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| Name | Class |
|---|---|
| University of Southern Denmark | OTHER |
| University of Copenhagen | OTHER |
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The study seeks to investigate whether 24 weeks of power training has neuroprotective effects in older PwMS. Additional purposes are to examine the effects of 24 weeks power training on physical function, cognitive function and neuromuscular function. Further, it is investigated whether the potential effects of power training are maintained after 24 weeks of follow-up.
Over the past 3-4 decades, the lifespan among people with multiple sclerosis (MS) has increased substantially. Today more than one-third of all people with MS are 60 years or older. With advanced age, people with MS are more likely to have impairments in cognitive and physical function.
Positive adaptations within the nervous system (~neuroplasticity) have been shown to occur in people with MS following periods of resistance training (RT). This resembles the observations in young and old healthy individuals. Moreover, a specific type of RT termed power training appears to be particularly beneficial, as it emphasizes an explosive concentric phase of muscle contraction. This taxes the nervous system to a very high extent. As a result, power training has been shown to improve several aspects that rely on the nervous system in older individuals without MS. These aspects include cognition, neuromuscular function, and physical function.
The investigators speculate that older people with MS would also benefit. However, no studies have looked into the effects of power training in older people with MS.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Training Group Multiple Sclerosis | Experimental | 24 weeks of moderate to high-intensity power training (resistance training- emphasizing an explosive concentric phase of muscle contraction) performed twice weekly. Balance- and functional exercises are included after week 8. |
|
| Control Group Multiple Sclerosis | No Intervention | Habitual lifestyle including standard care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Power training | Other | First a brief warm up on a stationary bike and uni-lateral knee raises is completed. Power training: Involves exercises performed with fast/explosive muscle contraction during the concentric phase, and slow/controlled (approximately 2-3 s) muscle contraction during the eccentric phase. Functional- and balance exercises are included from week 9-24. Progression: Week 1-4: 3 sets of 12 repetitions at a load of 14 repetitions maximum (RM) with focus on introducing resistance exercise and familiarizing participants with exercises. Week 5-8: 3 sets of 12 repetitions at a load of 14 RM the power training component. Week 9-16: 3 sets of 10 repetitions at a load of 12 RM. Week 17-24: 3 sets of 8 repetitions at a load of 10 RM Strengthening exercises:
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| Measure | Description | Time Frame |
|---|---|---|
| Percentage brain volume change. | Whole brain atrophy will be measured from MRI-scans. | Baseline, after 24 weeks and after 48 weeks. |
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| Measure | Description | Time Frame |
|---|---|---|
| Normalized gray and white matter volume change. | MRI scan. | Baseline, after 24 weeks and after 48 weeks. |
| Volume of the brain nucleis: thalamus, hippocampus, putamen, caudate, globus pallidus, corticospinal tract, cingulate gyrus, corpus callosum, cervical spinal volume, motor cortex |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tobias Gaemelke, MSc | Contact | +45 28264508 | gaemelke@ph.au.dk |
| Name | Affiliation | Role |
|---|---|---|
| Tobias Gaemelke, Msc | Exercise Biology, Department of Public Health, Aarhus University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tobias Gæmelke | Recruiting | Aarhus C | 8000 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21205683 | Background | Hurwitz BJ. Analysis of current multiple sclerosis registries. Neurology. 2011 Jan 4;76(1 Suppl 1):S7-13. doi: 10.1212/WNL.0b013e31820502f6. | |
| 18728060 | Background | Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Comorbidity, socioeconomic status and multiple sclerosis. Mult Scler. 2008 Sep;14(8):1091-8. doi: 10.1177/1352458508092263. |
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D012598 | Sclerosis |
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D003711 | Demyelinating Diseases |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D009422 | Nervous System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D010335 | Pathologic Processes |
