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Cognitive training, exercise training or combined training? A comparative effectiveness research study on subjective
Naomi Gyger1, Tobias Monschein1,2,3, Melanie Filser4
1Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 37, 3010, Bern, Switzerland.
Journal of Neurology
|January 16, 2026
Summary
Cognitive impairment in multiple sclerosis (MS) patients improved with computer training, treadmill walking, or both. The combined approach offered the most sustained benefits for subjective cognition, while treadmill walking and combined training also improved objective cognitive performance.
Area of Science:
- Neurology
- Neurorehabilitation
- Cognitive Science
Background:
- Cognitive impairment (CI) is a common and impactful symptom in people with multiple sclerosis (pwMS), often present from disease onset.
- Therapeutic interventions are crucial for managing CI in pwMS.
Purpose of the Study:
- To compare the effectiveness of computerized cognitive training (BrainStim, BS), treadmill walking (TW), and a combination (BS + TW) on subjective and objective cognitive functioning in pwMS with CI.
- To evaluate the long-term effects of these interventions over 6 months.
Main Methods:
- 61 pwMS with CI were recruited and randomized into three groups: BS, TW, or BS + TW.
- Cognitive functioning was assessed using the Perceived Deficits Questionnaire (PDQ-20) for subjective performance and the Symbol Digit Modalities Test (SDMT) for objective performance, before and after the intervention period.
- A 6-month follow-up was conducted to assess the durability of treatment effects.
Main Results:
- All three interventions significantly improved subjective cognitive performance (PDQ-20 scores).
- The combined BS + TW group demonstrated sustained improvements in subjective cognition at 6 months.
- Objective cognitive performance (SDMT scores) significantly improved in the TW and BS + TW groups, with effects lasting 6 months.
- Computerized cognitive training (BS) alone did not show significant effects on objective cognitive performance.
Conclusions:
- Combining treadmill walking with computerized cognitive training may offer superior and more sustained cognitive benefits for people with multiple sclerosis compared to individual interventions.
- Both exercise and combined training approaches are effective in improving cognitive function in pwMS, highlighting the potential of multimodal rehabilitation strategies.
