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Cognitive impairment impacts exercise effects on cognition in multiple sclerosis
Rademacher A, Joisten N, Proschinger S, Bloch W, Gonzenbach R, Kool J, Langdon D, Bansi J, Zimmer P
Frontiers in Neurology 2020 Jan 28;11(619500):Epub
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: Exercise training reveals high potential to beneficially impact cognitive performance in persons with multiple sclerosis (pwMS). Research indicates that high-intensity interval training (HIIT) has potentially higher effects on physical fitness and cognition compared to moderate continuous exercise. This study (i) compares the effects of a 3-week HIIT and moderate continuous exercise training on cognitive performance and cardiorespiratory fitness of pwMS in an overall analysis and (ii) investigates potential effects based on baseline cognitive status in a subgroup analysis. METHOD(S): Seventy-five pwMS were randomly assigned to an intervention (HIIT: 5x1.5-min intervals at 95 to 100% HRmax, 3 x/week) or active control group (CG: 24 min continuous exercise at 65% HRmax, 3x/week). Cognitive performance was assessed pre- and post-intervention with the Brief International Cognitive Assessment for MS (BICAMS). (I) To examine potential within (time) and interaction (time x group) effects in the overall analysis, separate analyses of covariance (ANCOVA) were conducted. (II) For the subgroup analysis, participants were divided into two groups (intact cognition or impaired cognition (> 1.5 standard deviation (SD) compared to healthy, age-matched norm data in at least one of the three tests of the BICAMS). Potential impacts of cognitive status and intervention were investigated with multivariate analyses of variance (MANOVA). RESULT(S): Overall analysis revealed significant time effects for processing speed, verbal learning, rel VO2peak, and rel power output. A time*group interaction effect was observed for rel. power output. Subgroup analysis indicated a significant main effect for cognition (impaired cognition versus intact cognition). Subsequent post-hoc analysis showed significant larger effects on verbal learning in pwMS with impaired cognition. CONCLUSION(S): Current results need to be confirmed in a powered randomized controlled trial with cognitive performance as primary endpoint and eligibility based on cognitive performance that is assessed prior to study inclusion.

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