Aerobic capacity moderates the association between cervical cord atrophy and clinical disability in mildly disabled multiple sclerosis patients
Description
Spinal cord atrophy is a key contributor to disability in multiple sclerosis (MS), with early and progressive loss of cervical cord volume correlating with worsening clinical outcomes. This study explored whether aerobic capacity moderates the association between spinal cord atrophy and clinical disability in people with MS. A cross-sectional analysis was conducted on 51 MS patients with mild to moderate disability (Expanded Disability Status Scale [EDSS] ≤ 6.0) and 33 age- and sex-matched healthy controls (HCs). All participants underwent 3T brain MRI to assess normalized mean upper cervical cord area (nMUCCA), a surrogate for spinal cord atrophy. Aerobic capacity was assessed via peak oxygen consumption (VO₂peak) measured during cardiopulmonary exercise testing (CPET), with low aerobic capacity defined as a z-score < –1.64. MS patients demonstrated significantly reduced nMUCCA and VO₂peak compared to HCs. Within the MS cohort, 61% were classified as having low aerobic capacity. Although no major differences in brain volumes or clinical characteristics (aside from body mass index) were observed between low and high aerobic capacity subgroups, a significant negative correlation between nMUCCA and EDSS was found only in those with low aerobic capacity. Moderation analysis confirmed a significant interaction between spinal cord atrophy and aerobic capacity in predicting disability (β = –0.099, p = 0.012). Specifically, reduced nMUCCA was associated with higher disability only in MS patients with low aerobic capacity, but not in those with high aerobic capacity. These findings suggest that greater aerobic capacity may attenuate the detrimental impact of spinal cord atrophy on clinical disability in MS, acting as a physical reserve factor. This highlights the potential of aerobic fitness enhancement as a non-pharmacological strategy to buffer neurodegenerative effects and support functional outcomes in MS, especially in the early stages of the disease.
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Ministero della Salute
GR-2019-12369599