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Does Exercise Protect the Brain in Pediatric MS?


Children with multiple sclerosis (MS) who reported higher levels of strenuous physical activity had lower T2 lesion volumes on MR studies, and lower relapse rates, according to a cross-sectional cohort study.

In a cohort of children with MS and monophasic acquired demyelinating syndrome (mono-ADS), smaller T2 lesion volumes (r= -0.66) and lower annualized relapse rate (r = -0.66) were associated with self-reported strenuous physical activity in MS patients, reported E. Ann Yeh, MD, of the Hospital for Sick Children at the University of Toronto, and colleagues.

Those who reported greater amounts of moderate physical activity metabolic equivalent (METs) had fewer sleep/rest fatigue symptoms (r = -0.4), they wrote in Neurology.

But no associations were found between total brain volume and participation in physical activity, they added.

The findings suggest that strenuous physical activity could have a protective effect in this population, Yeh's group suggested.

Data from the study, which evaluated the association between physical activity and MS disease activity, depression, and fatigue, also suggest a possible link between low physical activity, fatigue, and depression.

"Similar to other studies, we found higher levels of fatigue and depression in patients with MS than in children with monophasic demyelinating conditions," the investigators noted, adding that one-fifth of all children in the study had depression.

"Future studies should focus on establishing the causal nature of this relationship by investigating interventions to improve physical activity and examining associated consequences in this population," they wrote. "These future interventions have the potential to improve quality of life by attenuating symptoms such as depression and fatigue and potentially reducing the rate of disease progression."

Within the MS cohort, sleep/rest fatigue levels were higher in patients who reported lower moderate physical activity participation. The same association held for general fatigue and moderate and overall physical activity, suggesting that increased levels of physical activity could help reduce fatigue.
"Given the high correlation between fatigue and depression in our study, and high levels of depression in our patient population, future studies should examine whether depression decreases through time in children who experience increases in physical activity," they said.

In the study, 110 consecutive children and adolescents who attended a specialized pediatric MS clinic from June to December 2013 were enrolled. A total of 31 participants had MS and 79 had mono-ADS. The participants ranged in age from 5-18 years and the male-female ratio was 1:1.2.

Each participant (some assisted by an adult) was administered the PedsQL Multidimensional Fatigue Scale, Center for Epidemiological Studies Depression Scale, and Godin Leisure-Time Exercise Questionnaire. Quantitative MRI analysis was performed to obtain whole brain and T2 lesion volume in a subset of 60 participants.

No differences were seen between the Expanded Disability Status Scale (EDSS) scores of the mono-ADS and MS groups. However, five patients with mono-ADS had an EDSS score ≤4. This represented motor disability severe enough to limit walking. All patients with MS had an EDSS score of less than 4.

Patients with MS reported less strenuous (33.21 METs versus 15.97 METs, P=0.002) and total (44.48 METs versus 67.28 METs, P=0.0291) physical activity than those with mono-ADS.

"Future studies should be oriented toward understanding factors that may influence the complex relationships between physical activity, depression, and fatigue. Certainly, multiple factors, such as sleep, pain, and disease activity, and psychological factors, such as self-efficacy, among others, may influence these outcomes," they wrote.

Higher fitness in children has been associated with greater brain volumes, both overall and in the hippocampus and deep gray structures, the investigators noted. Higher fitness has also been associated with higher performance on measures of cognitive control that involve working memory, inhibition, and cognitive flexibility.

However, the authors cautioned that "analysis of gray matter volumes was outside the scope of the present work. Future studies focusing on the association of physical activity with gray matter volume and deep gray structures in children with MS are needed."

The cross-sectional study design does not allow determination of causality between exercise, fatigue, and depression, pointed out Maria Rocca, MD, of Vita-Salute San Raffaele University in Milan, and colleagues in the accompanying editorial.

Story Source: The above story is based on materials provided by MEDPAGETODAY
Note: Materials may be edited for content and length

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