Periodized versus classic exercise therapy in Multiple Sclerosis: a randomized controlled trial

Periodizing exercise interventions in Multiple Sclerosis (MS) shows good high intensity exercise training adherence. Whether this approach induces comparable training adaptations with respect to exercise capacity, body composition and muscle strength compared to conventional, linear progressive training programs however is not known.

Thirty-one persons with MS (all phenotypes, mean EDSS 2.3±1.3) were randomized into a twelve-week periodized (MS_PER, n=17) or a classic endurance (MS_CLA, n=14) training program. At baseline (PRE), exercise capacity (maximal exercise test, VO_2max), body composition (DEXA) and muscle strength (Biodex®) were assessed. Classic, moderate intensity endurance training (60-80% HR_max, 5 training sessions/2w, 60min/session) was performed on a stationary bicycle. Periodized exercise included 4 recurrent 3-week cycles of alternated endurance training (week 1: endurance training as described above), high intense exercise (week 2: 3 sessions/w, 3 × 20s all-out sprints, 10min/session) and recovery weeks (week 3: one sprint session as described above). POST measurements were performed similar to baseline. Total exercise volume of both programs was expressed as total peak-effort training minutes.

For MS_CLA, total exercise volume included 1728 total peak-effort training minutes, whereas MS_PER included only 736. Despite this substantially reduced training volume, twelve weeks of periodized training significantly (p<0.05) improved VO_2max (+14%, p=0.001), workload (+20%) and time until exhaustion (+25%). Classic training significantly (p<0.05) improved workload (+10%) and time until exhaustion (+17%), but not VO_2max (+5%, p=0.131). Pre-post improvements for VO_2max were significantly higher in MS_PER compared to MS_CLA (p=0.046).

These data show that despite substantially lower training time (57% less peak-effort training minutes), 12 weeks of periodized exercise training in persons with MS seems to induce larger improvements in parameters of exercise capacity compared to classic endurance training. We therefore recommend to further investigate the effect of training periodization on various functional rehabilitation measures in MS.