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Large Study Shows that Exercise and Cognitive Rehabilitation Programs Can Improve Thinking Speed in People with Progressive MS

September 22, 2023

A large international clinical trial (called CogEx) tested whether a 12-week program of aerobic exercise or computer-based cognitive rehabilitation, or a combination of both, could improve thinking speed in people with progressive MS who had signs of cognitive changes.
The results suggested that regardless of which group they were in, two-thirds of the participants showed improvements and half of those still showed improvements 6 months later. The combination of both approaches did not enhance the benefits. This study adds to evidence that cognitive problems can be improved in people with progressive MS.
The trial was led by Prof. Anthony Feinstein, MPhil, PhD, FRCP (University of Toronto) and was supported by MS Canada. The National MS Society (U.S.A.) supported a sub-study at the University of Alabama, Birmingham that added MRI scanning to enhance information to be learned from the larger trial.
More Details:  A total of 311 participants from Belgium, Canada, Denmark, Italy, the United Kingdom, and the U.S. They all had progressive MS and had experienced cognitive changes. The interventions were:
  • Cognitive rehabilitation with a computer-based, incremental approach to improve processing speed (called the RehaCom program).
  • Exercise involving individualized aerobic training using a recumbent arm–leg stepper.
  • Sham cognitive task consisted of internet training provided individually.
  • Sham exercise consisted of non-aerobic stretching and balance tasks.
Participants were assigned to one of four groups, where they received the following interventions twice a week over 12-weeks: 
  • Cognitive rehabilitation plus sham exercise
  • Aerobic exercise plus sham cognitive task
  • Cognitive rehabilitation plus aerobic exercise (combined intervention)
  • Sham cognitive task and sham exercise
Cognitive testing was done using the Symbol Digit Modalities Test (SDMT) which measures thinking speed.
Results: After 12 weeks, there were no significant differences in the cognitive tests between the four treatment groups. However, two-thirds of all participants, regardless of the type of intervention received, showed significant improvements in processing speed at 12 weeks of intervention compared with their test scores at the start of the study. Almost 50% of participants retained these improvements in processing speed at the 6-month follow-up.
Why Does This Matter? This large trial provides evidence that cognition can be improved in people living with progressive MS. It is possible that the participants who showed improvements may have benefited from being more active in the trial, pointing to the potential benefits of enhancing a person’s intellectual, physical, and social activities that build a resistance to damage in the brain, known as “cognitive reserve.”   
Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial,” by Anthony Feinstein, Maria Pia Amato, Giampaolo Brichetto, Jeremy Chataway, Nancy D Chiaravalloti, Gary Cutter, Ulrik Dalgas, John DeLuca, Rachel Farrell, Peter Feys, Massimo Filippi, Jennifer Freeman, Matilde Inglese, Cecilia Meza, Robert W Motl, Maria Assunta Rocca, Brian M Sandroff, Amber Salter, on behalf of the CogEx Research Team, was published online in Lancet Neurology for its October 2023 issue.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. Symptoms range from numbness and tingling to blindness and paralysis, and there is currently no cure for MS. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. An estimated 1 million people live with MS in the United States. Most people with MS are diagnosed between the ages of 20 and 50, and it affects women three times more than men.


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