PRIMERS Framework Aims to Better Understand How Exercise Helps Movement and Cognition in MS Patients

A new conceptual framework, called PRIMERS, has been proposed as a way of better understanding how physical exercise works to improve cognition and mobility in people with multiple sclerosis, and using what’s learned to create new types of rehabilitation therapy for MS patients.

PRIMERS, conceived by a team led by researchers the University of Alabama, is a way of examining the relationship between exercise and adaptive neuroplasticity — the brain’s ability to change over time and adapt to different situations.

The proposal is detailed in the article, “Integrative CNS Plasticity With Exercise in MS: The PRIMERS (PRocessing, Integration of Multisensory Exercise-Related Stimuli) Conceptual Framework,” published in the journal Neurorehabilitation and Neural Repair.

MS is a progressive and neurodegenerative disease characterized by the destruction of the myelin sheath that protects neurons in the central nervous system, leading to gradual loss of mobility and damage to cognition.  “Approaches for managing mobility and cognitive disability in this population” are needed, and “one such approach is exercise training,” the researchers wrote.

Although the benefits of physical exercise for people with neurological disorders are of growing scientific interest, the mechanisms — processes — behind the positive effects of exercise on mobility and cognition in MS remains poorly understood.

The scientists propose using the framework — PRIMERS stands for PRocessing, Integration of Multisensory Exercise-Related Stimuli — to enable a “systematic examination” of how exercise affect brain connectivity, structure, and signaling events that could explain improvement in mobility and cognition experienced by patients following physical activity.

“Many individuals with MS develop disabling deficits in mobility and cognition. Exercise is a low-cost, non-invasive modality that relieves both types of symptoms, so we are very interested in learning more about how activity results in these improvements,” John DeLuca, a senior VP of research and training at Kessler Foundation and a study author, said in a press release.

“Rethinking how we view exercise in our plans for the long-term management of people with MS and other neurological conditions is our first step,” DeLuca added. “We anticipate that use of the PRIMERS framework will accelerate advances in treatment by integrating the contributions from neuroscience, neurophysiology, and neurorehabilitation.”

According to the PRIMERS conceptual framework, physical exercise promotes adaptive neuroplasticity by inducing both the integration and processing of multiple signals in the brain, which are then translated into a complex motor response as exercises are performed.

“We argue that exercise can be viewed as an integrative, systems-wide stimulus for neurorehabilitation because impaired mobility and cognition are common and co-occurring in MS,” the researchers wrote.