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Dr. Bo Fernhall – “Exercise, Subclinical Atherosclerosis and Walking Mobility in Multiple Sclerosis”

Dr. Bo Fernhall, dean of the Department of the College of Applied Health Sciences at the University of Illinois at Chicago, and professor of kinesiology and nutrition, recently discussed his National MS Society grant-funded research project “Exercise, Subclinical Atherosclerosis and Walking Mobility in Multiple Sclerosis.” His main research interests are in the areas of exercise physiology with a specialization in cardiovascular function and health. He has been awarded several times for both his research and work in the classroom, and with over 25 years of experience in his field, his expertise is well regarded among his colleagues and constituents. Dr. Fernhall’s research is break-through work that is affecting people across all walks of life, and he is one of the top experts in his field.

What is the purpose of your study/what are you researching?

What we are trying to figure out is how to help MS patients become more mobile and decrease risk for atherosclerosis (plaque build-up in arteries) which is the leading cause for cardiovascular disease in America; also the risk for heart attack and stroke is greatly increased in people diagnosed with MS. People may not have focused on this aspect because mobility is a bigger issue for quality of life. With this research we are trying to address both of these issues at the same time.

We provide a home-based exercise program where patients do not need to come into the facility several times a week to exercise, which can be a burden to MS patients. We provide a stationary bike to our candidate patients that hooks up to the internet in order to monitor the workout – measuring time spent on the bike, changes in resistance, and rpm. Once a week the patient will go through an internet chat based sessions to describe how they feel about the bike and exercise, this is in order to make sure that the patient is adhering to the exercise, and if changes are needed to be made, they will be. It also increases their self-efficacy for exercise. I am working on this internet software in collaboration with Dr. Rob Motl at University of Illinois Urbana/Champaign. With this combination of internet intervention and acute exercise, we can reach a lot of people for relatively low cost.

How did you come up with this proposal for research?

Dr. Rob Motl and I have worked together for years and we were thinking about ideas, and we knew that we wanted to research on something that would have broad-based applicability. Dr. Motl has been able to show that this internet interaction actually increased physical activity among MS patients. We then thought of using this idea to enhance their ability to adhere to a more programmed exercise routine, and then it would have the potential for broad-impact.  

What effect will this research have on MS if proven successful?

If we do have success, it could have massive positive effects of mobility and quality of life for MS patients. And since many MS patients don’t get enough exercise because physical activity may be perceived as being uncomfortable, this exercise would help not only to show that exercise is appropriate for this population and that is will also reduce the risk of atherosclerosis and cardiovascular disease.

Where are you in your research process?

Right now, we are well into our recruitment process, recruiting patients to participate in the program. We have hired equipment technicians and research specialists who will set the environment so that we know our results will be pure and not questionable. By Christmas this year, we will have completed anywhere from 15-20 patients through the program.

After contact with the patient saying that he/she would like to participate, we would then screen them for eligibility. We establish the stage of MS, we cannot accept patients that have heart disease, or are severely hypertensive. Once they have fulfilled the eligibility criteria, we then need consent from their general physician to participate in an exercise study. Once we get all of that information, they would come to our campus where we develop an exercise prescription, and get them ready to start using the equipment. Then the bike manufacturers will go to patient’s residence and set up the bike and internet interface. It is a three –month exercise program, and we test them before, in the middle, and at the end of the program.

What other projects are you currently working on/or is this the sole project?

I am involved with a study with Dr. Motl called project “METZ.” It is a multicenter study that is still ongoing. What it is, is that we are utilizing resistance, cardiovascular, and balance training in patients with more advanced stages of MS, stage four and above. The main goal is to see if we can improve mobility and quality of life. Right now we are in the process of evaluating some of that data. I am also in the planning process of an exercise study, which would be a pilot study on the effects of acute exercise on brain blood flow which in turn, may affect cognitive brain function. This study will be headed by Dr. Tracy Baynard who is part of our Kinesiology Department.

What are your thoughts on current MS research?

I believe that exercise research dealing with MS has improved a lot, and this is due to the interesting studies that are being done by researchers all over the country. I see that we are starting to get some good results in exercise science, but there are still a bunch of unanswered questions that we have to deal with. How exercise works –if it works- in advanced stages of MS? Can it (exercise) be done outside of a standard testing facility and still be effective? What types of exercise would be most efficient to helping people with MS – anaerobic vs. aerobic and there are many different types of aerobic exercise. Should everyone with MS be doing some type of balance training – and can you do it at home safely?

When do you predict you will have results on your research either success or failure?

I believe that in the next two years we will begin to see results. This is when we will have had enough patients complete the program, and then we will be able to look at the data and know whether or not this project was a success. Part of the recruiting process that can take a while is that the patients need to contact us about interest; this is just an ethical concern for us. What we will do is post information on our website, and go to support groups and give them information about our study, it is then up to the patient to contact us with interest in participation.

Has this research brought any further questions about MS to your mind?

This research has shown to us how effective exercise can be – the participants who have done the program have been upbeat and feel very good about it. They have been very positive and optimistic about the program.  I don’t think that we anticipated this positive emotional outcome from the patients. One thing that can be detrimental in MS patients during exercise is an increase in body temperature which can be very uncomfortable and may promote symptoms, but we not have seen that yet in our participants.  

How did you get connected with the National MS Society?

Primarily through my previous work with Dr. Motl. I think that some of the beginning work that we did together was funded by the National MS Society, and from there we started applying for grants from the Society, and it has been a very good relationship between us.  This is the first time that I have been the Primary Investigator.

Why is this work important to you? Why did you choose to work with a disease such as MS?

It is very clear from the literature and experiences working with Dr. Motl that people with MS are typically not very physically active. The reduced organized physical activity, common in people with MS, also contributes to increases in co-morbidities of MS such as reduced mobility, quality of life and other co-morbidities. Being an exercise scientist, I thought to myself that this lack of exercise didn’t make any sense and I wanted to find out if we can change that.

In the future, where do you see MS treating advancing to?

I believe that some of the research into new potential medications is very exciting, and think that work is very important and cannot stop. I do trust that the idea of physical activity and lifestyle changes is a growing field and that impacts health in general and the co-morbidities that are associated with MS such as cancer and heart/cardiovascular disease. All of this can be imporved by increased physical activity, but we just don’t have enough data in the population of people with MS to know exactly what it does, what is the most effective program, and how can we help the patients in the most beneficial ways.  

Interview conducted by Elliot Gutman, Marketing Intern, National MS Society, Greater Illinois Chapter

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