Home-based walking program may boost cognition in MS: Pilot study

A four-month home-based aerobic walking program was feasible and may help improve cognitive function for multiple sclerosis (MS) patients, according to data from a recent pilot study funded by the Kessler Foundation.

Findings from this small study support the design of a randomized, controlled clinical trial to evaluate the intervention in a larger group of MS patients, researchers said.

“Our study shows that remote aerobic walking exercise training is not only feasible but also might be efficacious for treating cognitive processing speed impairment in persons with MS,” Brian Sandroff, PhD, the study’s first author, said in a press release.

“We anticipate that these findings will encourage the development of more accessible, convenient, and broad-scale exercise interventions, ultimately leading to improved quality of life for those affected by this challenging disease,” added Sandroff, who is also a senior research scientist in the Center for Neuropsychology and Neuroscience Research at the Kessler Institute.

The study, “Feasibility of remotely delivered and supported aerobic walking exercise training for cognitive processing speed impairment in fully-ambulatory persons with multiple sclerosis,” was published in Multiple Sclerosis and Related Disorders.

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Cognitive problems affect about 70% of MS patients

Cognitive problems, particularly slowed information processing speeds, are common and considered an early symptom of MS, affecting about 70% of patients. Such difficulties can in turn influence patients’ ability to work and participate in social activities, which can significantly impact their quality of life.

Evidence suggests that certain exercise approaches, particularly aerobic exercise, may be beneficial for the cognitive function of MS patients. Aerobic exercise, or “cardio,” refers to exercise approaches like walking, running, swimming, or biking that elevate a person’s breathing or heart rate.

Still, in-person exercise programs may be difficult for MS patients to adhere to due to issues such as transportation or financial constraints.

In the pilot study (NCT05344040), the researchers examined the feasibility of a remotely-coached aerobic walking program and explored its potential benefits on MS patients’ cognitive function.

A total of 25 adults with MS were enrolled, all of whom retained their ability to walk (ambulatory), but had impairments in cognitive processing.

Participants were randomly assigned to participate in a remotely-coached aerobic walking program or a stretching and range-of-motion program (a control group) for 16 weeks, or about four months.

The exercise program was based on current guidelines for MS adults with mild-to-moderate disability and included at least 30 minutes of moderate exercise three times a week, with one day of rest between sessions. All participants started with the same duration of exercise for the first two weeks (10 minutes of exercise three times per week), and progressed to reach the desired exercise duration over the next 4-6 weeks.

Participants in both groups performed their prescribed exercises at home or in their community, but received one-on-one weekly video consultations with an exercise specialist, who made sure patients were safely using the right techniques and adhering to the training program.

A wearable fitness tracker and written activity logs were also used to track each participant’s activity.

Our study shows that remote aerobic walking exercise training is not only feasible but also might be efficacious for treating cognitive processing speed impairment in persons with MS.

Study reports 3 adverse events

Three adverse events were reported, two of which occurred in the walking group — one MS relapse resulting in the participant discontinuing the study and a minor fall that did not interfere with study participation.

This is a relatively small number of adverse events given that the program “took place in the home/community settings without direct supervision,” the researchers wrote.

Adherence to the exercise program was high in both groups. Participants in the walking group completed a mean of 38.3 out of 48 exercise sessions (80%), whereas those in the control group completed 45.6 out of 48 (95%).

Also, compliance was 92.6% and 97.7% for the intervention and control groups, respectively, meaning that patients walked or stretched for at least the prescribed duration in their sessions.

In terms of feasibility, the trial was overall found to be “cost-effective, accessible, and acceptable,” according to the researchers.

Overall, 19 patients completed the study and follow-up cognitive assessments. These participants were primarily women with relapsing-remitting MS, mild disability, and substantial impairments in cognitive processing speeds.

The Symbol Digit Modalities Test, a measure of information processing speed that is often used to determine cognitive impairment, was delivered remotely before and after the exercise program. Patients assigned to the walking program saw a clinically meaningful, 4.8-point improvement on the test scores after the exercise regimen, compared with a 1-point increase in the control group.

Patients with a slower processing speed prior to the intervention saw the greatest gains in test scores after the exercise program, suggesting that those patients “might benefit the most from such an intervention,” the researchers wrote.

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The benefits also extended to verbal learning and memory, as assessed by the California Verbal Learning Test, where scores were relatively stable in the walking group but declined by 2.9 points in the control group.

Still, given the small number of participants included in this pilot trial, larger and longer studies are needed to confirm these findings.

Overall, the remotely-conducted walking program was “safe and feasible for fully-ambulatory, [cognitive processing speed]-impaired persons with MS,” the researchers wrote, noting that the findings “support the design and implementation of an appropriately-powered” clinical trial.