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Resistance training increases cortical thickness in RRMS - results of a pilot RCT
S. Siemonsen1,2, J.-P. Stellmann1,3, T. Kjølhede4, D. Wenzel1,3, S. Ringgaard5, B.G. Pedersen5, E. Stenager6,7, T. Petersen8, C. Heesen1,3, K. Vissing4, U. Dalgas4
1Institute of Neuroimmunology and MS (INIMS), 2Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 3Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany, 4Section of Sport Science, Department of Public Health, Faculty of Health, Aarhus University, 5The MR Research Centre, Aarhus University Hospital, Aarhus, 6Institute of Regional Health Research, University of Southern Denmark, Odense, 7The Multiple Sclerosis Clinic of Southern Jutland, Department of Neurology, SDU Hospital, Sønderborg, 8The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Background: It has been suggested that exercise therapy has a disease modifying effect in people with Multiple Sclerosis (MS). Changes of structural Magnetic Resonance Imaging (MRI) measures following exercise interventions such as progressive resistance training (PRT), represent a substantial indicator of neuroprotective effects as reported in other clinical as well as healthy populations.
Objective: To evaluate the effects of PRT on global brain volumes and regional cortical thickness following 24 weeks of PRT.
Methods: This study was a 24-week randomised controlled trial, with a training group (n=17, 24 weeks of supervised PRT) and a waitlist group (n=12, continuing their habitual lifestyle). During an extension of another 24 weeks the waitlist group were offered the same PRT program. All patients (44y; median Expanded Disability Status Scale 3 [2-4]) were in the relapsing-remitting phase of the disease and treated with interferon-β 1A or 1B therapy. Three cranial MRIs (T1w, T2w images) were obtained on a 1.5 Tesla scanner. Standard MRI atrophy measures included FSL-SIENAX derived global volumes, lesion load and percentage brain volume change (PBVC). Cortical thickness estimates from T1w images were automatically processed by FreeSurfer. Thickness of each of the 74 cortical segments was then compared pairwise before and after PRT for all patients. In addition, cortical thickness changes through PRT were compared between the two groups. All analyses were corrected for age and gender as well as for multiple testing.
Results: EDSS as well as T2 lesion load did not change. Global volumes as well as PBVC were also not significantly altered after PRT and did not differ between the two groups. A higher absolute cortical thickness was found in nine cortical regions (p< 0.05) after PRT. Two of them, the superior part of the precentral sulcus and the occipito-temporal lateral fusiform gyrus could be as well confirmed when comparing relative cortical thickness changes between both groups (p< 0.05).
Conclusion: PRT seems to induce a measurable increase in cortical thickness of the precentral sulcus and fusiform gyrus and probable in other cortical regions. Our findings indicate that exercise interventions might have a neuroprotective or even a neuroregenerative effect in MS.
S. Siemonsen1,2, J.-P. Stellmann1,3, T. Kjølhede4, D. Wenzel1,3, S. Ringgaard5, B.G. Pedersen5, E. Stenager6,7, T. Petersen8, C. Heesen1,3, K. Vissing4, U. Dalgas4
1Institute of Neuroimmunology and MS (INIMS), 2Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 3Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany, 4Section of Sport Science, Department of Public Health, Faculty of Health, Aarhus University, 5The MR Research Centre, Aarhus University Hospital, Aarhus, 6Institute of Regional Health Research, University of Southern Denmark, Odense, 7The Multiple Sclerosis Clinic of Southern Jutland, Department of Neurology, SDU Hospital, Sønderborg, 8The Multiple Sclerosis Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Background: It has been suggested that exercise therapy has a disease modifying effect in people with Multiple Sclerosis (MS). Changes of structural Magnetic Resonance Imaging (MRI) measures following exercise interventions such as progressive resistance training (PRT), represent a substantial indicator of neuroprotective effects as reported in other clinical as well as healthy populations.
Objective: To evaluate the effects of PRT on global brain volumes and regional cortical thickness following 24 weeks of PRT.
Methods: This study was a 24-week randomised controlled trial, with a training group (n=17, 24 weeks of supervised PRT) and a waitlist group (n=12, continuing their habitual lifestyle). During an extension of another 24 weeks the waitlist group were offered the same PRT program. All patients (44y; median Expanded Disability Status Scale 3 [2-4]) were in the relapsing-remitting phase of the disease and treated with interferon-β 1A or 1B therapy. Three cranial MRIs (T1w, T2w images) were obtained on a 1.5 Tesla scanner. Standard MRI atrophy measures included FSL-SIENAX derived global volumes, lesion load and percentage brain volume change (PBVC). Cortical thickness estimates from T1w images were automatically processed by FreeSurfer. Thickness of each of the 74 cortical segments was then compared pairwise before and after PRT for all patients. In addition, cortical thickness changes through PRT were compared between the two groups. All analyses were corrected for age and gender as well as for multiple testing.
Results: EDSS as well as T2 lesion load did not change. Global volumes as well as PBVC were also not significantly altered after PRT and did not differ between the two groups. A higher absolute cortical thickness was found in nine cortical regions (p< 0.05) after PRT. Two of them, the superior part of the precentral sulcus and the occipito-temporal lateral fusiform gyrus could be as well confirmed when comparing relative cortical thickness changes between both groups (p< 0.05).
Conclusion: PRT seems to induce a measurable increase in cortical thickness of the precentral sulcus and fusiform gyrus and probable in other cortical regions. Our findings indicate that exercise interventions might have a neuroprotective or even a neuroregenerative effect in MS.