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MS research update - Can exercise increase brain protecting molecules in people with MS? - 21 March 2016

Summary

Previous studies have found that short periods of exercise can increase levels of a protein called brain derived neurotrophic factor (BDNF). This is found in the nervous system and plays a crucial role in the development, maintenance and repair of the nervous system. When levels of BDNF are measured in people with MS they are lower than levels found in the general population. This study aimed to look at BDNF levels in people with MS after a long term exercise programme.

22 people with relapsing remitting MS were allocated to either an sedentary group or an exercise group where they took part in a cardio and strength exercise programme.

The study found that after 24 weeks levels of BDNF were significantly higher in the group that had taken part in the exercise training than in the participants who had been in the sedentary group.

This is the first study to investigate the effect of long term exercise on levels of BDNF in people with MS. It found that exercise can increase levels of BDNF. This suggests that an exercise programme may be neuroprotective to people with MS, as these increased levels of BDNF may help repair or protect nerve cells from damage caused by MS.

Background

Previous research has shown that exercise has numerous benefits for people with MS, such as helping to reduce levels of fatigue and improve mobility, as well as reducing the risk of other conditions such as cardiovascular disease developing. Research has also shown it can have beneficial effects on brain health in the general population.

Studies in the general population and people with MS have found that exercise can increase levels of a protein called brain derived neurotrophic factor (BDNF). This is found in the nervous system and plays a crucial role in the development, maintenance and repair of the nervous system. When levels of BDNF are measured in people with MS they are lower than levels found in the general population, this may be because people with MS have less of it or that more of it is trying to protect nerves in the central nervous system so it cannot be detected in the blood.

Previous studies have found levels of BDNF are temporarily boosted after short periods of exercise in people with MS, but researchers have not yet looked at the effect of long term exercise. This study aimed to look at BDNF levels after a long term exercise programme.

How this study was carried out

22 people with relapsing remitting MS and 19 control participants took part in this study. The participants with MS were randomly allocated to be in the sedentary group (seven participants) or the exercise group (15 participants). Those who were in the sedentary group did not participate in any training programme and were told to continue their usual routine.

Those in the exercise group took part in 24 weeks of exercise training. This consisted of five sessions spread over two week periods (three sessions in the first week and two sessions in the next week). Each session started with cardiovascular training on a cycle and treadmill. The second part of the session consisted of resistance training using gym equipment to perform six exercises: leg press, leg curl, leg extension, vertical traction, arm curl and chest press.

Before the trial started information about each of the participants was collected and blood samples were taken from all participants to measure levels of BDNF, the blood tests were repeated again at the end of the 24 week trial period, at least 48 hours after the last exercise session.

The participants with MS also underwent physical tests that assessed their muscle strength, exercise tolerance and body composition, including proportions of body fat and lean tissue.

What was found

At the start of the study levels of BDNF were lower in the participants with MS than the controls. After 24 weeks levels of BDNF were significantly higher in the group that had taken part in the exercise training than in the participants who had been in the sedentary group. Additionally as would be expected, the exercise group also had improved muscle strength, exercise tolerance and increased lean tissue mass, when compared to their assessments before the study started.

What does it mean?

This is the first study to investigate the effect of long term exercise on levels of BDNF in people with MS. It found that exercise can increase levels of BDNF. This suggests that an exercise programme may be neuroprotective to people with MS, as these increased levels of BDNF may help repair or protect nerve cells from damage caused by MS.

The researchers do highlight that although the results are encouraging this was a pilot study in a relatively small group of people. They also suggest that they cannot rule out that social interaction in group exercise sessions could have potentially influenced some of the results. They conclude by saying that combined exercise training appears to have a broad range of beneficial effects for people with MS.

