A clinical trial at Oregon Health & Science University is testing the proposition that exercise is not only good for health, but that it also improves clinical outcomes and repairs neural damage for people with multiple sclerosis, or MS.
The trial is among the first to test in people with MS whether aerobic exercise combined with existing treatments leads to the repair of myelin, the protective sheath that covers nerve fibers in the central nervous system. MS slows or blocks signals required for people to see, move their muscles, feel sensations and think. Myelin repair may restore function and prevent neurodegeneration.
“People with MS are plagued by fatigue and low energy, and they need to manage their time productively,” said Lindsey Wooliscroft, M.D., M.Sc., M.C.R., an assistant professor of neurology in the OHSU School of Medicine who is leading the trial. “We’re testing whether exercise might modify their disease so they can integrate it into their care routine with their neurologist and physical therapist.”
Several treatments and medications alleviate the symptoms of MS, but currently there is no cure that repairs neural damage.
In animal models of MS, aerobic exercise can release molecules that promote myelin repair and help immature cells, called oligodendrocyte precursor cells, mature into cells that can wrap myelin, Wooliscroft said.
Further, she said it’s possible aerobic exercise may maximize the effectiveness of myelin repair medications currently under development.
The OHSU clinical trial is testing whether a regular routine of aerobic exercise in people improves the body’s capacity to regenerate myelin by activating the same circuits that are important for walking, balance and physical activity.
Tom Jacobs is convinced it made a difference for him.
An avid fly fisherman, Jacobs found that he was able to wade into streams in central Idaho and western Montana without so much as a wobble, despite slippery rocks and rushing water. He called it a big improvement since his thrice-weekly regimen on the exercise bike began in October of 2021.
“It’s not just that I’ve improved my overall cardio health, but I didn’t expect necessarily that my balance would have improved too,” said Jacobs, 57, who was the first participant enrolled in the ongoing OHSU trial.
Because of the COVID-19 pandemic, the OHSU study was modified to provide participants with an exercise bike at home rather than asking them to come into a central location on OHSU’s South Waterfront campus. Each participant exercises on the bike three days a week for 30 minutes over six months.
The trial is enrolling people with MS who are under 65 years of age and still capable of exercising, despite their MS diagnosis.
In Jacobs’ case, he’s kept up with regular exercise even after finishing the clinical trial. He said he’s definitely in better shape overall, and he’s convinced that his symptoms of MS have improved — especially his strength and balance while fishing for steelhead and trout.
“I do a lot of fishing, and I don’t mean sitting in a boat in the middle of the Willamette River,” he said. “We’re out in the middle of nowhere, tromping up and down hills, bushwhacking through forested areas that don’t have trails. I definitely discern an improvement in my balance.
“It’s subtle, but significant enough that it’s important to me.”
Wooliscroft said recruitment is continuing for the clinical trial; she expects to finish collecting data by the end of this year, with early results possible in early 2024.
Funding and support for this research comes from Oregon Health & Science University, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Portland VA Health Care System, the Oregon Clinical and Translational Research Institute at OHSU, the Myelin Repair Foundation, and the Medical Research Foundation of Oregon. The research is supported by the Multiple Sclerosis Leadership and Innovation Network funded by EMD Serono, Inc., USA, an affiliate of Merck KGaA, Darmstadt, Germany in the U.S. and Canada.