The Effects of Aerobic Exercise on the Recovery of Walking Ability and Neuroplasticity in People with Multiple Sclerosis: A Systematic Review of Animal and Clinical Studies.

Augustine Joshua Devasahayam,Michelle Ploughman,Matthew Bruce Downer

doi:10.1155/2017/4815958

Augustine Joshua Devasahayam, Michelle Ploughman + Show 1 more

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https://doi.org/10.1155/2017/4815958

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Abstract

Introduction Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. This review aims to consolidate evidence to develop optimal aerobic training parameters to enhance walking outcomes and neuroplasticity in PwMS. Methods Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. From a total of 1783 articles, 12 clinical and 5 animal studies were included. Results Eleven clinical studies reported improvements in walking ability. Only two clinical studies evaluated both walking and neurotrophins, and neither found an increase in neurotrophins despite improvements in walking. Patients with significant walking impairments were underrepresented. Long-term follow-up revealed mixed results. Two animal studies reported a positive change in both neurological recovery and neurotrophins. Conclusion Aerobic exercise improves walking ability in PwMS. Gains are not consistently maintained at 2- to 9-month follow-up. Studies examining levels of neurotrophins are inconclusive, necessitating further research. Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS.

Highlights

Walking is of high priority for people with multiple sclerosis (PwMS)
Consolidated evidence suggests that aerobic exercise training can improve walking ability in people having Multiple sclerosis (MS) without severe walking impairments
We have outlined the optimal aerobic training parameters (30 min 3x week for 6–8 weeks at mild to vigorous intensity) that improved walking in people with EDSS scores less than 6.0

Summary

Introduction

Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. Aerobic exercise improves walking ability in PwMS. Studies examining levels of neurotrophins are inconclusive, necessitating further research Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS. Rehabilitative interventions should maximize walking ability, while simultaneously facilitating plasticity of neural pathways that execute walking to foster long-term restoration of function [13,14,15]. The exact cellular cascades underlying the neural plasticity for walking remain to be explored, there is a general consensus suggesting that such plasticity may take place involving neuroplastic markers at the site of injury and/or lesions [16, 17]

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