Feasibility of Aerobic Exercise in People With Advanced Multiple Sclerosis: Characterizing Acute Responses to Inform Exercise Prescription

Background: The role of exercise for people with advanced multiple sclerosis (MS) is largely unknown. Characterizing acute exercise responses could inform exercise interventions. Methods: Eighteen people with advanced MS (Expanded Disability Status Scale score of 7.0-8.0) performed three 15-minute bouts of submaximal exercise using an arm cycle ergometer (ACE), a recumbent stepper (RS), and a functional electrical stimulation (FES) cycle. Change in neurological function, symptoms of fatigue and pain, affect, and adverse events (AEs) were recorded. Results: Participants demonstrated increased sensory impairment immediately after completing exercise compared with before engaging in exercise (P = .03), as well as 30 minutes post exercise (P = .005). Participants’ performance on the Stroop Color and Word Test improved at 30 minutes after exercise compared with before exercise (P = .008). Participants reported elevated pain immediately after (P = .02) and 24 hours after (P = .003) exercise compared with pre-exercise levels. Compared with how they felt immediately after exercise, participants reported feeling better at 30 minutes (P < .001) and 24 hours (P = .01) after exercise. Participants reported more fatigue symptoms with ACE compared with FES, and more pain symptoms with ACE and RS compared with FES (all P > .02). Participants reported feeling better in response to FES compared with ACE (P = .002). No serious AEs were reported, and there were no differences in the number of AEs across modalities. Conclusions: This study demonstrated transient changes in sensory function and increased pain with acute aerobic exercise. Improved cognitive performance, specifically selective attention and executive control, and an overall positive experience were noted in response to exercise. A greater symptomatic response and less favorable experience may be expected with ACE or RS compared with FES exercise. Results of this study can inform exercise prescriptions in advanced MS.