Exercise Training and Biomarkers of Neuroaxonal Injury in Multiple Sclerosis: Narrative Review

Area of Science:

• Neurology
• Exercise Science
• Biomarker Research

Background:

• Multiple sclerosis (MS) is a chronic neurological disease with increasing interest in exercise training (ET) for its disease-modifying potential.
• ET may influence MS progression markers like relapses, lesions, disability, and cognitive-processing speed (CPS).
• Limited evidence exists on ET's impact on body fluid biomarkers of neuroaxonal injury in MS.

Purpose of the Study:

• To build a rationale for focusing on exercise training and neuroaxonal injury biomarkers in MS.
• To review the association between ET and specific biomarkers: neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP).

Main Methods:

• A narrative review of literature from PubMed, EBSCOhost, and EMBASE databases.
• Analysis of studies reporting on NfL and GFAP levels in MS patients.
• Inclusion of two meta-analyses specifically examining ET effects on sNfL and sGFAP in MS.

Main Results:

• Serum NfL (sNfL) and GFAP (sGFAP) levels are elevated in MS compared to controls.
• Biomarker levels vary with demographic and clinical factors and respond to disease-modifying therapies.
• Meta-analyses revealed significant positive effects of ET on sNfL, but not sGFAP, in MS.

Conclusions:

• Exercise training demonstrates potential disease-modifying effects in MS, particularly influencing sNfL.
• Future research should utilize discovery models and experimental medicine frameworks for ET and neuroaxonal injury biomarker trials in MS.