Efficacy of High-Intensity Aerobic Exercise on Brain MRI Measures in Multiple Sclerosis

Martin Langeskov-Christensen, Lars Grøndahl Hvid, Mikkel Karl Emil Nygaard, Steffen Ringgaard, Henrik Boye Jensen, Helle Hvilsted Nielsen, Thor Petersen, Egon Stenager, Simon Fristed Eskildsen, Ulrik Dalgas

Research output: Contribution to journalJournal articleResearchpeer-review


OBJECTIVE: To determine whether 24 weeks of high-intensity progressive aerobic exercise (PAE) affects brain MRI measures in people with multiple sclerosis (MS). METHODS: We conducted a randomized, controlled, phase 2 trial (with a crossover follow-up) including an exercise group (supervised PAE followed by self-guided physical activity) and a waitlist group (habitual lifestyle followed by supervised PAE). Mildly to severely impaired patients with MS aged 18-65 years were randomized (1:1). The primary outcome was percentage brain volume change (PBVC) after 24 weeks, analyzed using the intention-to-treat principle. RESULTS: Eighty-six participants were recruited. PBVC did not change over the intervention period (mean between-group change +0.12%, 95% confidence interval [CI] -0.27 to 0.51, p = 0.55). In contrast, cardiorespiratory fitness (+3.5 mL O2/min/kg, 2.0 to 5.1, p < 0.01) and annualized relapse rate (0.00, 0.00-0.07 vs +0.45, 0.28 to 0.61, p < 0.01) improved in the exercise group. CONCLUSION: These findings do not support a neuroprotective effect of PAE in terms of total brain atrophy in people with MS and it did not lead to a statistically significant difference in gray matter parenchymal fraction. PAE led to improvements in cardiorespiratory fitness and a lower relapse rate. While these exploratory findings cautiously support PAE as a potential adjunct disease-modifying treatment in MS, further investigations are warranted. CLINICALTRIALSGOV IDENTIFIER: NCT02661555. CLASSIFICATION OF EVIDENCE: This study provides Level I evidence that 24 weeks of high-intensity PAE did not elicit disease-modifying effects in PBVC in people with MS. Exploratory analyses showed that PAE may reduce relapse rate.

Original languageEnglish
Issue number2
Pages (from-to)e203-e213
Publication statusPublished - 12. Jan 2021


  • Adult
  • Brain/diagnostic imaging
  • Cross-Over Studies
  • Denmark/epidemiology
  • Exercise/physiology
  • Female
  • Follow-Up Studies
  • High-Intensity Interval Training/methods
  • Humans
  • Magnetic Resonance Imaging/methods
  • Male
  • Middle Aged
  • Multiple Sclerosis/diagnostic imaging
  • Treatment Outcome


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