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

## TL;DR

This study compares the effectiveness of cognitive training, exercise, and their combination on cognitive outcomes in people with multiple sclerosis.

## Contribution

The study reveals that combining cognitive and exercise training may offer longer-lasting cognitive benefits than either alone.

## Key findings

- All three treatments improved subjective cognitive performance, with the combined group showing the longest-lasting effect.
- Objective cognitive performance improved in the treadmill walking and combined groups, but not in cognitive training alone.
- The combined training group showed stable effects over six months.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s00415-025-13535-w.