Home-Based Exercise Improves Brain Characteristics of People with Multiple Sclerosis: A Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging of Lesion, Thalamus and Hippocampus
Poster Presentation XML
1Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
2Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
3Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
4Applied Physiology Research Laboratory, School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, Scotland, UK
5Clinical Exercise-Neuroimmunology Group, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
Pathophysiological mechanisms underlying beneficial effects of exercise on central nervous system in people with multiple sclerosis (pwMS) are still not clearly understood. This study examined the effects of home-based exercise (HBE) on lesion, thalamus and hippocampus structure, connectivity and metabolites in MS using a multimodal magnetic resonance (MR) protocol.
We recruited 64 pwMS (43 female) with Expanded Disability Status Scale ≤5 who were randomly assigned into HBE or control conditions. Participants in the HBE condition undertook home-based exercise over a 24-week period. The exercise program consisted of three aerobic (dancing, running and cycling which monitored by Polar watch) and two power/resistance (i.e., push-ups, elastic band exercise) sessions per week. Overall physical activity of both groups was screened by objective activity trackers. The MR protocol included volumetric MR imaging (MRI), diffusion tensor imaging (DTI), and MR spectroscopy (MRS), and yielded the metrics of lesion, thalamus and hippocampus volumes, metabolites and connectivity at baseline and following the 24-week period.
The data revealed a tendency toward reduced global brain, thalamus and hippocampus atrophy, but there were no significant changes following the intervention (p>0.05). There was a clear increase in N-acetyl aspartate (NAA) concentration of thalamus (p=0.025) and hippocampus (p=0.04) in the HBE group, and Myo-inositol (Ins) concentration deceased in the hippocampus (p=0.001) and lesion (p=0.011) following HBE. Additionally, creatine and phosphocreatine (Cr) levels only decreased in lesion after HBE (p=0.041). Choline-containing compounds, glutamate, and glutamine showed no significant change in the regions (p>0.05). However, there was a trend for a decrease in mean diffusivity as a myelin loss indicator in the thalamus, no significant differences were observed for global (axonal loss and myelin content indicators) and tract-based spatial statistical differences of DTI measures between HBE and control conditions (p>0.05).
Increased NAA (thalamus and hippocampus), and decreased Ins (hippocampus and lesion) and Cr (lesion) concentrations are thought to reflect beneficial effects of exercise on neuro-axonal damage or loss and gliosis, respectively. However, DTI and volumetric measures tended to improve, not significantly deteriorate was shown over the intervention. Collectively, this suggests that exercise could potentially slow down accumulation of microstructural brain tissue damage in pwMS.