weeks of supervised aerobic exercise or control condition. Population-based control data (Danish MS Registry) was included (n = 850, disease duration <2 years). Relapse rates were obtained from medical records, and patients underwent structural and diffusion-kurtosis MRI at baseline, 24 and 48 weeks. Results: No between-group differences were observed for primary outcomes, relapse rate (incidence-rate-ratio exercise relative to control: (0.49 (0.15; 1.66), p = 0.25) and global brain atrophy rate (−0.04 (−0.48; 0.40)%, p = 0.87), or secondary measures of lesion load. Aerobic fitness increased in favour of the exercise group. Microstructural integrity was higher in four of eight a priori defined motor-related tracts and nuclei in the exercise group compared with the control (thalamus, corticospinal tract, globus pallidus, cingulate gyrus) at 48 weeks. Conclusion: Early supervised aerobic exercise did not reduce relapse rate or global brain atrophy, but does positively affect the microstructural integrity of important motor-related tracts and nuclei.

OriginalsprogEngelsk
TidsskriftMultiple Sclerosis Journal
ISSN1352-4585
DOI
StatusE-pub ahead of print - 16. mar. 2022

Bibliografisk note

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: M.R. and U.D. report grants for the present manuscript from the Tryg Foundation, The Danish MS Society and Augustinus Foundation. U.D. reports grants from the Canadian MS Society, Aarhus University, Sanofi Genzyme and Fabrikant Vilhelm Peternsens Legat, outside the submitted work. L.G.H. reports grants from The Danish MS Society and Helsefonden, outside the submitted work, and serves as an unpaid board member on the board of Rehabilitation in Multiple Sclerosis (RIMS). M.M. reports grants and personal fees from Biogen, Merck, Sanofi, Abbvie, Alexion and Roche, outside the submitted work. S.R., M.K.E.N., S.K.E., T.G., H.B.J., H.H.J., M.K., M.F., T.P. and E.S. have nothing to disclose.

Publisher Copyright:
© The Author(s), 2022.

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