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Multiple SclerosisNEXIMSNCT06374108

Resistance Training and Corticospinal Excitability in Multiple Sclerosis

A study testing Progressive resistance training in people with Multiple Sclerosis, run by University of Aarhus at 2 sites in Denmark.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of the present study is to investigate effects of progressive resistance training on central nervous system functioning (corticospinal excitability (CSE)) and walking capacity in persons with multiple sclerosis (pwMS). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Multiple Sclerosis
What is being tested?
Progressive resistance training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
54 participants
Where
2 sitesDenmark
Study dates
1 May 2024to 31 May 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years
  • MS diagnosis according to the McDonald diagnostic criteria
  • Shows impairments in walking capacity
  • Ability to self transport to test and exercise

Who cannot join

  • Pregnancy
  • Neurological or other comorbidities that affects the nervous system
  • Relapse within the past 2 months
  • Pacemaker or metallic implants
  • Hypertension (medically unregulated)
  • Participation in structured RT over the past 3 months (≥ 2 sessions/week).

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Lars Hvid, PhD contact

93508717

lhvid@ph.au.dk

Denmark2 sites, 2 recruiting
  • Department of Public Health

    Aarhus, Central Jutland, 8000

    Annette Bachmann, +4587167986, ab@ph.au.dk

    Recruiting
  • Department of Nutrition, Exercise and Sports, University of Copenhagen

    Copenhagen, Copenhagen N, 2200

    Kristian Levring Madsen, +45 3532 0829, nexs@nexs.ku.dk

    Recruiting

Other trials in Denmark

About this study

Official title: Effects of Supervised Progressive Resistance Training on Central Nervous System Functioning (Corticospinal Excitability) and Walking Capacity in Persons With Multiple Sclerosis

The goal of the present study is to investigate effects of progressive resistance training on central nervous system functioning (corticospinal excitability (CSE)) and walking capacity in persons with multiple sclerosis (pwMS). A total of 54 pwMS will be enrolled and randomized into 1 of 3 groups: high dose resistant training (RT), low dose RT, and waitlist control.

Read the detailed description

Neurodegeneration is a hallmark of multiple sclerosis (MS), affecting both structure and function of the central nervous system (CNS). Neurodegeneration is the main driver of disability progression in MS, evidenced by studies showing deleterious structural and functional CNS changes, ultimately reducing quality of life. Consequently, the interaction between the nervous system and muscular system undergoes deleterious changes causing reduced neuromuscular function (i.e., ability to develop muscle strength and power) and physical function.

The functional CNS changes have been evidenced by using the non invasive brain stimulation technique Transcranial Magnetic Stimulation, showing decreased corticospinal excitability alongside increased central motor conduction time. Moreover, functional peripheral nervous system (PNS) changes have been evidenced by nerve conduction methods, revealing decreased amplitude of compound muscle action potential and increased latency of nerve signaling. In an ongoing exploratory study (unpublished), the investigators have observed that functional CNS and PNS outcomes deteriorate with disability progression from healthy to mildly to moderately disabled people with MS (PwMS).

Exercise is beneficial from both an individual and a societal perspective, and has proven to be both safe and without any noticeable side effects in PwMS. Resistance training (RT) appears particularly effective in improving neuromuscular function (mainly muscle strength) and physical function (especially walking capacity). Whilst RT and other exercise modalities may elicit positive effects on CNS structure in PwMS, it seems to require a long-term (≥ 6 months) exposure. In contrast, CNS (and potentially PNS) function may adapt much more rapidly, despite a scarcity of studies (and with heterogeneous findings) involving PwMS. Interestingly, an exploratory exercise study (non-controlled, low sample size, 10 weeks treadmill walking intervention) assessed corticospinal excitability in PwMS, and observed substantial improvements after the intervention. Apart from this study, a major knowledge gap exists in terms of elucidating the potential beneficial effects of exercise (RT in particular) on CNS (and PNS) function. Based on evidence from healthy young individuals, substantial improvements in corticospinal excitability have been shown following 2-12 weeks of RT, supporting that RT-induced improvements in corticospinal excitability can also be seen in PwMS. Lastly, as existing exercise guidelines for PwMS fails to refer to evidence on dose-response to exercise, and a recent systematic review on exercise studies found no dose-response studies in PwMS (n=202), this aspect is also of great clinical relevance.

Being tested
Progressive resistance training
Medical subject headings
Multiple Sclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Progressive resistance trainingBehavioural

    The RT exercise regime will focus on lower extremity exercises (60-90% of 1 repetition maximum) as well as incorporating functional exercises.

