Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19

Abstract

Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.

Aged brain and neuroimmune responses to COVID-19: post-acute sequelae and modulatory effects of behavioral and nutritional interventions

“…The positive effects of regular exercise on the brain were found to be related to restored neurotransmission and remyelination, to the refining of BBB-integrity, and to the improvement of the immune responses [ 5 , 195 ] as well as to mitigating effects on chronic inflammation and autoimmunity [ 196 , 197 ]. The improved BBB-permeability was reached through changes in proteins of the tight junctions, in the supporting activity of surrounding astrocytes, and in oxidative capacity of microglia, as well as by decreasing of inflammation [ 198 , 199 ].…”

“…It has been demonstrated that physical activity may buffer the effects of psychosocial stress induced by COVID-19 and improve mental and physical health among the population [ 5 , 201 ]. Therefore, regular physical exercise may possibly mitigate mental and psychological impairments related to the long COVID syndrome by improving the neuroimmune homeostatic conditions, including balanced interactions between neuromodulatory cytokines and neurotransmitters, opioids, and neurotrophic and growth factors.…”

“…Age-related neuroinflammation accompanied by an increased release of pro-inflammatory cytokines and cortisol may additionally accelerate the progression of various neurodegenerative and neuropsychiatric complications caused by virus-related pathological activity and hyperinflammation, leading to further neuroimmune inflammatory responses by oxidative damage to cells, proteins, lipids, and DNA in the brain. As a result of these cumulative effects, the decline in brain function and lasting brain tissue damage occurs leading to the loss of life autonomy in the elderly [ 5 ]. Additionally, neuropsychiatric complications, such as anxiety, depression, traumatic stress disorder, insomnia, etc., related to COVID-19 were reported to be extremely common and may negatively impact the quality of life [ 10 ].…”

Respiratory issues in patients with multiple sclerosis as a risk factor during SARS-CoV-2 infection: a potential role for exercise

“…Additionally, regarding the expression of ACE2 on microvascular endothelial cells and vascular smooth muscles, SARS-CoV-2 disrupts the relationship between endothelium and smooth muscles which results in disordered vasodilation and vasoconstriction as well as disorders in gas exchange [ 73 ]. It has been documented that some central autoimmune diseases are susceptible to other diseases involving immune system [ 74 , 75 ]. MS is a chronic central disease characterized by inflammatory demyelination.…”