Podcast Summary: Living Well with Multiple Sclerosis

Episode: The Latest Research in Exercise for MS with Dr Robert Motl | S6E18
Date: September 4, 2024
Host: Overcoming MS (Facilitated by Veronique Gautier Simmons)
Guest: Dr. Robert Motl, Professor of Kinesiology, Nutrition, and Rehabilitation Sciences, University of Illinois, Chicago

Episode Overview

This episode dives into the latest research on exercise and physical activity for people living with multiple sclerosis (MS), featuring one of the world’s foremost experts in the field, Dr. Robert Motl. The conversation explores why Dr. Motl focuses on MS, the profound benefits that structured exercise and lifestyle physical activity provide for those with MS, how exercise compares to and complements disease modifying therapies, and the future of exercise prescriptions as precision therapy. Listeners also hear insights into Dr. Motl’s current research projects, including an innovative study on exercise and clinical depression in MS, and the importance of a holistic wellness approach.

Key Discussion Points and Insights

1. Dr. Motl’s Background and Motivation

• Dr. Motl is an internationally recognized researcher with nearly 900 publications focused on exercise and MS.
• He credits the people with MS that his team studies for providing “a big why” and motivation in his research.

  “It gives us something really important to shoot for and really meaningful.” (Dr. Motl, 02:09)

How Dr. Motl Entered the Field

• Initially focused on exercise and spinal reflexes in anxiety disorders for his dissertation.
• Became interested in MS after reading research on spasticity measurement in MS with methods similar to his own.
• Successfully received a grant from the National MS Society, leading him into this research path.

  “MS and exercise found me.” (Dr. Motl, 03:22)
  “It’s been really rewarding, and that’s where it started.” (Dr. Motl, 05:43)

2. The Benefits of Exercise for People with MS

• Profound Multi-System Benefits:

  • Exercise benefits “functional consequences, symptomatic consequences, and quality of life consequences.”
  • Particularly effective at reducing fatigue and depression.
  • Enhances walking ability, independence, and overall quality of life.

  “Exercise has profound benefits… for a lot of the functional, symptomatic, and quality of life consequences.” (Dr. Motl, 05:57)

• Safety:

  • The adverse event profile is comparable to that of the general population.

• Consistent Guidelines:

  • There are now MS-specific exercise dosage guidelines.
  • Both formal exercise and increased lifestyle activity prove beneficial.

3. "Exercise vs. Movement" in MS

• Structured Exercise:

  • Activities like gym sessions with set durations and intensities.
  • Best supported by prescriptions and guidelines.

• Lifestyle Physical Activity:

  • Everyday movements: walking, taking stairs, household activities.
  • Particularly impactful for those who struggle with structured routines.

  “People with MS have two approaches, two choices: they can engage in exercise, or they can do this thing that we call ‘sitting less and moving more.’” (Dr. Motl, 13:53)

• Behavioral Interventions:

  • Teaching self-monitoring, goal setting, and tracking to boost activity.
  • Gains achieved during intervention typically maintained beyond the program.

  “We’ve demonstrated that this approach reduces fatigue, reduces depression, improves processing speed, walking performance, and quality of life.” (Dr. Motl, 12:43)

  • Objective biological benefits: reduced body fat, increased lean and bone mass.

4. How Much Physical Activity is Enough?

• Step-Based Guidelines:

  • Adding 1,500 steps daily (5 days/week) shows meaningful improvement; 3,000 steps yields even greater benefits.
  • Quality of steps matters too—faster walking speeds are linked to higher benefit.

  “If you can get an extra 1,500 steps per day…that’s enough to have a meaningful effect.” (Dr. Motl, 15:03)

• Individual Limits:

  • There’s no upper threshold; “listen to your body” remains core advice.

5. Exercise as a Disease-Modifying Behavior

• Comparison to Disease-Modifying Therapies (DMTs):
  • Exercise is associated with reduced lesion burden, fewer relapses (27% reduction—on par with early DMTs), and a flattened disability trajectory.
  • Exercise improves walking and cognitive processing speed.

  “Exercise is associated with about a 27% reduction in relapse rates compared to control…that’s comparable to the very early classes of disease modifying therapies.” (Dr. Motl, 18:53)

  • Exercise should complement DMTs, not replace them.