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|
MRI scan. |
| Baseline, after 24 weeks and after 48 weeks. |
| Diffusivity of the brain nucleis: thalamus, hippocampus, putamen, caudate, globus pallidus, corticospinal tract, cingulate gyrus, corpus callosum, cervical spinal volume, motor cortex | DTI scan. | Baseline, after 24 weeks and after 48 weeks. |
| White matter fibre orientations | MKI scan. | Baseline, after 24 weeks and after 48 weeks. |
| Glial fibrillary acidic protein (GFAP) change. | Resting blood sample- Marker of neurodegeneration. | Baseline, after 24 weeks and after 48 weeks. |
| Neurofilament light chain (NfL) change. | Resting blood sample-Marker of neurodegeneration: | Baseline, after 24 weeks and after 48 weeks. |
| Brain-derived neurotrophic factor (BDNF) change. | Resting blood sample-Neurotrophic factor. | Baseline, after 24 weeks and after 48 weeks. |
| Insulin-like growth factor-1 (IGF). | Resting blood sample-Neurotrophic factor. | Baseline, after 24 weeks and after 48 weeks. |
| C-reactive protein (CRP) change. | Resting blood sample-Inflammatory markers. | Baseline, after 24 weeks and after 48 weeks. |
| Interleukin-6 (IL-6) change. | Resting blood sample-Inflammatory markers. | Baseline, after 24 weeks and after 48 weeks. |
| Tumor necrosis alpha (TNF-alpha) change. | Resting blood sample-Inflammatory markers. | Baseline, after 24 weeks and after 48 weeks. |
| C-terminal collagen cross-links (CTX) change. | Resting blood sample- Bone turnover markers. | Baseline, after 24 weeks and after 48 weeks. |
| Type-1n-terminal propeptide (P1NP) change. | Resting blood sample- Bone turnover markers. | Baseline, after 24 weeks and after 48 weeks. |
| Bone mineral density of the femoral neck and lumbar spine change. | Dexa scan. | Baseline, after 24 weeks and after 48 weeks. |
| Body composition change. | Dexa scan- whole body scan. | Baseline, after 24 weeks and after 48 weeks. |
| Cognition change . | Selective Reminding Test (memory) and Symbol Digit Modalities Test (processing speed). | Baseline, after 24 weeks and after 48 weeks. |
| Nine step stair test change. | Time to climb a 9 step flight of stairs. | Baseline, after 24 weeks and after 48 weeks |
| Six Spot Step Test (SSST) change. | SSST is a measure of walking ability, balance and coordination. Measured as the time to complete the course. | Baseline, after 24 weeks and after 48 weeks. |
| Six-minute walk test (&MWT) change. | Distance covered on a 30 meter track during six minutes maximal walking. Distance covered each minute is noted. | Baseline, after 24 weeks and after 48 weeks. |
| Timed 25-Feet Walk Test (T25FWT) change. | Time to walk 25 feet (normal walk and maximal walk pace). | Baseline, after 24 weeks and after 48 weeks. |
| Short Physical performance battery change. | Composite score from Five Times Sit- to- Stand Test, Tandem Test and 3 meter walk test. | Baseline, after 24 weeks and after 48 weeks. |
| Maximal Voluntary Contraction (MVC) change. | The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor. | Baseline, after 24 weeks and after 48 weeks. |
| Rate of force development (RFD) change. | The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor. | Baseline, after 24 weeks and after 48 weeks. |
| Dynamic Strength change. | The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor. | Baseline, after 24 weeks and after 48 weeks. |
| Force Steadiness change. | Unilateral leg press | Baseline, after 24 weeks and after 48 weeks. |
| Voluntary activation | Interpolated twitch technique applied on the quadriceps muscle | Baseline, after 24 weeks and after 48 weeks. |
| Electromyography (EMG) | The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor. | Baseline, after 24 weeks and after 48 weeks. |
| Grip strength change. | Measured by Hand Dynamoter. | Baseline, after 24 weeks and after 48 weeks. |
| SF-12 change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| Pittsburg Sleep Qulity Index change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| Brief pain inventory change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| Baecke Physical Activity change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| HADS change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| EQ-5D change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| FES-I change. | Patient Reported Outcome Measure. | Baseline, after 24 weeks and after 48 weeks. |