Wens I, Keytsman C, Deckx N, et al.
Brain derived neurotrophic factor in multiple sclerosis: effect of 24 weeks endurance and resistance training.
Eur J Neurol. 2016 Mar 16. doi: 10.1111/ene.12976. [Epub ahead of print]
Abstract

More about exercise

In the past, people with multiple sclerosis were advised to avoid exercise especially activities that might be tiring. A number of studies have shown that regular moderate exercise is a good thing although the exercise should be something that is enjoyable and fits within someone's capabilities.

Exercise can be something energetic or something more leisurely. There is no right or wrong exercise. However, the nature of MS may mean that someone has to be more aware of what they can achieve than someone who doesn't have MS. If you have concerns about undertaking certain activities, talk to a relevant health professional (eg a neurologist, GP, MS specialist nurse, physiotherapist or occupational therapist) beforehand. You have to learn to listen to your own body and to be honest with what it is telling you. As recovery time can be longer for someone with MS, be prepared to stop before your body tells you that you've reached your limit.

You can view or download some exercises for people with MS, watch our exercise videos online or order the free DVD. There is also a relaxation exercise with an MS specialist nurse which you can either watch or download as an MP3 file for your MP3 player.

Research by topic areas...

Disease modifying drugs

Branger P, Parienti JJ, Sormani MP, et al.
The effect of disease-modifying drugs on brain atrophy in relapsing-remitting multiple sclerosis: a meta-analysis.
PLoS One. 2016;11(3):e0149685.
Abstract
Read the full text of this paper

Risson V, Saini D, Bonzani I, et al.
Patterns of treatment switching in multiple sclerosis therapies in US patients active on social media: application of social media content analysis to health outcomes research.
J Med Internet Res. 2016 Mar 17;18(3):e62.
Abstract
Read the full text of this paper

Epidemiology

Albor C, du Sautoy T, Kali Vanan N, et al.
Ethnicity and prevalence of multiple sclerosis in east London.
Mult Scler. 2016 Mar 17. [Epub ahead of print]
Abstract
Read the full text of this paper

Falls

Tijsma M, Vister E, Hoang P, et al.
A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis.
Disabil Rehabil. 2016 Mar 17:1-7. [Epub ahead of print]
Abstract

Pathophysiology

Petracca M, Cordano C, Cellerino M, et al.
Retinal degeneration in primary-progressive multiple sclerosis: A role for cortical lesions?
Mult Scler. 2016 Mar 18. [Epub ahead of print]
Abstract

Physical activity

Arpin DJ, Davies BL, Kurz MJ.
Multiple sclerosis influences the precision of the ankle plantarflexon muscular force production.
Gait Posture. 2016 Mar;45:170-4.
Abstract

Collett J, Meaney A, Howells K, et al.
Acute recovery from exercise in people with multiple sclerosis: an exploratory study on the effect of exercise intensities.
Disabil Rehabil. 2016 Mar 13:1-8. [Epub ahead of print]
Abstract

Provision of care

McKay KA, Tremlett H, Zhu F, et al.
A population-based study comparing multiple sclerosis clinic users and non-users in British Columbia, Canada.
Eur J Neurol. 2016 Mar 15. [Epub ahead of print]
Abstract
Read the full text of this paper

Psychological aspects

Gottberg K, Chruzander C, Backenroth G, et al.
Individual face-to-face cognitive behavioural therapy in multiple sclerosis: a qualitative study.
J Clin Psychol. 2016 Mar 16. [Epub ahead of print]
Abstract

Strober LB.
Personality in multiple sclerosis (MS): impact on health, psychological well-being, coping, and overall quality of life.
Psychol Health Med. 2016 Mar 18:1-10. [Epub ahead of print]
Abstract

Symptoms and symptom management

Fonseca BA, Pereira CB, Jorge F, et al.
A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis.
Arq Neuropsiquiatr. 2016 Feb;74(2):106-11.
Abstract

Binétruy M, Chopard G, Laurent E, et al.
Slowing of information processing speed without motor slowing in multiple sclerosis observed during two crossing-off tasks.
Rev Neurol (Paris). 2016 Mar 15. [Epub ahead of print]
Abstract

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