Wednesday, 11 February 2015

ClinicSpeak: effects of exercise on cognition

Are you exercising regularly? #ClinicSpeak #MSBlog #MSResearch

"The study below provides tantalizing proof of concept data that exercise may impact on cognitive function. The investigators use reaction time as a surrogate for cognition; this may be too simplistic. What they show is that exercise improves reaction times, but not accuracy, in MSers. It would be interesting if this observation is generalisable to other cognitive domains."

"I for one feel cognitively sharper when I am fit and running every day compared to when I am not exercising. I have heard many of my patients tell me the same thing. Clearly, the field of exercise and cognition, or cognitive reserve, needs more work in the MS space. It is exciting that researchers are developing experimental paradigms to test hypotheses."

"Should you be doing anything about exercise? Yes, you should just do it. The health benefits of exercise are are now well established, whether or not you have MS. What if you are too disabled to exercise? I have mentioned in the past that regardless of your level of disability there are exercises you can do. So please speak to your physiotherapist about designing you a realistic and pragmatic exercise programme. If you don't have a physiotherapist ask your neurologist or nurse specialist to refer you to one. There are also a large number of online self-help programmes that you can engage in. I am aware that exercise is easier said than done and I have no easy way of nudging everyone so they adopt this as part of their routine MS therapy package. May be you as a community can help each other, or help us, with getting exercise adopted as part of the standard treatment for MS."

Epub: Sandroff et al. Acute effects of walking, cycling, and yoga exercise on cognition in persons with relapsing-remittingmultiple sclerosis without impaired cognitive processing speed. J Clin Exp Neuropsychol. 2015 Feb 6:1-11.

Background: Cognitive impairment is a highly prevalent, disabling, and poorly managed consequence of MS. Exercise training represents a promising approach for managing cognitive impairment in this population. However, there is limited evidence supporting an optimal exercise stimulus for improving cognition in MS. 

Objective: The current study compared the acute effects of moderate-intensity treadmill walking, moderate-intensity cycle ergometry, and guided yoga with those of quiet rest on executive control in 24 RRMSer without impaired cognitive processing speed using a within-subjects, repeated measures design. 

Method: Participants completed four experimental conditions that consisted of 20 minutes of moderate-intensity treadmill walking exercise, moderate-intensity cycle ergometer exercise, guided yoga, and quiet rest in a randomized, counterbalanced order. Participants underwent a modified-flanker task as a measure of executive control immediately prior to and following each condition.

Results: Repeated measures analyses of variance indicated general pre-to-post improvements in reaction time, but not accuracy, on the modified-flanker task for all three exercise modalities compared with quiet rest. However, there were additional, selective pre-to-post reductions in the cost of interfering stimuli on reaction time on the modified-flanker task for treadmill walking, F(1, 23) = 4.67, p = .04, ηp2= .17, but not cycle ergometry, F(1, 23) = 0.12, p = .73, ηp2 < .01, or guided yoga, F(1, 23) = 0.73, p = .40, ηp2 = .03, compared with quiet rest.

Conclusions: The present results support treadmill walking as the modality of exercise that might exert the largest beneficial effects on executive control in persons with relapsing-remitting MS without impaired cognitive processing speed. This represents an exciting starting point for delineating the appropriate exercise stimulus (i.e., modality and intensity) for inclusion in a subsequent longitudinal exercise training intervention for improving cognitive performance in this population.


  1. Subjective study of 1 case: exercise does influence cognition ( probably mostly through alertness/attention, but it also affects mood big style). Not all exercise is created equal: jogging is definitely number 1 (at least half an hour, preferably until properly warm/sweating and needing a shower). Elliptical trainer is OK, but not quite the same ( too low intensity?). Strength training is great for other reasons, but does not produce "runner's high" in the way a good run does :-(.

  2. Skipping rope is great ( for those who still can do it): it costs close to nothing, is fast and fun + helps coordination.

  3. I use an aerobic rebounder trampoline. So great. I jog on it. I have some problems with my knees from a previous episode. The aerobic rebounder means that it doesn't shock my body, so I can get a good amount of exercise. I also go out for brisk walks. Pilates helps too. We have a group at our local MS association.

  4. Most significant comment here: 'Just do it'. Has to be a top priority for so many reasons. And, unlike so much about having MS, it is within our control. I think that partly explains why Msers feel so good when they've done some exercise.

  5. It is not true that there is an excercise for each level of disability. There is a horizon of neurological disability, orthogonal to physical fitness, beyond which one cannot gain any benefit from (attempts) to move. There is the possibility of MS and patient specific physio, with good results and slightly different aims, but certainly not on NHS. In short, enjoy it while you can.


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