Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Neurol. 2023 Mar;270(3):1672-1681. doi: 10.1007/s00415-022-11513-0. Epub 2022 Dec 12.
Impairment of cardiovascular control is common in multiple sclerosis (MS), possibly due to damage of strategic brain regions such as the insula. Aerobic training (AT) targets cardiopulmonary system and may represent a neuroprotective strategy.
To investigate whether insular damage (T2-hyperintense lesions and volume) is associated with cardiovascular fitness (CF) and influences AT effects in MS.
Sixty-one MS patients were randomized to an AT intervention group (MS-AT) and a motor training control group (MS-C). At baseline and after training (24 sessions over 2-3 months), peak of oxygen consumption (VO2max), heart rate reserve (HRR), 6-min walk test (6MWT) and whole brain and insula MRI data were collected. Two healthy control (HC) groups were enrolled for CF and MRI data analysis.
At baseline, MS patients vs HC showed impaired VO2max, HRR and 6MWT (p < 0.001) and widespread gray matter atrophy, including bilateral insula. In MS patients, left insula T2-lesion volume correlated with HRR (r = 0.27, p = 0.042). After training, MS-AT, especially those without insular T2-hyperintense lesions, showed 6MWT improvement (p < 0.05) and a stable insular volume, whereas MS-C showed left insular volume loss (p < 0.001).
By increasing 6MWT performance, our results suggest that AT may improve walking capacity and submaximal measure of CF in MS patients. Such beneficial effect may be modulated by insula integrity.
心血管控制受损在多发性硬化症（MS）中很常见，可能是由于脑岛等战略区域的损伤。有氧运动训练（AT）针对心肺系统，可能是一种神经保护策略。
研究脑岛损伤（T2 高信号病变和体积）是否与心血管健康（CF）相关，并影响 MS 中的 AT 效果。
61 名 MS 患者被随机分为 AT 干预组（MS-AT）和运动训练对照组（MS-C）。在基线和训练后（2-3 个月内进行 24 次），收集了峰值摄氧量（VO2max）、心率储备（HRR）、6 分钟步行测试（6MWT）和全脑及脑岛 MRI 数据。还招募了两个健康对照组（HC）进行 CF 和 MRI 数据分析。
基线时，MS 患者与 HC 相比，VO2max、HRR 和 6MWT 降低（p<0.001），且存在广泛的灰质萎缩，包括双侧脑岛。在 MS 患者中，左侧脑岛 T2 病变体积与 HRR 相关（r=0.27，p=0.042）。训练后，MS-AT，特别是无脑岛 T2 高信号病变的患者，6MWT 改善（p<0.05），脑岛体积稳定，而 MS-C 患者的左侧脑岛体积减少（p<0.001）。
通过提高 6MWT 表现，我们的结果表明 AT 可能改善 MS 患者的步行能力和亚最大 CF 测量值。这种有益的效果可能受到脑岛完整性的调节。
