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NEW STUDY: Being highly fit (aerobically) helps protect the brain in MSers big time

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  • NEW STUDY: Being highly fit (aerobically) helps protect the brain in MSers big time

    I have an ongoing friendly debate with a good MSer buddy: I say aerobics is important, he says its killing me. With this just released study from Ohio State (below), it looks like I'm winning this round! It's nice to know that our hard work at staying fit is paying off, even if it might not be noticeable on a day-to-day basis.

    So if you can, keep the heart rate revving and protect that gray matter; your brain will thank you. - Dave

    Public release date: 18-Feb-2010

    Exercise helps protect brain of multiple sclerosis patients

    COLUMBUS, Ohio Ė Highly fit multiple sclerosis patients perform significantly better on tests of cognitive function than similar less-fit patients, a new study shows.

    In addition, MRI scans of the patients showed that the fitter MS patients showed less damage in parts of the brain that show deterioration as a result of MS, as well as a greater volume of vital gray matter.

    "We found that aerobic fitness has a protective effect on parts of the brain that are most affected by multiple sclerosis," said Ruchika Shaurya Prakash, lead author of the study and assistant professor of psychology at Ohio State University.

    "As a result, these fitter patients actually show better performance on tasks that measure processing speed."

    The study, done with colleagues Robert Motl and Arthur Kramer of the University of Illinois and Erin Snook of the University of Massachusetts, Amherst, appears online in the journal Brain Research and will be published in a future print edition.

    The study involved 21 women diagnosed with relapsing-remitting MS. They were compared with 15 age- and education-matched healthy female controls. The study assessed fitness, cognitive function, and structural changes in all participants.

    In order to measure fitness levels, the participants underwent a VO2 max test, in which they rode a stationary bicycle until they felt exhausted. During the test, they breathed into a mask which measured their oxygen consumption.

    All the women also took a variety of tests designed to evaluate cognitive functions, such as processing speed and selective attention. In one test, for example, participants had to write down in one minute as many words as they could think of that began with the letter "F." MS patients generally perform poorly on these tests compared to healthy people.

    The third analysis involved MRIs of the participants, revealing any damage to their brains.

    As expected, the MS patients did much worse than the healthy controls on the tests of brain functioning, and showed more deterioration in their brains as revealed through the MRIs.

    But what was interesting, Prakash said, was the significant differences between the more aerobically fit MS patients and those who were less fit.

    Take, for instance, lesions, which are the characteristic feature of MS. Lesions are areas of inflammation in the central nervous system in which neurons have been stripped of myelin, an insulating protein.

    "Physically fit MS patients had fewer lesions compared to those who weren't as fit and the lesions they did have tended to be smaller," Prakash said. "This is significant and can help explain why the higher-fit patients did better on tests of brain functioning."

    Aerobic fitness was also associated with less-damaged brain tissue in MS patients, both the gray matter and white matter.

    Gray matter is the cell bodies in the brain tissue, while white matter is the fibers that connect the various gray matter areas.

    The study found that fitness in MS patients was associated with larger volume of gray matter, accounting for about 20 percent of the volume in gray matter. That's important, Prakash said, because gray matter is linked to brain processing skills.

    "Even in gray matter that appeared relatively healthy, we found a deterioration in the volume in MS patients," she said. "But for some of the highest fit MS patients, we found that their gray matter volume was nearly equivalent to that of healthy controls."

    Another MRI analysis involved the integrity of the white matter in the brain. In MS patients, the white matter deteriorates as the myelin is stripped from neurons. Again, higher-fit MS patients showed less deterioration of white matter compared to those who were less fit.

    Overall, the three MRI tests in this study showed that parts of the brain involved in processing speed are all negatively affected by MS Ė but less so in patients who are aerobically fit.

    Prakash noted that other researchers have found that exercise promotes the production of nerve growth factors, proteins which are important for the growth and maintenance of neurons in the brain.

    "Our hypothesis is that aerobic exercise enhances these nerve growth factors in MS patients, which increases the volume of the gray matter and increases the integrity of the white matter," she said.

