Long-term endurance exercise improves aerobic capacity in patients with relapsing-remitting multiple sclerosis: impact of baseline fatigue.

Little is known about the sustainability of exercise effects in patients with relapsing-remitting Multiple Sclerosis (RRMS). We present the results of a prospective, observer-blinded, single-center case control study using a "pre-post" design including 89 ambulatory patients with RRMS and an EDSS score of ≤3.5 who participated in an individualized 12 month aerobic endurance exercise program. Peak oxygen consumption (VO2 peak) increased and fatigue levels decreased significantly over time (p=0.03, p<0.02). Subgroup analysis of patients with fatigue (FSS>4) revealed that the increase of VO2 peak remained significant after 12 months whereas patients without fatigue did not improve any further after six months. A significant decrease of the FSS score was only observed after nine months (p<0.03) In conclusion, aerobic exercise leads to a sustainable improvement of VO2 peak over an extended exercise period of 12 months. There is a weak, but significant effect on fatigue levels which becomes detectable only after nine months. Since subgroup analysis revealed that MS patients behaved differently according to their baseline fatigue levels, adjustment to the individual fatigue levels is recommended for future exercise interventions in RRMS patients.