Exercise a day keeps the doctor away

Int J Mol Sci. 2015 Jul 2;16(7):14901-11. doi: 10.3390/ijms160714901.
Mental Health in Multiple Sclerosis Patients without Limitation of Physical Function: The Role of Physical Activity.
Tallner A, Waschbisch A, Hentschke C, Pfeifer K, Mäurer M.

Multiple sclerosis (MS) patients, in general, show reduced physical function, physical activity, and quality of life. Positive associations between physical activity and quality of life have been reported. In particular, we were interested in the relation between physical activity and mental health in MS patients without limitation of physical function, since limitations of physical function may influence both physical activity and quality of life.
Assessment comprised the Baecke questionnaire on physical activity, the Short Form 36 Health Survey (SF-36), and Beck Depression Inventory (BDI). We ranked our sample according to physical activity into four groups and performed an ANOVA to analyze the relationship between levels of physical activity and health-related quality of life (HRQoL). Then we performed a subgroup analysis and included patients with unlimited walking distance and a score of less than 18 in the BDI. Most active vs. inactive patients were compared for the mental subscales of the SF-36 and depression scores.

From 632 patients, 265 met inclusion criteria and hence quartiles were filled with 67 patients each. Active and inactive patients did not differ considerably in physical function. In contrast, mental subscales of the SF-36 were higher in active patients. Remarkable and significant differences were found regarding vitality, general health perception, social functioning and mental health, all in favor of physically active patients.

Our study showed that higher physical activity is still associated with higher mental health scores even if limitations of physical function are accounted for. Therefore, we believe that physical activity and exercise have considerable health benefits for MS patients.

Faivre ARico AZaaraoui WReuter FConfort-Gouny SGuye MPelletier JRanjeva JPAudoin B.
Brain functional plasticity at rest and during action in multiple sclerosis patients.J Clin Neurosci. 2015 Jul 3. pii: S0967-5868(15)00169-1. doi: 10.1016/j.jocn.2015.02.033. [Epub ahead of print]

We aimed to demonstrate that basal functional connectivity reorganization observed in a specific network at rest using resting state functional MRI (rs-fMRI) could be associated with functional cortical reorganization in such network during action (ta-fMRI) in a population of early multiple sclerosis (MS) patients. Altered basal functional connectivity has been previously reported in patients with MS but relationships with cortical reorganization during action have not been explored.

Thirteen patients with early relapsing-remitting MS and 14 matched healthy controls were explored on a 3T MRI scanner at rest and during a motor task (conjugate finger flexion and extension movements of each hand). Hand motor networks were extracted from rs-fMRI data using group spatial independent component analysis. For the non-dominant motor network, patients presented a higher basal functional connectivity at rest and recruited a supplementary prefrontal cortical area during action compared to the controls. The levels of hyperconnectivity at rest and of activation in the recruited area during action were significantly correlated. No differences were demonstrated for the dominant motor network at rest and during action.

The present study, combining rs-fMRI and ta-fMRI in non-disabled patients with early MS, revealed for the first time a direct association between functional reorganization depicted at rest and during action within the same system.

Brain plasticity is one the reasons why the number of MS plaques does not correlate well with disability and vice versa. When a group of MSers during the early stages of MS without any motor disability were studied, there was an increase in basal motor network connectivity. This is associated with functional plasticity during action, suggesting that it is a compensatory mechanism in the brains of MSers.

Figure: Relative cortical activation during hand motor movements of patients in comparison to healthy controls, corrected for nine hole peg test performance. The difference between the groups demonstrated a supplementary activation in patients compared to controls during the non-dominant hand motor task in the right prefrontal cortex (frontal inferior gyrus).

It is well known that brain volumes correlate with physical disability and cognitive difficulties in MS. There is also consistent evidence that physical activity has a positive impact on MS outcomes. Whereas moderate-to-vigorous exercise is associated with larger hippocampal (responsible for memory) volume and lowered brain atrophy rates, light physical activity or sedentary lifestyle has no protective benefit.

Moreover, the latest evidence suggests that mental health is also in favor of the physically active MSers. This association is still apparent even after controlling for physical limitations. This effect size is comparable to those achieved by DMTs in health quality outcomes simply from relapse rate reduction.

Figure: Sport activity and health-related quality of life (SF-36). Patients are grouped according to the sport index value, with higher values indicating higher sport activity.

About the author

Neuro Doc Gnanapavan


  • I believe in physical activity, of course for those who can still work out. I think it even has helped me a lot, I'm CIS, always played sports, and as I finished physical therapy sessions went back to bodybuilding because just thought the following: "I have to do this is to enjoy it while I can still exercise me." Regardless of what the factor or the causal factors of MS (whether genetic, infectious, low levels of vitamin D3, smoking, etc.) to physical activity helped me in my recovery, physical and mental … What treatments for progressive forms of IN come true, actually I wanted was a complete cure, but at least really effective treatments a reality and everyone to return to work or physical activity …

  • Soon after dx 12 years ago, a neuro physio told me that all MS patients MUST move every part of their body every day. Seemingly simple to do… but of course it isn't. When I think of all the advice claims, 'discoveries' etc around the treatment of MS, the importance of exercise has been an unchanged message. I make it a top priority and so far it's kept me OK.

  • I exercise every day at gym – row, cycle, cross trainer etc. It makes me far less fatigued BUT it does increase my spasticity. As I exercise my toes curl in spasm! My spasticity is worse even at rest than it was over a year ago when i started this exercise campaign. Every other part of me has improved – core strenght, leg, arm strength, bladder and bowel But spasticity is worse.

    • It's interesting that you mention an increase in spasticity on exercise, exercise is normally very helpful by stretching etc. The toes curling up themselves are an interesting phenomenon, either a dystonic response or a heightened spinal reflex. The latter two happening are highly probable as you boost the spinal motorneurones and interneurones (which comprise of bulk of the regenerative attempts by the adult nervous system) through exercise, you also boost/reinforce the dystonia/reflex!

    • NDG
      An interesting comment from you. My toes and other bits of my feet curl under sometimes for no apparent reason, or in response to an unwise movement, and it is always a very specific spot in the arch of my feet which is knotted. Have also had other muscle spasms from time to time in other parts of my lower legs (imagine a foot wearing an invisible six inch stiletto heel). I also have quite potent hyper-reflexia in my lower limb reflexes and some hyper-reflexia in my arms (medical students – stand to one side when you are practising your reflex testing skills!)
      Do you mean that sometimes these types of spasms are a result of the body attempting to repair bits of the spinal column (I have several spinal lesions) and thus the nerve messages are being jumbled or ??? Or is it generally a sign of further damage occurring? I can't do "exercise" as such – my leg coordination is too bad – I haven't been able to run for about six years and my walking has one speed only – slow and careful.
      Maybe you could do some posts to explain some of this stuff to us ordinary MSers – in nice simple language that's not overly technical – a bit like the MRI Education post of January this year (pretty please…)

  • Neuro Doc Gnanapavan but then, if I understand right, the Anonymous 4:39 above should avoid exercises that provoke this dystonia?

    • No! This is a complex topic, and I'll pull together some diagrams to do a proper post on this at some stage.



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