Improving Cognition in People With Progressive Multiple Sclerosis Using Aerobic Exercise and Cognitive Rehabilitation
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| ClinicalTrials.gov Identifier: NCT03679468 |
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Recruitment Status :
Active, not recruiting
First Posted : September 20, 2018
Last Update Posted : April 27, 2022
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Multiple Sclerosis, Primary Progressive Cognitive Impairment | Other: Cognitive Rehabilitation Other: Sham Exercise Other: Sham Cognitive Rehabilitation Other: Aerobic Exercise | Not Applicable |
Aim: The broad aim of this proposal is to evaluate a multidisciplinary and multi-modal approach to rehabilitation in people with progressive MS. Cognitive rehabilitation and aerobic exercise will be evaluated individually and in combinations to address cognitive dysfunction as the primary outcome variable.
Over 20 years have passed since the introduction of the first disease modifying treatment, interferon beta-1betaseron (b), for multiple sclerosis (MS).Since then 13 treatments have been approved and made it onto the market. All are for relapsing-remitting disease (RRMS), apart from mitoxantrone which is limited to progressive disease with relapses, Interferon-beta-1b, which is for secondary progressive disease (SPMS), but does not delay disability progression and Ocrelizumab for primary progressive MS only. Thus, for a sizeable proportion of people with MS there is no therapeutic option to slow progression. This raises the question, how are patients with primary and secondary progressive MS (PPMS and SPMS) to be helped? While research is underway to find a medication that holds promise of halting further deterioration in a disease that has already entered a progressive stage, patients and their clinicians are left with basically symptomatic treatments.
Hypothesis: The investigators hypothesize that CR and aerobic exercise are effective treatments for cognitive impairment (processing speed deficits) in people with progressive MS. In particular a combination of these two treatment given twice weekly over 12 weeks is more effective than each individual treatment given alone or as sham. The investigators further hypothesize that improvements in processing speed will be matched on functional MRI (fMRI) by enhanced neural activity in networks associated with information processing speed.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 309 participants |
| Allocation: | Randomized |
| Intervention Model: | Sequential Assignment |
| Intervention Model Description: | We propose undertaking a randomized, blinded, sham controlled clinical trial investigating the effectiveness of CR and exercise, either singly or in combination, in treating cognitive dysfunction in people with progressive MS. Subjects will be randomly assigned to one of four groups: CR plus exercise; CR plus passive exercise; passive CR plus exercise and passive CR plus passive exercise. Subjects will receive one of these four treatments for 12 weeks, twice a week. One in three subjects will undergo structural and functional MRI to investigate how the brain responds to the two interventions. |
| Masking: | Double (Participant, Investigator) |
| Masking Description: | In order to prevent bias in our research results, we will employ a double-blind study design in which the examiner nor the research participant will know which group membership they were assigned to. |
| Primary Purpose: | Other |
| Official Title: | Improving Cognition in People With Progressive Multiple Sclerosis: A Multi-Arm, Randomized, Blinded, Sham-Controlled Trial of Cognitive Rehabilitation and Aerobic Exercise. |
| Actual Study Start Date : | March 18, 2019 |
| Estimated Primary Completion Date : | June 30, 2022 |
| Estimated Study Completion Date : | December 30, 2022 |
| Arm | Intervention/treatment |
|---|---|
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Sham Comparator: Cognitive Rehab & Sham Exercise
Cognitive Rehabilitation by computer based brain tasks, and Sham exercises focusing primary on balance and stretching. Sessions will take place twice a week for 12 weeks.
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Other: Cognitive Rehabilitation
RehaCom software Information processing speed and attention modules Other: Sham Exercise Sets of balance and stretching exercises |
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Sham Comparator: Sham Cognitive Rehab & Sham Exercise
Sham cognitive Rehabilitation will consist of basic internet searches and learning to use a computer, and sham exercises focusing primary on balance and stretching. Sessions will take place twice a week for 12 weeks.
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Other: Sham Exercise
Sets of balance and stretching exercises Other: Sham Cognitive Rehabilitation Kompozer software 24 session module consisting of basic internet searches |
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Sham Comparator: Sham Cognitive rehab & Aerobic Exercise
Sham cognitive rehabilitation will consist of basic internet searches and learning to use a computer, and aerobic exercises will focus primarily on improving cardio-respiratory fitness using a recumbent bike. Sessions will take place twice a week for 12 weeks.
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Other: Sham Cognitive Rehabilitation
Kompozer software 24 session module consisting of basic internet searches Other: Aerobic Exercise Recumbent NuStep Bike Aerobic cycling |
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Active Comparator: Cognitive Rehab & Aerobic Exercise
Cognitive Rehabilitation by computer based brain tasks and aerobic exercises will focus primarily on improving cardio-respiratory fitness using a recumbent bike. Sessions will take place twice a week for 12 weeks.
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Other: Cognitive Rehabilitation
RehaCom software Information processing speed and attention modules Other: Aerobic Exercise Recumbent NuStep Bike Aerobic cycling |
- Change from baseline cognitive Information processing speed at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
The Symbol Digit Modalities Test (SDMT) will be used to measure cognitive information processing speed
The SDMT is a simple matching task that requires the participant to refer to a reference key, in order to correctly match a geometric symbol with the corresponding number. Participant will be under a 90 second time constraint to quickly and correctly match each pair.
Test will be administered at index assessment, 12 weeks following cognitive rehab/ aerobic exercise, and at 6 months to examine cognitive retention
- Change from baseline cognitive verbal memory at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, & 6 month ]
The California Verbal Learning Test (CVLT) will be used to measure verbal memory
The CVLT test begins with the examiner reading a list of 16 words, participants are then instructed to report as many of the words as they can remember. After recall is recorded, the entire list is read again, altogether, there are five learning trials.
