Project R-2760

Agreement between the UHasselt and PHL in the context of the PhD of Inez Wens titled "Rehabilitation of Persons with MS: influence of exercise on muscle strength and functional exercise capacity" (Research)

To date, the incidence of Multiple Sclerosis (MS) is rapidly increasing in the Western society (REF). MS is an inflammatory and neurodegenerative disease of the central nervous system (CNS) that mostly affects young to middle-aged adults and is characterized by demyelization and axonal loss of the CNS leading to a number of symptoms such as general fatigue, muscular weakness and reduced muscle strength (Noseworthy et al., 2000; Compston and Coles, 2002). The impairment of motor function and the presence of fatigue restricts MS patients in activities of daily living and reduces their level of physical activity increasing the incidence of, amongst others, insulin resistance (Noseworthy et al., 2000). (A) In the past, a few studies have shown that increased physical activity can reduce muscle fatigue and can improve muscle strength and quality of life, without worsening other MS symptoms (Dalgas et al., 2008). The influence of physical activity on the development of insulin resistance in MS patients is never been explored. (B) Pathophysiologically, recent research indicated that MS is accompanied by a shift in the balance between pro- and anti-inflammatory cytokines towards an elevated Th-1 profile (Boxel-Dezaire et al., 1999). For instance, in healthy persons physical activity can increase the IL-6 activity in the blood serum. This increase is related to the exercise intensity (Pedersen, 2000). If physical activity can cause a similar effect in MS patients, their cytokine profile can be favorably influenced. Therefore it seems worthwhile to also investigate the immunological changes associated with MS either or not in combination with exercise therapy. Heesen et al. (2003) and White et al. (2006) already reported in a pilot study some trends. These trends indicate that intense physical activity can influence the release of cytokines in MS patients. Due to the limited number of subjects, the short time of training (< 8 weak) and the differences in trainings modes, however, it is difficult to draw solid conclusion. To evaluate the effect of physical activity on (A) functional muscle strength and the development of insulin resistance as well as on (B) the cytokine balance it is useful to use in the first phase of this study Experimental Autoimmune Encephalomyelitis (EAE) in laboratory animals (de Haan et al., 2004). Given the explorative nature of the hypothesis the use of an animal MS model such as EAE seems appropriate. So far, literature investigating the impact of exercise training on disease progression in EAE is limited but results are promising. The findings obtained will be administered in the second phase of this study on MS patients. If higher exercise intensities are tolerable for MS patients enhanced training/rehabilitation outcome could be expected as reported in healthy subjects (Hawley et al., 2002), in persons with coronary disease (Amundsen et al., 2008) and diabetes (Harmer et al., 2008).

16 November 2010 - 15 November 2014