Feasibility of a 12-month, remotely delivered and supported aerobic walking exercise training program for brain and cognition in adults with multiple sclerosis.

The 12-month remotely delivered aerobic walking exercise training trial was feasible across process, resource, and management metrics with high adherence rates.

• The trial enrolled 25 fully-ambulatory persons with MS who were pre-screened for slowed cognitive processing speed.
• Both exercise prescriptions were described as safe and associated with high adherence rates.
• Feasibility was assessed across process, resource, and management metrics.
• The trial was 12 months in duration with remotely delivered and supported exercise.

The higher-dose walking exercise training prescription was too difficult in terms of duration and intensity.

• Two different doses of a 12-month aerobic walking exercise training program were tested.
• The higher-dose walking ET prescription was specifically noted to be too difficult regarding both duration and intensity parameters.
• This finding has implications for the design of a subsequent randomized controlled trial.

Twelve months of remotely delivered aerobic walking exercise training was associated with preservation of thalamic volume.

• Data were pooled across conditions for the scientific feasibility analysis.
• The effect size for thalamic volume preservation was d=1.01.
• Thalamic atrophy is described as a highly common and disabling consequence of MS that occurs early in the disease process and progressively worsens over time.
• The sample consisted of 25 fully-ambulatory persons with MS.

Twelve months of aerobic walking exercise training was associated with benefits on cognitive processing speed.

• The effect size for cognitive processing speed was d=0.41.
• Participants were pre-screened for slowed cognitive processing speed at enrollment.
• Data were pooled across both exercise dose conditions for this analysis.
• Cognitive processing speed was identified as a downstream outcome of thalamic volume.

Twelve months of aerobic walking exercise training was associated with improvements in walking endurance and aerobic fitness.

• The effect size for walking endurance was d=0.33.
• The effect size for aerobic fitness overall was d=0.48.
• Walking performance was identified as a downstream outcome of thalamic volume.
• Data were pooled across conditions for these analyses.

The feasibility data support the design and testing of a subsequent randomized controlled trial of 12-month remotely delivered aerobic walking exercise training on thalamic volume and its downstream consequences in persons with MS.

• The subsequent RCT would focus on thalamic volume/atrophy and its downstream consequences.
• The feasibility trial included 25 participants across two exercise dose conditions.
• The trial duration was 12 months with remote delivery and support.
• Downstream consequences to be examined in a future RCT include cognitive processing speed, walking performance, and quality of life.