Exercise: how important is it?
Why is exercise the most underrated and under-utilised DMT? And why is it not part of the standard MS care package?
I am often quoted as saying that ‘exercise is the most underrated and under-utilised DMT’. Why?
Running or exercise, in general, maybe one of the most underutilised treatments we have for multiple sclerosis and neurodegeneration in general. Exercise and diet have to be at the base of any brain health pyramid. As always there is biology that underpins the treatment effects of these simple lifestyle interventions. Most of us have assumed exercise works by simply stimulating growth factors and endorphins in the central nervous system. Growth factors are responsible for anti-ageing effects and endorphins for their mood-elevating effects that explain the runner’s high. However, the recent research suggests that the health benefits of exercise on ageing may be mediated by Gpld1 a hormone that is released from the liver (Horowitz et al. Blood Factors Transfer Beneficial Effects of Exercise on Neurogenesis and Cognition to the Aged Brain. Science. 2020 Jul 10;369(6500):167-173.).
The circulating factor increases after exercise and was shown to correlate with improved cognitive function in aged mice. Importantly blood levels of Gpld1 are increased in active healthy elderly humans. If this work is confirmed it means we may be able to hack exercise’s effects on this pathway and create a drug that you can take that will prevent you from ageing and if you have MS potentially slow down your disease progression. Wouldn’t that be a remarkable innovation?
This work is important because participation in exercise is largely driven by genetics. Twin studies show that genetic variation is important in relation to individual behaviour when it comes to exercise. Heritability of exercise participation in males and females is similar and ranges from 48% to 71% (Stubbe et al. Genetic Influences on Exercise Participation in 37,051 Twin Pairs From Seven Countries. PLoS One, 1 (1), e22 2006 Dec 20.), which may explain why you love or hate exercise. At the moment we don’t know what this heritability in relation to exercise is due to; it may involve genes influencing the acute mood effects of exercise, high exercise ability, high weight loss ability, and personality.
If we can develop drugs to mimic exercise then whether or not you like exercise may become irrelevant. My problem with this reductionist approach is that exercise is very complex. For example, exercise can be aerobic (oxygen) or anaerobic (lack of oxygen) and can involve resistance. Then there is intensity and duration. Is HIIT (high-intensity interval training) better than aerobic exercise? What about movement? Does exercise require you to move; is a treadmill run equivalent to an outdoor run? How important is exercise frequency; is daily better than 3-4 times a week versus the weekend warrior’s activity on Saturday and Sunday?
We know exercise works for some pwMS. I am sure many of you can vouch for exercise and its benefits on your MS. However, we don’t know if exercise may have negative effects in certain groups of pwMS. For example, during a relapse or in more advanced MS. Is flogging a dying horse, i.e. making people with walking impairment exercise their lower limbs, potentially bad for them in that overuse of the pathway through exercise is speeding up its degeneration? I am also careful in not making pwMS feel guilty about not exercising when we don’t have a mature evidence base to recommend it or not.
From a personal perspective, I am missing running terribly. Ever since I ditched football, or soccer as it is called in the Americas, as a skinny 13-year old for long-distance running I knew intuitively that there was something extraordinary about aerobic exercise. Running is not only mindfulness, but it makes you think clearer in general and lifts your mood. Long-distance running is a philosophy and it adds true meaning to life. For those of you who are exercise junkies, you will know what I am talking about and you will understand why I am missing it so much. For those of you who haven’t experienced the uplifting benefits of exercise, I would suggest reading Haruki Murakami’s book ‘What I Talk About When I Talk About Running’. Murakami is an extraordinary writer and brings a wonderful and mystical Japanese philosophical twist to the task at hand.
If you don’t exercise regularly I would suggest you are assessed by a physiotherapist and have an exercise programme designed for your needs. I have many patients with MS who despite being disabled are able to exercise. Just this morning I heard from one of my patients, who is unable to walk very well, that she is now using a rowing machine and is managing to get a good workout this way each day.
I would be interested to hear about your exercise regimens and what works for you.
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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust. The advice is intended as general advice and should not be interpreted as being personal clinical advice. If you have problems please tell your own healthcare professional who will be able to help you.
With the support of friends , a purpose built mounting block, a neck strap that I can grab onto and a very patient old horse , I manage low level horse riding a few times a week . If I miss out , for any reason , I feel the the difference in my legs almost immediately.
Even being around horses is calming . It’s a recognized form of therapy and one that I’d love to see being made more accessible to anyone interested.
I was under the care of Dr Matt Craner (RN) for many years. We were idly talking about cycling across the US (he has, I wanted to cycle across Canada) and he suggested that one reason I have done so well after 28y is because I have exercised through most of it.
I can’t cycle anymore (eye issues) but I climb and walk a lot. The greater the time I don’t exercise the worse I feel.
Climbed Scafell Pike a few weeks ago!
Nothing compares to that worn out feeling after a good session.
It is hard to get fit and harder still to stay fit with MS.
Dom