Test will be administered at index assessment, 12 weeks following cognitive rehab/ aerobic exercise, and at 6 months to examine cognitive retention
- Change from baseline cognitive visual memory at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, & 6 month ]
The Brief Visuo-Spatial Memory Test (BVMT) will be used to measure visual memory
Participants are presented with six abstract designs for 10 seconds, the display is then removed from view and participant are instructed to draw the designs from memory via pencil on paper. Each design is scored from 0 to 2 points representing accuracy and location. There are three learning trials.
Test will be administered at index assessment, 12 weeks following cognitive rehab/ aerobic exercise, and at 6 months to examine cognitive retention
- Change from baseline anxiety & depression, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
The following self report scale will be used to measure anxiety and depression:
The Hospital Anxiety and Depression Scale (HADS) - The HADS is comprised of seven questions for anxiety and seven questions for depression, each reply has a likert scale ranging from 0-3.
Total score will indicate:
0-7 = normal 8-10 = borderline abnormal 11-21 = abnormal
- Change from baseline depression, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
The following self report scale will be used to measure depression:
Beck Depression Inventory-revised (BDI-II) - The BDI-II questionnaire is comprised of 21 questions, participant will circle a reply that closely matches their answer, each reply has a likert scale that ranges from 0-3.
Total score indicate the following:
1-10 = these ups and downs are considered normal 11-16 = Mild mood disturbance 17-20 = Borderline clinical depression 21-30 = Moderate depression 31-40 = Severe depression over 40 = Extreme depression
- Change from baseline fatigue, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
The Modified Fatigue Impact Scale (MFIS), will evaluate the participants fatigue.
The total score for the MFIS is the sum of the scores for the 21 items. Individual subscale scores for physical, cognitive, and psychosocial functioning can also be generated by calculating the sum of specific sets of items.
- Change from baseline perceived deficits, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
The Perceived Deficits Questionnaire (PDQ), will evaluate the participants subjective cognitive difficulties.
The total score for the PDQ is the sum of the scores for the 20 items. Individual subscale scores for attention/concentration, retrospective memory, prospective memory, and planning/organization will be generated by calculating the sum of specific sets of items.
- Change from baseline subjective impact of walking, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
The Multiple Sclerosis Walking Scale (MSWS-12), will evaluate the participants subjective impact of walking.
The MSWS-12 consist of 12 questions, each question ranges from 0-5. A high total score indicates greater impact on walking than lower scores.
- Change from baseline impact of Multiple Sclerosis, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
Multiple Sclerosis Impact Scale (MSIS-29-V2) - will evaluate the participants impact of Multiple Sclerosis.
The MSIS-29 is a 29 item scale measuring the physical (20 item) and psychological (9 item) impact of Multiple scleroses.
- Change from baseline quality of life, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
European Quality of Life-5 Dimensions (EQ5D-5) - will be used to evaluate the participants quality of life.
The EQ5D-5 comprises of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions.
The EQ5D-5 also records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled "The best health you can imagine" and "The worst health you can imagine".
- Change from baseline global function, at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, and 6 month ]
Self report scale:
The Functional Assessment of Multiple Sclerosis (FAMS), will be used to asses the participants global function.
The FAMS consist of 59 items, and domains that consist of questions on: mobility, symptoms, emotional well-being, general contentment, thinking/fatigue, family/social well-being, and additional concerns.
FAMS total score range = 0 -176. Higher scores indicate better quality of life.
- Change from baseline brain activity at 12 weeks and 6 months [ Time Frame: Baseline, 12 weeks, 6 months ]
The participant will perform a modified Go no Go task while in the MRI. Changes in brain activity will indicate superiority of one of the four study groups.
Go no Go task:
Participants are required to either respond (i.e., pressing designated key) or withhold a response (not pressing designated key) depending on whether a go stimulus or a no-go stimulus is presented
MRI Go no Go task will be administered at index assessment, 12 weeks following cognitive rehab/ aerobic exercise, and at 6 months to examine brain activity and anatomical changes
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| Ages Eligible for Study: | 25 Years to 65 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Have a confirmed diagnosis of progressive Multiple Sclerosis
- Visual Acuity of 20/70
- Language comprehension, to ensure subjects have the ability to understand instructions
Exclusion Criteria:
- Wheelchair dependent (EDSS > 7.0)
- History of central nervous system disease other than progressive MS
- Steroids use within the past 3 months
- Regular aerobic training (eg. bi-cycling, running, swimming or rowing)
- Unwilling to travel to study sites for rehabilitation 2 times a week for 3 months
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03679468
| Canada, Ontario | |
| Sunnybrook Health Science Center | |
| Toronto, Ontario, Canada, M4N3M5 | |
| Principal Investigator: | Anthony Feinstein, MD | Sunnybrook Health Sciences Centre |
| Responsible Party: | Dr. Anthony Feinstein, Professor, department of psychiatry, University of Toronto, Sunnybrook Health Sciences Centre |
| ClinicalTrials.gov Identifier: | NCT03679468 |
| Other Study ID Numbers: |
232-2018 |
| First Posted: | September 20, 2018 Key Record Dates |
| Last Update Posted: | April 27, 2022 |
| Last Verified: | April 2022 |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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Multiple Sclerosis Multiple Sclerosis, Chronic Progressive Sclerosis Pathologic Processes Demyelinating Autoimmune Diseases, CNS |
Autoimmune Diseases of the Nervous System Nervous System Diseases Demyelinating Diseases Autoimmune Diseases Immune System Diseases |