title: Can aerobic exercise alleviate flu-like symptoms following interferon beta-1a injections in patients with multiple sclerosis?
abstract: BACKGROUND
  Flu-like symptoms (FLS) are common side effects of interferon beta (IFNß) treatment, and may affect the willingness to initiate therapy, the long-term acceptability, and the adherence to the treatment. Case reports suggest that aerobic exercise is able to markedly reduce FLS following IFNß-1a injections in persons with multiple sclerosis (PwMS).
  
  
  OBJECTIVE
  To test the hypothesis that aerobic exercise can alleviate FLS following IFNß-1a injections in PwMS, and secondarily to examine whether or not fluctuations in circulating cytokines provide a mechanism that can explain a potential positive effect.
  
  
  METHODS
  Seventeen PwMS who frequently experience FLS following IFNß-1a injections completed four days of testing. On two of the testing days they completed 35min of aerobic exercise on a bicycle-ergometer following IFNß-1a injection. On the two other testing days, no intervention took place following the injection. FLS were assessed pre-injection and 3h, 5h, 12h and 24h post-injection. Blood samples were taken pre-injection and 1h and 3h post-injection to determine levels of circulating interleukin 6 and 17 and IFNγ. The primary study endpoint was the comparison of the change in FLS severity from pre-injection to 5h post-injection between days with injection alone and days with injection followed by aerobic exercise.
  
  
  RESULTS
  FLS severity change was significantly lower on days with exercise compared to days with rest. IL6 was significantly increased 3h following IFNß-1a injection and exercise compared to 1h post and pre and when compared to the resting condition. Participants reported no adverse events in addition to FLS during the study period.
  
  
  CONCLUSIONS
  Data from this study suggest that moderate intensity aerobic exercise following IFNß-1a injections is safe and can alleviate the FLS severity in PwMS. Based on these results, 35min of aerobic exercise should be encouraged for PwMS who often experience FLS following IFNß-1a injections.
authors.affiliation: Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark. Electronic address: mach@ph.au.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Langeskov-Christensen
authors.affiliation: Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark.
authors.forename: Tue
authors.initials: T
authors.lastname: Kjølhede
authors.affiliation: MS-Clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Hospital of Southern Denmark, Sønderborg, Denmark.
authors.forename: Egon
authors.initials: E
authors.lastname: Stenager
authors.affiliation: MS-Clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Hospital of Southern Denmark, Sønderborg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Henrik Boye
authors.initials: HB
authors.lastname: Jensen
authors.affiliation: Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Dalgas
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D000704:Analysis of Variance; D016207:Cytokines / Q000097:blood; D004185:Disability Evaluation; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000097:blood / Q000139:chemically induced* / Q000534:rehabilitation*; D000068556:Interferon beta-1a / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000188:drug therapy; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D016207:Cytokines; D000068556:Interferon beta-1a
keywords: Aerobic exercise; Cytokines; Exercise therapy; Flu-like symptoms; Interferon beta-1a; Multiple sclerosis