ClinicSpeak: exercise the next big thing in neurodegenerative disease

Exercise therapy; will it work in MS? #MSBlog #MSResearch #ClinicSpeak

“Exercise is the next big thing in neurodegenerative diseases. It looks as if exercise delays the onset of age-related neurodegenerative diseases. It may have a similar effect in MS. Hence the interest in using exercise as a treatment for MS; to improve symptoms and possibly as a disease-modifying therapy to delay the onset of clinically-apparent progressive MS and to slow the rate of progression. The abstract below describes a randomised controlled trial that has started in Ireland to assess the impact of exercise on MS.”

“How does exercise work? Firstly, it conditions you and as a result improves your overall health. As a result you feel better. Exercise also stimulates the production of endorphins in the brain that act as anti-depressants. In addition, it causes the production of growth factors, in particular IGF-1 (insulin-like growth factor-1) that may be neuroprotective. People who exercise regularly sleep better and generally not improved quality of life.”

“We recommend to all our patients to try and engage in an active exercise programme. Even patients who are disabled can do exercise; physiotherapists are very good at designing exercise programmes if have a disability. Exercise is a core component of the brain health initiative that many public health doctors are beginning to promote at a National level to deal with the incipient dementia epidemic in developed countries.”

If you live in Ireland you may be eligible for this study; please checkout the eligibility criteria here. You can also contact the PIs who are running the trial:

Contacts: Susan Coote, PhD, +35361234278,   
Contact: Sara Hayes, PhD, +35361234861,   

Epub: Coote et al. A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol. BMC Neurol. 2014 Dec 21;14(1):241.

Background: Exercise has consistently yielded short-term, positive effects on health outcomes in people with multiple sclerosis (MS). However, these effects have not been maintained in the long-term. Behaviour change interventions aim to promote long-term positive lifestyle change. 

Aims: This study, namely, “Step it Up” will compare the effect of an exercise plus Social Cognitive Theory (SCT)-based behaviour change intervention with an exercise plus control education intervention on walking mobility among people with MS.

Methods/design: People with a diagnosis of MS who walk independently, score of 0-3 on the Patient Determined Disease Steps, who have not experienced an MS relapse or change in their MS medication in the last 12 weeks and who are physically inactive will be randomised to one of two study conditions. The experimental group will undergo a 10-week exercise plus SCT-based behavioural change intervention. The control group will undergo a 10-week exercise plus education intervention to control for contact. Participants will be assessed at weeks 1, 12, 24 and 36. The primary outcome will be walking mobility. Secondary outcomes will include: aerobic capacity, lower extremity muscle strength, participant adherence to the exercise programme, self-report exercise intensity, self-report enjoyment of exercise, exercise self-efficacy, outcome expectations for exercise, goal-setting for exercise, perceived benefits and barriers to exercise, perceptions of social support, physical and psychological impact of MS and fatigue. A qualitative evaluation of Step it Up will be completed among participants post-intervention.

Discussion: This randomised controlled trial will examine the effectiveness of an exercise plus SCT-based behaviour change intervention on walking mobility among people with MS. To this end, Step it Up will serve to inform future directions of research and clinical practice with regard to sustainable exercise interventions for people with MS. 

Trial registration NCT02301442.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • I often think that progressive forms of MS resemble early senescence – as if the chronic CNS inflammation of the earlier years turns on the genetic programs for cell aging too early. Can exercise help?
    I am still RRMS and relatively new to exercise programs, but the benefits of exercise at the moment are huge ( better endurance, muscle strength, better balance + I feel I am doing something, not just helplessly waiting for the decline in function).

  • I must be doing something wrong because I've been averaging 15,000 steps, approx 7 miles (at a fast pace) every day for over ten years, I run 5-miles at least once a week and do interval training and mountain climbing but I have quite major cognitive and mood problems. So either it means I'd be in a far worse state or it's not that brilliant for staving off depression and cognitive decline in MS, at least not for me. Yup, no EDSS after over 15 years diagnosed, 25 if including my CIS event and I have very strong legs, 'athletes' heart rate according to GP, perfect BMI blah blah but my brain is still turning to mush.

    • Brains turn into mush over time anyway ( in most tested areas other than langauge skills younger people beat older people). MS probably speeds the process of cognitive decline/speeds brain aging, but then again we also observe and criticise ourselves more than "healthy" people. ("I forgot to buy X, it's surely my MS" …"I can't remember her name, my brain is rubbish" and so on).

      Exercise is certainly not panacea for all problems, I find I am more "awake" after running ( walking does not do it for me – too low intensity?). I know of studies showing some effect of exercise on depression/cognition etc. Not sure. I think meditation did more for me.
      But then again we don't know where we would have been without exercise, do we ? 😉

    • I've exercised my whole adult life. Yes it does help, It helps my mood and my mobility. I have SPMS now and am struggling with my mobility now. However, unlike Anon 5:48 my mind is still active. My peers ask me to remember things or people they've forgotton. People want me on their quiz teams. I don't think I'm clever just have a good memory. I see pictures in my head of events that took place years ago. I always thought that this was because of my MS not in spite of it. MS works in mysterious ways.

  • As if multiple sclerosis itself and the DMT's weren't bad enough, now I need to exercise too?!

    In all seriousness, I have noticed a clear difference in when I exercise. My symptoms feel reduced, I sleep better, my numbness improves, my mood improves, and so on; and the effects seem to persist for several days after. I've found running every other day is the best balance to prevent overexerting/injuring myself while still feeling the benefits.

    Every time I wake up and don't feel like exercising, I just pull out Prof G's favorite brain atrophy picture, and it gets me moving real quick.

  • I have had MS for 19 years, was bad at the beginning with 7 attacks over 2 years then nothing for 15 years, was on avonex for this time, in which I ran and trained for 2 marathons. Not without tripping more than most but still completing. Felt absolutely great, continued spin classes for 7 years (a bit of an addiction) Over the past 2 years, symptoms started getting worse. Have finally got onto Natalizumab as funding just came thru in NZ (was paying up to NZ$3000.00 a month previously). I have just completed my first 30 minute spin class for a year and feel great and hoping to work up to an hour. I have tried to maintain my muscle fitness over the past year with weights will continue with this. for me exercise has been totally positive physically and mentally, As far as MS goes I have no idea if it has had an effect, maybe I would be a lot worse if I hadn't and as we don't really know what we are dealing with anything is worth a shot given the alternative.

  • I was diagnosed w/ MS in '98 at 40yo. Prior to that I was Physically active running and biking coaching kids soccer…but soon my legs stiffened up to where running & biking were distant memories. Early on I was hospitalized because of severe bladder infection Upon release I went to PT for rehab. They told me to adjust my expectations about exercise because of heat fatigue etc etc and that water areobics (sp) would be good….No way so I went to the gym weights and light stationary bike But then in 2013 I discovered handcyling BAM things started to look up. In year 1 I gradually went or longer rides and that fall I rode 28miles in an all day cruise on Nantucket 2 miles here 5 miles there sight seeing. In 2014 I decided to ride in BikeMS…I got in shape over the off season and was either going to ride 35m or 50m until my sister-in-law said "there is no way you could go 50m" So that was all it took. I rode 50 and was sad that I didnt ride further. This year I was shooting for the Century ribbon but the hill were too much so I was averaging just over 10mph so time became an issue… But yes exercise certainly changed my outlook on things and people viewed me differently. As I struggle to walk with my cane they ask whats wrong with you? or are you hurt? with pity in their eyes. They ask completely different question when I'm on my handbike. Better posture better mood

By Prof G



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