Cognitive training, exercise training or combined training? A comparative effectiveness research study on subjective and objective cognitive outcomes in multiple sclerosis.

Objective
Cognitive impairment (CI) in people with multiple sclerosis (pwMS) may be present from the onset, is common, and has a profound impact on those affected. This study compared the effectiveness of three different therapeutic approaches (computerized cognitive training, BrainStim (BS); treadmill walking (TW); combined training (BS + TW)) on subjective and objective cognitive functioning in pwMS and CI.Methods
61 pwMS were recruited from the Department of Neurology outpatient clinic of the University Hospital Düsseldorf and neurologists in private practice. After screening for eligibility, pwMS were randomized into three treatment arms: 1) BS, 2) TW, 3) BS + TW. Subjective and objective cognitive functioning were evaluated before and after intervention, including the Perceived Deficits Questionnaire (PDQ-20) and Symbol Digit Modalities Test (SDMT) as primary end points, respectively.Results
46 pwMS entered the final analysis (n = 15 excluded). Change scores revealed significant effects on PDQ20 total score for all three treatment groups. These effects were stable over 6 months in the BS + TW group only. Moreover, change scores revealed significant effects on the SDMT for the TW group and BS + TW group, lasting 6 months. Between-group differences were not significant.Conclusion
Comparing three different behavioral treatments, we found that exercise training (TW), computer-based cognitive training (BS), and their combination (BS + TW) significantly improved subjective cognitive performance, with the combined group showing the most long-lasting effect. Objective cognitive performance improved significantly in the TW and BS + TW group, while cognitive training alone showed no effect. Results suggest that combining exercise with cognitive training may provide additional cognitive benefits than either intervention alone.