Examining the Effects of Video-game Exercise on Mobility and Brain Plasticity in Individuals With Multiple Sclerosis

Dance Dance Revolution (DDR) may offer an innovative and highly effective format for
delivering exercise programs to people with MS. It is a fun, engaging and interactive video
game that requires players to move their feet to targets while matching the rhythm of a
song. In addition, DDR, involving both aerobic exercise and cognitive training, is an ideal
intervention for improving cognitive functioning in those with MS. The purpose of this pilot
study is to examine the use of DDR as a novel and highly specific exercise intervention to
improve mobility and cognition among individuals with MS. We will be guided by the following
three specific aims and hypotheses:

Specific Aim 1: Determine if an eight-week exercise program administered using DDR improves
dynamic balance in people with MS relative to a wait-list control group.

Hypothesis 1: Dynamic balance as measured by the Berg Balance Scale will be more improved
with the DDR intervention than the wait-list control group.

Specific Aim 2: Determine if the DDR intervention, combining fitness and cognitive training,
over the course of an eight-week intervention, will have a more positive effect on domains
of processing speed and executive control, than a wait-list control group.

Hypothesis 2: The DDR group relative to the wait-list control group, will show significant
improvement in cognitive functioning as assessed by the Paced Auditory Serial Addition Test
(PASAT), a measure of processing speed, and executive functioning. Specifically, we
hypothesize that given severe deficits in processing speed and executive control,
participation in a DDR intervention, will result in a significant improvement on the PASAT,
a widely used measure to assess cognitive functioning in patients with MS.

Specific Aim 3: We will also examine whether improvements in cognitive processes engendered
by DDR on the PASAT will be supported by changes in underlying neural circuits, as inferred
from patterns of event-related functional magnetic resonance imaging (fMRI) activation
obtained in a 3 Tesla scanner.

Hypothesis 3: Improvements in cognition as indexed by higher accuracy scores and faster
reaction time on the PASAT, will be accompanied by a change in the recruitment of underlying
neural processes as inferred from functional magnetic resonance imaging. MS participants in
the DDR group will show an increase in recruitment of the attentional network, and more
specifically the prefrontal and parietal cortices, cortical regions responsible for
successful performance on the PASAT task.

Inclusion Criteria:

- Expanded Disability Status Score of < 5 and a diagnosis of relapsing-remitting
multiple sclerosis

Exclusion Criteria:

- other neurological or orthopedic diagnosis that limits ambulation, age 30-59