C. Cordani1, P. Preziosa1,2, F. Bonetti3, A. Tettamanti4, G.C. Riccitelli1, M. Filippi1,2,5,6, M.A. Rocca1,2
1IRCCS San Raffaele Scientific Institute, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Milan, Italy, 2IRCCS San Raffaele Scientific Institute, Neurology Unit, Milan, Italy, 3IRCCS San Raffaele Scientific Institute, Cardiovascular Rehabilitation Service, Cardiology Unit, Milan, Italy, 4IRCCS San Raffaele Scientific Institute, Rehabilitation and Functional Recovery Department, Milan, Italy, 5IRCCS San Raffaele Scientific Institute, Neurophysiology Unit, Milan, Italy, 6Vita-Salute San Raffaele University, Milan, Italy
Background: Aerobic training (AT) induces cardiovascular, metabolic and muscular changes and has been proposed as a promising rehabilitative approach in elderly and neurological patients to improve both motor and cognitive performances.
Purpose: The study aims to investigate the role of AT in patients with multiple sclerosis (MS) on motor and cognitive functions and the underlying anatomo-functional brain substrates, using advanced magnetic resonance imaging (MRI) techniques.
Methods: This randomized, controlled, monocentric trial will enroll 40 healthy controls (HC) and 40 patients with MS, randomized into 2 aerobic groups (currently HC-AG=10, MS-AG=12) and 2 nonspecific motor groups (currently HC-MG=10, MS-MG=14) who perform mobilization, stretching and balance exercises. In all subjects, cardiological, neuropsychological, global mobility and structural and functional MRI data at rest (hippocampal and anterior cingulum networks) are collected at baseline (t0) and after 2 months of treatment (t2).
Results: The preliminary analysis shows that at t0, there are significant differences between HC and MS for all cardiovascular, motor and some cognitive parameters (p<0.05). At t2, aerobic fitness improved in both HC- and MS-AG. Both MS subgroups improved significantly in mobility, while MS-AG also improved in fatigue perception and walking endurance (p <0.05). All groups reported improvements in cognitive performance regardless of type of training (p<0.05). There were improvements in depressive symptoms in all groups except HC-MG (p<0.04). Structural MRI analyses showed changes in gray matter volumes in sensorimotor, prefrontal and temporal areas in both HC-AG and MS-AG; while there were no changes in the white matter and in the hippocampus. MS-AG group also showed changes in resting state functional connectivity of sensorimotor and medial-temporal areas of the two networks analyzed. Clinical improvements were associated with the MRI changes observed (r range -0.86/0.84, p<0.001).
Conclusion(s): Two months of AT induce clinical and emotional/behavioral benefits in MS patients. These effects are mediated by structural and functional modifications of relevant brain networks.
Implications: AT is receiving increasing attention in MS rehabilitation field. Understanding its potential in improving both motor and cognitive performance is of fundamental importance for MS patients, in order to introduce in clinical practice new rehabilitative strategies with great impact on disability and quality of life of these patients.
Funding, acknowledgements: The authors received no specific funding for this study
Keywords: Multiple sclerosis, aerobic training, magnetic resonance imaging
Topic: Neurology: multiple sclerosis
Did this work require ethics approval? Yes
Institution: IRCCS San Raffaele Scientific Institute; Milan, Italy
Committee: Ethical Committee of IRCCS San Raffaele Hospital, Milan, Italy
Ethics number: 59/INT/2015
All authors, affiliations and abstracts have been published as submitted.