6. Mechanisms: Inflammation vs. Neurodegeneration

• Current Data:
  • Limited impact of exercise on serum inflammation markers.
  • Stronger evidence for exercise boosting neurotrophic factors (BDNF) linked to neuroprotection and neurodegeneration prevention.

  “Exercise exerts more of an effect on neurodegeneration than it does on inflammation.” (Dr. Motl, 20:29)

7. Exercise and Brain Structure

• Brain Volume and Connectivity:
  • Exercise linked to larger thalamus/basal ganglia volumes and stronger brain region connections.
  • These changes relate to better cognition, balance, and movement.

  “Exercise is associated with larger volumes of the thalamus… and better connectivity.” (Dr. Motl, 22:12)

  • Balance-based exercise specifically shown to strengthen cerebellar connectivity (external study).

8. Not All Benefit Equally: Toward Precision Exercise Prescriptions

• Response Heterogeneity:
  • Not everyone benefits equally; some may worsen, improve, or see no change.
  • The goal is “precision-based prescriptions” tailored to individual characteristics, mirroring advances in cancer therapy.

  “If I give 10 people the exact same exercise prescription, will all 10 show the exact same adaptations? The answer… is no.” (Dr. Motl, 25:50)

  • The search for biomarkers to guide personalized exercise regimens is ongoing.

9. Who Should Prescribe Exercise Therapy?

• What People with MS Want:
  • Dr. Motl’s research shows most people want their neurologist to guide exercise.
  • Neurologists are willing but often lack specific knowledge; toolkits have been created for both patients and providers.

  “People with MS want the healthcare providers, particularly the neurologists… Neurologists are willing… but we have to create the knowledge base and the system for this dialogue.” (Dr. Motl, 28:42)

10. Current Research: Exercise for Major Depressive Disorder in MS

• Major Trial Ongoing:
  • First to specifically recruit people with MS and clinical depression (major depressive disorder).
  • Comparing aerobic/resistance exercise at home with remote coaching vs. a range of motion program.
  • Coaching and support structure key for adherence; post-intervention follow-ups to check for maintenance.

  “We hope to demonstrate that these programs are effective for reducing depression… this would provide the first class one evidence that exercise could be prescribed for treating depression in MS.” (Dr. Motl, 33:14)

11. Invitation to Participate in Research

• The Exercise Neuroscience Research Lab at UIC is open to volunteers, many studies designed for remote participation.
  • Goal: Promote a global movement for exercise in MS, not just in industrialized nations.

12. Holistic Approach to Wellness

• Dr. Motl encourages integrating exercise, diet, sleep, and lifestyle for optimal MS outcomes.

  “Living your best life involves doing things like exercising, eating well, diet, lifestyle… it’s the totality of those things that will really make the biggest difference in the end—but exercise first.” (Dr. Motl, 36:15)

• This echoes the Overcoming MS Program’s holistic philosophy.

Memorable Quotes

• “Exercise is the only stimulus that activates every system in the human body in a systematic, integrative, organized way.” (Dr. Motl, 25:50)
• “People with MS have two approaches, two choices: they can engage in exercise, or they can do this thing that we call ‘sitting less and moving more.’” (Dr. Motl, 13:53)
• “It doesn’t have to be exercise, but exercise is probably the most potent of these agents.” (Dr. Motl, 36:15)

Timestamps for Key Segments

• Dr. Motl’s research journey and motivation: 02:09–05:43
• Benefits and key findings of exercise in MS: 05:57–09:37
• Structured exercise vs. lifestyle physical activity: 09:37–14:47
• How much physical activity is enough?: 15:03–17:20
• Exercise as disease-modifying behavior: 17:20–20:17
• Inflammation and neurodegeneration: 20:17–22:06
• Brain changes from exercise: 22:06–24:54
• Individual variability and future directions: 25:50–28:26
• Who should prescribe exercise therapy: 28:26–31:05
• Research on exercise and clinical depression in MS: 31:05–34:31
• How to join current studies: 34:31–36:00
• Holistic health and closing thoughts: 36:15–36:56

Conclusion

This episode delivers a rich exploration of contemporary exercise research for MS, highlighting that both structured exercise and increased movement in daily life provide meaningful benefits, from symptom management to potential disease modification. Dr. Motl’s research continues to break ground, especially in personalized exercise prescriptions and innovative approaches to depression in MS. The message is clear: exercise is safe, effective, and a cornerstone of holistic MS management—“exercise first,” but always as part of a broader approach to living well with MS.