The insula modulates the effects of aerobic training on cardiovascular function and ambulation in multiple sclerosis
Description
Cardiovascular dysregulation is a frequent non-motor manifestation of multiple sclerosis (MS), potentially linked to structural damage in autonomic control regions such as the insular cortex. This study examined the role of insular integrity in modulating cardiovascular fitness (CF) and ambulation, and its influence on the efficacy of aerobic training (AT) in people with MS. A total of 61 MS patients (20 with relapsing–remitting and 41 with progressive MS) were retrospectively analyzed and randomized into two intervention arms: an AT group (MS-AT, n = 31) performing moderate-intensity aerobic exercise, and a motor training control group (MS-C, n = 30) performing non-aerobic exercises. Each patient underwent clinical, cardiopulmonary, and MRI evaluations at baseline and after 24 training sessions over 2–3 months. Two separate healthy control groups were included: one for cardiopulmonary assessment (HC-clinic, n = 20) and another for imaging comparison (HC-MRI, n = 60). At baseline, MS patients demonstrated significantly reduced VO₂max, HR reserve (HRR), and 6-minute walk test (6MWT) performance compared to healthy controls, alongside widespread gray matter atrophy including the bilateral insula. Notably, the presence of left insular T2-hyperintense lesions correlated with impaired HRR. Following AT, the MS-AT group—particularly patients without insular lesions—showed significant improvement in 6MWT distance and preservation of insular volume. In contrast, the MS-C group exhibited progressive left insular atrophy. Moreover, greater gains in walking capacity were significantly associated with more limited loss of left anterior insular volume. These results highlight the insula’s role in modulating both baseline cardiovascular impairment and training-related functional improvements. Assessing insular integrity via MRI may offer predictive value for rehabilitation outcomes and guide individualized aerobic training strategies in MS care.
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Ministero della Salute
GR-2019-12369599