    "As a result there is an improvement in cognitive function."

    Prakash and her colleagues plan to extend this research by studying whether exercise interventions with MS patients can actually improve their cognition and have positive physical effects on the brain.

    "For a long time, MS patients were told not to exercise because there was a fear it could exacerbate their symptoms," she said.

    "But we're finding that if MS patients exercise in a controlled setting, it can actually help them with their cognitive function."
    Dave Bexfield

  • #2
    Yet more vindication

    Iím very much on your side in your argument with your friend, Dave. You say, ďÖ our hard work at staying fit Ö might not be noticeable on a day-to-day basisĒ. Iíll go even further and say that the benefit of our hard work might not EVER be ďnoticeableĒ. It might only show up as a year or two or TEN of continued mobility that we might not have had without all of that ďhard work at staying fitĒ. They sell a lot of DMDís based on a similar argument, but of course they can show some type of FDA approved 30% of 30% statistically less impairment.

    There have been scores if not hundreds of small studies involving some form and degree of physical exercise in both animals with simulated neurological problems and humans with clinical neurological problems. Nearly every single study indicated what would be a statistically significant positive impact on the nervous system when compared to control groups IF the study sample size had been statistically significant. I wish I knew how far back in time these studies reach but Iím sure itís a couple of decades at least.

    Yet, it has only been in the last couple of years that the predominant MS clinic in my area has conceded, in a rather footnote sort of way, that exercise is a vitally important part of the therapy that an individual with MS should undertake. While it is good that the sheer volume of these small studies seems to have finally persuaded at least some MS specialists, I have found these same doctors are quick to point out that the studies involving exercise and MS do not incorporate statistically significant populations. And so the Doctors donít place too much emphasis the exercise component.

    Well of course the studies donít include a statistically significant population, thereís no financial incentive and bla, bla, bla, the same old tired arguments that I should repeat here until something changes, but I wonít.

    If I ever get to be the Nike CEO for a day, Iím going to allocate the many millions of dollars it will take to conduct a statistically significant, comprehensive, conclusive study on the effects of different forms and strengths of exercise on people with MS. And, compare the results to other conventionally accepted treatments. I know the study is a shoe in for success. With a little luck and good marketing, it might even sell more tennis shoes than Tiger Woods, probably be cheaper too. But, Iíd do it just to shove it down the medical industries throat.

    I know the exercise option isnít for everybody with MS, some courses of this disease are mercilessly aggressive and some people might have moved past this option. But I believe the majority of us can benefit, some of us tremendously. I have tried to stop harping on it though, and just lead by example.

    To leave you with something positive, hereís the web site of the American College of Sports Medicine. They publish an electronic quarterly journal you can subscribe to that has helped me put the benefits from the exercise I do in better perspective. There is a lot of other good info on just staying healthy too. Be sure to check out the past journals.

    And if anyone out there is just getting into exercise as a therapy for MS, I recommend you find a good book and learn how gain the most benefit without harming yourself from whatever form(s) of exercise you choose.

    Thanks Dave and keep on doing what youíre doing,


    • #3
      How hard should you exercise

      Recently read an article from about how professional endurance athletes train. Bottom line was that they spend about 80% of their total training time well BELOW 80% of maximum heart rate and only about 20% training above. The article also mentioned that most recreational endurance sport enthusiasts probably train too hard on easy days and not hard enough on hard days resulting in essentially the same type of workout every training day. Unfortunately the article didn't speculate on the results of this type of behavior maybe because of other significant differences in the way the recreational enthusiast differs from the professional athlete, and of course, there are other training theories. It's a bit technical and a horendously long url but have a look. With respect to the article Dave posted above, it seems reasonable to assume that an MSers physiological response to exercise is similar to anybody elses, the ability to do the exercise due to neural damage perhaps being the main difference.


      • #4
        Keep it up...

        Last edited by ActiveMSers; 02-25-2010, 05:31 PM. Reason: Sorry Nicole, I try to keep the forum free of any marketing messages.


