Moving exercise research in multiple sclerosis forward (the MoXFo initiative): Developing consensus statements for research.

Exercise as a subset of physical activity is a cornerstone in the management of multiple sclerosis (MS) based on its pleotropic effects. There is an exponential increase in the quantity of research on exercise in MS, yet a number of barriers associated with study content and quality hamper rapid progress in the field. To address these barriers and accelerate discovery, a new international partnership of MS-related experts in exercise has emerged with the goal of advancing the research agenda. As a first step, the expert panel met in May 2018 and identified the most urgent areas for moving the field forward, and discussed the framework for such a process. This led to identification of five themes, namely "Definitions and terminology," "Study methodology," "Reporting and outcomes," "Adherence to exercise," and "Mechanisms of action." Based on the identified themes, five expert groups have been formed, that will further (a) outline the challenges per theme and (b) provide recommendations for moving forward. We aim to involve and collaborate with people with MS/MS organizations (e.g. Multiple Sclerosis International Federation (MSIF) and European Multiple Sclerosis Platform (EMSP)) in all of these five themes. The generation of this thematic framework with multi-expert perspectives can bolster the quality and scope of exercise studies in MS that may ultimately improve the daily lives of people with MS.

Whole-body cooling does not compromise muscle oxidative capacity in subjects with multiple sclerosis.

BACKGROUND: Whole-body cooling improves exercise tolerance in patients with multiple sclerosis (pwMS). To be able to exercise at greater intensities and/or for longer durations with whole-body cooling, it should be examined whether this compromises skeletal muscle oxidative capacity (assessed by exercise-onset VO2 kinetics). OBJECTIVE: To study the impact of whole-body cooling on exercise-onset VO2 kinetics in pwMS. METHODS: From 12 pwMS (EDSS 3.5 ± 1.5) and 12 healthy age, BMI, and gender-matched subjects exercise-onset VO2 kinetics (mean response time [MRT]) and body temperature were determined under normothermic and hypothermic (pre-exercise 60-min whole-body cooling) conditions during submaximal exercise testing (two 6-min constant-load exercise bouts). Moreover, heart rate, blood lactate content, expiratory volume and ratings of perceived exertion (RPE) were assessed during exercise. RESULTS: Exercise heart rate (-7 ± 6 beats/min) and end-exercise body temperature (-0.9 ± 0.5°C) was significantly lower in hypothermic vs. normothermic conditions in both populations (p < 0.05). In pwMS exercise RPE was lower in hypothermic vs. normothermic condition (p = 0.056). No significantly different MRT was found between normothermic vs. hypothermic conditions in both populations. CONCLUSIONS: Lowering body temperature prior to endurance exercise does not affect muscle oxidative capacity in pwMS, but lowers RPE, thus making it possible to prescribe exercises of greater intensity and/or longer duration.

Creatine supplementation increases soleus muscle creatine content and lowers the insulinogenic index in an animal model of inherited type 2 diabetes.

Creatine supplementation may exert beneficial effects on muscle performance and facilitate peripheral glucose disposal in both rats and human subjects. The present study was undertaken to explore the effects of creatine supplementation on the ATP, creatine, phosphocreatine and glycogen content of white and red gastrocnemius and soleus muscles and on blood D-glucose and plasma insulin concentrations before and during an intravenous glucose tolerance test in Goto-Kakizaki rats, a current animal model of inherited type 2 diabetes mellitus. Creatine supplementation increased muscle creatine content, especially in the soleus muscle of young rats (+35.5-/+15.8%; d.f.=10; p<0.05), and lowered the insulinogenic index, i.e. the paired ratio between plasma insulin and blood D-glucose concentrations. The latter change was mainly attributable to a lowering of plasma insulin concentration. It is proposed, therefore, that creatine supplementation may improve the sensitivity to insulin in extrapancreatic sites in the present animal model of type 2 diabetes.