| Multiple Sclerosis Impact Scale (MSIS-29) change. | Patient Reported Outcome Measure (only applicable for people with MS). | Baseline, after 24 weeks and after 48 weeks . |
| Modified Fatigue Impact Scale (MFIS) change. | Patient Reported Outcome Measure (only applicable for people with MS). | Baseline, after 24 weeks and after 48 weeks . |
| 12-Item MS walking Scale (MSWS-12) change. | Patient Reported Outcome Measure (only applicable for people with MS). | Baseline, after 24 weeks and after 48 weeks . |
| Expanded Disability Status Scale (only applicable for people with MS). | The EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability. Scoring is based on an examination by a trained exercise physiologist. | Baseline, after 24 weeks and after 48 weeks. |
| Nine hole peg test | Manual dexterity and upper body function | Baseline, after 24 weeks and after 48 weeks. |
| Physical activity | Accelerometry (7 days ware time) | Baseline, after 24 weeks and after 48 weeks. |
| 27090485 | Background | Hvid LG, Strotmeyer ES, Skjodt M, Magnussen LV, Andersen M, Caserotti P. Voluntary muscle activation improves with power training and is associated with changes in gait speed in mobility-limited older adults - A randomized controlled trial. Exp Gerontol. 2016 Jul;80:51-6. doi: 10.1016/j.exger.2016.03.018. Epub 2016 Apr 14. |
| 20487503 | Background | Aagaard P, Suetta C, Caserotti P, Magnusson SP, Kjaer M. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Sports. 2010 Feb;20(1):49-64. doi: 10.1111/j.1600-0838.2009.01084.x. |
| 25113097 | Background | Schoenfeld BJ, Contreras B, Willardson JM, Fontana F, Tiryaki-Sonmez G. Muscle activation during low- versus high-load resistance training in well-trained men. Eur J Appl Physiol. 2014 Dec;114(12):2491-7. doi: 10.1007/s00421-014-2976-9. Epub 2014 Aug 12. |
| 26581787 | Background | Best JR, Chiu BK, Liang Hsu C, Nagamatsu LS, Liu-Ambrose T. Long-Term Effects of Resistance Exercise Training on Cognition and Brain Volume in Older Women: Results from a Randomized Controlled Trial. J Int Neuropsychol Soc. 2015 Nov;21(10):745-56. doi: 10.1017/S1355617715000673. |
| 20101012 | Background | Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med. 2010 Jan 25;170(2):170-8. doi: 10.1001/archinternmed.2009.494. |
| 25199912 | Background | Reid KF, Martin KI, Doros G, Clark DJ, Hau C, Patten C, Phillips EM, Frontera WR, Fielding RA. Comparative effects of light or heavy resistance power training for improving lower extremity power and physical performance in mobility-limited older adults. J Gerontol A Biol Sci Med Sci. 2015 Mar;70(3):374-80. doi: 10.1093/gerona/glu156. Epub 2014 Sep 8. |
| 18248533 | Background | Caserotti P, Aagaard P, Larsen JB, Puggaard L. Explosive heavy-resistance training in old and very old adults: changes in rapid muscle force, strength and power. Scand J Med Sci Sports. 2008 Dec;18(6):773-82. doi: 10.1111/j.1600-0838.2007.00732.x. Epub 2008 Jan 30. |
| 17146693 | Background | Bottaro M, Machado SN, Nogueira W, Scales R, Veloso J. Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men. Eur J Appl Physiol. 2007 Feb;99(3):257-64. doi: 10.1007/s00421-006-0343-1. Epub 2006 Dec 5. |
| 11441371 | Background | Earles DR, Judge JO, Gunnarsson OT. Velocity training induces power-specific adaptations in highly functioning older adults. Arch Phys Med Rehabil. 2001 Jul;82(7):872-8. doi: 10.1053/apmr.2001.23838. |
| 18245765 | Background | Henwood TR, Riek S, Taaffe DR. Strength versus muscle power-specific resistance training in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2008 Jan;63(1):83-91. doi: 10.1093/gerona/63.1.83. |
| 40966534 | Derived | Kupjetz M, Langeskov-Christensen M, Riemenschneider M, Inerle S, Ligges U, Gaemelke T, Patt N, Bansi J, Gonzenbach RR, Reuter M, Rosenberger F, Meyer T, McCann A, Ueland PM, Eskildsen SF, Nygaard MKE, Joisten N, Hvid L, Dalgas U, Zimmer P. Persons With Multiple Sclerosis Reveal Distinct Kynurenine Pathway Metabolite Patterns: A Multinational Cross-Sectional Study. Neurol Neuroimmunol Neuroinflamm. 2025 Nov;12(6):e200461. doi: 10.1212/NXI.0000000000200461. Epub 2025 Sep 18. |
| 38444875 | Derived | Gaemelke T, Laustsen C, Feys P, Folkestad L, Andersen MS, Jorgensen NR, Jorgensen ML, Jespersen SN, Ringgaard S, Eskildsen SF, Dalgas U, Hvid LG. Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial. Contemp Clin Trials Commun. 2024 Feb 19;38:101279. doi: 10.1016/j.conctc.2024.101279. eCollection 2024 Apr. |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D056784 | Leukoencephalopathies |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D001519 | Behavior |