Study groups in NCT06374108
Study groupRoleWhat they receive
High dose resistance trainingActive comparator10 weeks intervention with 2.5 weekly supervised resistance training sessions (2 or 3 sessions/week for high dose resistance training; 25 sessions in total).
Receives: Behavioral: Progressive resistance training
Low dose resistance trainingActive comparator10 weeks intervention with 1 weekly supervised resistance training session (low dose resistance training; 10 sessions in total).
Receives: Behavioral: Progressive resistance training
Waitlist control.No interventionThe waitlist control group will initially be instructed to maintain their normal daily activity during the 10 week intervention period. Hereafter, they will be offered a 10 week high dose resistance training intervention that combines supervised and home based exercise sessions .

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. MEP/Mmax ratio

    Cortical excitability measured as amplitude percentage ratio between MEP (resting) and Mmax (Cmap of TA). Unit (intended): %

    Measured: Change from Baseline to 10 weeks

Secondary outcomes (31)
  1. Muscle strength

    Maximal voluntary contraction (MVC) is the maximal force-generating capacity (plantar flexion and dorsal flexion). Unit (intended): N

    Measured: Change from Baseline to 10 weeks

  2. Voluntary activation I

    Assessed by Interpolated Twitch Technique (ITT) (dorsal flexion). Unit (intended): %

    Measured: Change from Baseline to 10 weeks

  3. Voluntary activation II

    EMG amplitude during MVC (plantar flexion and dorsal flexion). Unit (intended): μV

    Measured: Change from Baseline to 10 weeks

  4. Force Steadiness

    A quantitative measure of the ability to control muscle tonus (dorsal flexion). Unit (intended): root-mean-square (RMS) error (Coefficient of Variation (CV))

    Measured: Change from Baseline to 10 weeks

  5. Rate of Force Developement

    This is defined as the speed at which the contractile elements of the muscle can develop force (plantar flexion and dorsal flexion). Unit (intended): N/s

    Measured: Change from Baseline to 10 weeks

  6. Ultrasound

    Measure of muscle thickness of the tibialis anterior. Unit (intended): mm

    Measured: Change from Baseline to 10 weeks

  7. Resting Motor Threshold (rMT)

    The intensity necessary to produce a motor-evoked potential (MEP) that exceeds a defined peak-to-peak amplitude (50 μV) 50% of the time in a finite number of trials. Unit (intended): % Maximum stimulator output (MSO)

    Measured: Change from Baseline to 10 weeks

  8. Active Motor Threshold (aMT)

    The intensity necessary to produce a motor-evoked potential (MEP) that exceeds a defined peak-to-peak amplitude (50 μV) 50% of the time in a finite number of trials during voluntary activation (20% of MVC). Unit (intended): % Maximum stimulator output (MSO)

    Measured: Change from Baseline to 10 weeks

  9. MEP latency (resting)

    The transmission time from stimulating the cortex to the start of the evoked potential in the EMG of the target muscle. Unit (intended): ms

    Measured: Change from Baseline to 10 weeks

  10. MEP latency (active)

    The transmission time from stimulating the cortex to the start of the evoked potential in the EMG of the target muscle. Unit (intended): ms

    Measured: Change from Baseline to 10 weeks

  11. MEP amplitude (resting)

    Peak-to-peak of averaged MEP (20 stimulations of 120% rMT). Unit (intended): mV

    Measured: Change from Baseline to 10 weeks

  12. MEP amplitude (active)

    Peak-to-peak of averaged MEP (20 stimulations of 120% rMT). Unit (intended): mV

    Measured: Change from Baseline to 10 weeks

  13. Short-interval intracortical Inhibition (SICI)

    SICI measures cortical inhibition and is a TMS protocol in which two stimuli are delivered with an interstimulus interval (ISI) of 2.5 ms. Unit (intended): the relative amplitude difference of motor evoked potentials (MEPs) (%).

    Measured: Change from Baseline to 10 weeks

  14. Intracortical facilitation (ICF)

    ICF measures cortical facilitation and is a TMS protocol in which two stimuli are delivered with an interstimulus interval (ISI) of 10 ms. Unit (intended): the relative amplitude reduction of motor evoked potentials (MEPs) (%).

