Power Training in Older Multiple Sclerosis Patients (POTOMS)

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.

Multiple Sclerosis, Sclerosis, Demyelinating Autoimmune Diseases, CNS, Autoimmune Diseases of the Nervous System, Demyelinating Diseases, Healthy Aging, Aging

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.

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: Bilateral leg-press Bilateral plantar flexion Bilateral knee extension Unilateral banded dorsal flexion Bilateral lying leg curl Back extension Shoulder press Seated row Chest press Lat pull-down

Volume of the brain nucleis: thalamus, hippocampus, putamen, caudate, globus pallidus, corticospinal tract, cingulate gyrus, corpus callosum, cervical spinal volume, motor cortex

Diffusivity of the brain nucleis: thalamus, hippocampus, putamen, caudate, globus pallidus, corticospinal tract, cingulate gyrus, corpus callosum, cervical spinal volume, motor cortex

SSST is a measure of walking ability, balance and coordination. Measured as the time to complete the course.

Distance covered on a 30 meter track during six minutes maximal walking. Distance covered each minute is noted.

The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor.

The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor.

The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor.

The following muscle groups are tested: Knee flexors, Knee extensors, Plantar flexor and Dorsal flexor.

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.

Inclusion Criteria: ≥ 60 years of age. Clinically diagnosed with MS according to the McDonald criteria (48). Having an EDSS ≤ 6.5. able to transport themselves to the testing at Aarhus University and Aarhus University Hospital. able to transport themselves to training, if randomized to the PRP group. Exclusion Criteria: having comorbidities (cardiovascular, respiratory, orthopedic, or other neurological diseases than MS) affecting PRP participation or MRI scans. having a pacemaker. having metallic implant(s) that prevents MRI scans. having untreated osteoporosis; t-score below -2.5 and a history of low energy facture or t-score below -3.0. participating in more than two sessions per week of structured PRE and have done so for the past 3 months. Are cognitively impaired at a level expected to prevent the participant from understanding training and testing instructions.

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