        • #5
          hey dave, i'm not trying to market...i'm trying to share this totally beneficial physical one knows about it...have you been to the website...i'm so jazzed about a movement that doesn't get me overheated or over fatigued...i got your message last october about not marketing...but thru this forum i think it is only fair to keep the doors open when it comes to being fit...gyrotonics is even more amazing than yoga...believe me i'm only sharing and the gyro world is very tight knit and not into my persuit of others with the same condition and the same outlook to handle our ms is totally innocent.


          • #6
            I have been exercising to prevent muddled thinking for a year now - and that was well before my actual diagnosis. I noticed my brain was working better with exercise; I just couldn't have imagined that's because it was being damaged by disease. I started exercising again yesterday.

            Thanks for posting this.


            • #7
              Speaking only from personal experience, my cognitive function has stayed pretty sharp and I do a lot of cardio. But cardio and MS don't always mix that well, so be careful not to over do it right out of the gate...
              Dave Bexfield


              • #8
                It's a good point! On Monday, I did a 400kcal workout and hardly broke a sweat. But Tuesday was tingle city for me.

                I'll have to tone it down, though it wasn't much of a workout compared to what I used to do.



                • #9
                  The full study is now available free. Great read if you are into this stuff. -D

                  Brain Res. 2010 Jun 23;1341:41-51. doi: 10.1016/j.brainres.2009.06.063. Epub 2009 Jun 25.

                  Aerobic fitness is associated with gray matter volume and white matter integrity in multiple sclerosis.

                  Prakash RS1, Snook EM, Motl RW, Kramer AF.
                  Author information
                  1Department of Psychology, The Ohio State University, USA.


                  Alterations in gray and white matter have been well documented in individuals with multiple sclerosis. Severity and extent of such brain tissue damage have been associated with cognitive impairment, disease duration and neurological disability, making quantitative indices of tissue damage important markers of disease progression. In this study, we investigated the association between cardiorespiratory fitness and measures of gray matter atrophy and white matter integrity. Employing voxel-based approaches to analysis of gray matter and white matter, we specifically examined whether higher levels of fitness in multiple sclerosis participants were associated with preserved gray matter volume and integrity of white matter. We found a positive association between cardiorespiratory fitness and regional gray matter volumes and higher focal fractional anisotropy values. Statistical mapping revealed that higher levels of fitness were associated with greater gray matter volume in the midline cortical structures including the medial frontal gyrus, anterior cingulate cortex and the precuneus. Further, we also found that increasing levels of fitness were associated with higher fractional anisotropy in the left thalamic radiation and right anterior corona radiata. Both preserved gray matter volume and white matter tract integrity were associated with better performance on measures of processing speed. Taken together, these results suggest that fitness exerts a prophylactic influence on the structural decline observed early on, preserving neuronal integrity in multiple sclerosis, thereby reducing long-term disability.

                  FULL STUDY (FREE):
                  Dave Bexfield


                  • #10
                    I was just talking with someone the other day, remarking that I have had only 1 new lesion on MRI in 5 yrs, have not had any disability progression, still working full time (no cog impairment) and I wasn't sure how much to attribute to DMD (Copaxone) and how much to attribute to the fact I remain active (cycling, equestrian, kayaking, yoga_), or how much is just "my course" of the disease. Nice to have some evidence that the exercise is playing a role, (trying to justify purchase of a new bike )
                    Callenge life before life challenges you - from inside collar of my "Bike Off More Than You Chew" bike jersey


                    • #11
                      This is great thread! I've needed a push recently to get out there again. I've been plagued by very weak core, an unstable hip girdle, so when I walk, or move upright, my lower joints hurt, a lot. I've been discouraged. But you all remind me that to hold onto what I got now, I need to figure out ways to exercise my body ( and soothe my mind ). Much needed push. Thanks! Suebee.


                      • #12
                        Bumping to the top as a reminder to get out and exercise (or stay in, you know, social distance!).
                        Dave Bexfield