    Measured: Change from Baseline to 10 weeks

  15. Cortical Silent Period (CSP)

    The temporary interruption of electromyographic signal from a muscle following a motor-evoked potential (MEP) triggered by transcranial magnetic stimulation (TMS). Unit (intended): ms

    Measured: Change from Baseline to 10 weeks

  16. Central Motor Conduction Time (CMCT)

    The time it takes for the fastest action potentials to travel from the site of cortical stimulation to the spinal motoneuron. It is calculated by subtracting the peripheral motor conduction time (PMCT) from the MEP latency or by the F-wave method. Unit (intended): ms

    Measured: Change from Baseline to 10 weeks

  17. EEG-EMG coherence (0-1)

    Synchronization between brain activity (EEG) and muscle activity (EMG) over a specific frequency range. Unit (intended): ranging from 0 to 1, where 0 is no coherence and 1 is perfect coherence.

    Measured: Change from Baseline to 10 weeks

  18. Timed 25 feet walk test (T25FWT)

    Objective test that measures walking speed. Unit (intended): seconds.

    Measured: Change from Baseline to 10 weeks

  19. 6-minute walk test (6MWT)

    Objective test that measures walking endurance. Unit (intended): meters.

    Measured: Change from Baseline to 10 weeks

  20. Six spot step test (SSST)

    Objective test that measures walking coordination and balance. Unit (intended): seconds.

    Measured: Change from Baseline to 10 weeks

  21. 5 sit-to-stand (5STS)

    Objective test that measures functional lower limb muscle strength and power. Unit (intended): seconds.

    Measured: Change from Baseline to 10 weeks

  22. 9-step stair ascend (9SSA)

    Objective test that measures functional lower limb muscle strength and power. Unit (intended): seconds.

    Measured: Change from Baseline to 10 weeks

  23. Patient determined disease steps (PDDS)

    A patient-reported measure of disability. Unit (intended): score (0-8; 0 is normal).

    Measured: Change from Baseline to 10 weeks

  24. Multiple Sclerosis Walking Scale (MSWS)

    Questionnaire that measures quality of life. Unit (intended): score (0-100; 0 is better).

    Measured: Change from Baseline to 10 weeks

  25. Modified fatigue impact scale (MFIS)

    Questionnaire that measures the impact fatigue has on daily life. Unit (intended): score (0-84; 0 is better)

    Measured: Change from Baseline to 10 weeks

  26. MS impact scale (MSIS)

    Questionnaire that measures the impact MS has on daily life. Unit (intended): score (29-145; 29 is better)

    Measured: Change from Baseline to 10 weeks

  27. Falls-efficacy scale - international (FES-1)

    Questionnaire that measures concerns about falling. Unit (intended): score (16-64; 16 is better)

    Measured: Change from Baseline to 10 weeks

  28. The Physical Activity Enjoyment Scale (PACES)

    Questionnaire that measures enjoyment for physical activity. Unit (intended): score (8-56; Higher score reflect greater level of enjoyment)

    Measured: Change from Baseline to 10 weeks

  29. Brief pain inventory (BPI)

    Questionnaire that measures pain severity and pain interference. Unit (intended): No scoring algorithm, but "worst pain" or the arithmetic mean of the four severity items can be used as measures of pain severity; the arithmetic mean of the seven interference items can be used as a measure of pain interference.

    Measured: Change from Baseline to 10 weeks

  30. Baecke physical activity

    Questionnaire (patient-reported outcome) assessing patient-reported participation in physical activities. Unit (intended): Score range is continuous (0-xx). Higher is better.

    Measured: Change from Baseline to 10 weeks

  31. Accelerometry

    Method used to measures and analyze movement and acceleration in three dimensions of a person (physical activity). Unit (intended): g (m/s^2)

    Measured: Change from Baseline to 10 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Apr 2024
  2. Study start1 May 2024
  3. Primary completion31 Dec 2025 (estimated)
  4. Study completion31 May 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
54 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06374108
Sponsor's protocol ID
Neuro_Exercise
Acronym
NEXIMS
Status last verified
Dec 2024
First submitted
16 Apr 2024
Last updated
11 Dec 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Andersen TM, Riis H, Tankisi H, Mamoei S, Langeskov-Christensen M, Dalgas U, Lundbye-Jensen J, Hvid LG. Effects of supervised progressive resistance training on corticospinal excitability in persons with multiple sclerosis: A randomized controlled trial protocol for the NEXIMS study. Contemp Clin Trials. 2026 Jun;165:108317. doi: 10.1016/j.cct.2026.108317. Epub 2026 Apr 15.

    PubMed 41991058

Questions about this trial

What is this clinical trial studying?

A study testing Progressive resistance training in people with Multiple Sclerosis, run by University of Aarhus at 2 sites in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 11 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Lars Hvid, PhD (93508717, lhvid@ph.au.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

MEP/Mmax ratio (time frame: Change from Baseline to 10 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06374108, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Dec 2024; AzTrials last refreshed its copy on 1 Nov 2026.

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