<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02264704</url>
  </required_header>
  <id_info>
    <secondary_id>157624</secondary_id>
    <nct_id>NCT02264704</nct_id>
  </id_info>
  <brief_title>Exercise Intensity and Immune Function in Multiple Sclerosis</brief_title>
  <official_title>Exercise Intensity and Immune Function in Multiple Sclerosis</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of the West of Scotland</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Heatlh Service Ayrshire and Arran</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of the West of Scotland</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      This study aims to determine the effect of exercise intensity within a 15 week programme in&#xD;
      moderately disabled people with multiple sclerosis (MS). Although earlier research has shown&#xD;
      that exercise is safe and may improve health related factors such as mobility and fatigue,&#xD;
      the intensity at which exercise offers the most benefit has not yet been defined.&#xD;
&#xD;
      Participants will be randomly assigned to one of three groups - high intensity, moderate&#xD;
      intensity or usual care. Participants in the exercising groups (high and moderate intensity)&#xD;
      will take part in a supervised 15 week cycling exercise programme based in the Douglas Grant&#xD;
      Rehabilitation Centre. Those assigned to the usual care (control) group will continue to&#xD;
      receive their usual medical care and will not participate in the exercise programme. The&#xD;
      acute immune response to exercise will also be measured.&#xD;
&#xD;
      Participants from all three groups will be monitored regularly. Clinical outcomes of the&#xD;
      study include immunological markers, exercise capacity, mobility, fatigue, quality of life&#xD;
      and cognitive ability. These will be measured by a combination of blood tests, physical&#xD;
      assessments and questionnaires.&#xD;
&#xD;
      It is hypothesised that high intensity exercise will cause a favourable, anti-inflammatory&#xD;
      response which will be associated with greater improvements in physical and psychological&#xD;
      outcomes than both moderate intensity exercise and usual care.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Recruited patients will initially undergo baseline measurements including BMI. Neurotrophin&#xD;
      (BDNF and NGF) and cytokine (IFN-Y and IL-4) concentration will be measured from participant&#xD;
      serum using commercially available ELISA kits (R&amp;D systems).&#xD;
&#xD;
      Assessments of cognitive ability, mood, fatigue and quality of life will also be performed&#xD;
      using psychometric tests as described in outcomes. Exercise capacity and mobility will be&#xD;
      also be measured.&#xD;
&#xD;
      Participants will also undergo a maximal exercise test, recently validated for use in this&#xD;
      patient population (Heine et al., 2014). Briefly, rested participants will initially cycle at&#xD;
      a power of 25W whilst maintaining a minimum cadence of 60rpm as a 5 minute warm-up. This&#xD;
      leads directly into the testing period, during which the power is increased incrementally&#xD;
      (15W per minute) until the point of volitional termination or a drop in cadence of 10rpm&#xD;
      below the minimum (60 rpm). Peak oxygen consumption (VO2 peak) is used as a measure of&#xD;
      cardiorespiratory fitness.&#xD;
&#xD;
      Participants will be randomly assigned to one of three groups - high intensity (HI), moderate&#xD;
      intensity (MI) or usual care (UC). Exercising groups will take part in a 15 week programme.&#xD;
      All exercise will be performed on a cycle ergometer and will be carried out twice per week&#xD;
      for 15 weeks (30 sessions) at the Douglas Grant Rehabilitation Centre, Irvine. In all&#xD;
      sessions HI participants will exercise intermittently (30 seconds on 30 seconds off) at 80%&#xD;
      of the peak power (based on maximal exercise test) for 15 minutes. MI participants will&#xD;
      exercise continuously at 40% peak power for 15 minutes. To ensure exercise intensity remains&#xD;
      consistent throughout the programme the workload will progressively increase over time to&#xD;
      accommodate any increases in participant fitness levels as measured by %HR. UC participants&#xD;
      will not participate in the supervised exercise programme but will continue to receive their&#xD;
      usual care.&#xD;
&#xD;
      5 weeks after completion of the exercise programme, a follow-up testing session will occur.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Not yet recruiting</last_known_status>
  <start_date>November 2014</start_date>
  <completion_date type="Anticipated">July 2015</completion_date>
  <primary_completion_date type="Anticipated">July 2015</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Supportive Care</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in serum brain-derived neurotrophic factor (BDNF) level</measure>
    <time_frame>Chronic - Baseline, week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise</time_frame>
    <description>The level of brain-derived neurotrophic factor in participant serum will be determined by analysing blood samples using commercially available ELISA assays.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in serum nerve growth factor (NGF) level</measure>
    <time_frame>Chronic - Baseline, week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise</time_frame>
    <description>The level of nerve growth factor in participant serum will be determined by analysing blood samples using commercially available ELISA assays.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in serum interleukin-4 (IL-4) level</measure>
    <time_frame>Chronic - Baseline (week 0), week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise</time_frame>
    <description>The level of interleukin-4 in participant serum will be determined by analysing blood samples using commercially available ELISA assays.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in serum interferon gamma (IFN-γ) level</measure>
    <time_frame>Chronic - Baseline (week 0), week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise</time_frame>
    <description>The level of interferon gamma in participant serum will be determined by analysing blood samples using commercially available ELISA assays.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in mobility</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>Participant mobility and balance will be assessed by the timed up and go test (TUG). Individuals safely rise from a standard armchair, walk a distance of 3 metres, turn around and return to a seated position. Usual walking aids may be used however personal assistance is not permitted.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in exercise capacity</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>Exercise capacity will be assessed by the six minute walk test (6MWT). Participants walk continuously, turning at a defined distance, until six minutes have passed. Total distance travelled is the measured outcome.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in fatigue</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>Self-reported fatigue will be assessed by the 21 item modified fatigue impact scale (MFIS) which has been previously validated for use in this patient population.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in health-related quality of life</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>Health-related quality of life will be assessed by the 29 item multiple sclerosis impact scale questionnaire (MSIS-29). MSIS-29 analyses both mental and physical aspects of quality of life.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in cognitive ability</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>The brief international cognitive assessment for multiple sclerosis (BICAMS) is a short test battery which assesses information processing speed, visual memory and verbal learning ability.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Number of sessions attended</measure>
    <time_frame>15 weeks</time_frame>
    <description>Adherence will be measured by number of exercise sessions attended across the 15 week intervention (30 sessions).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in cardiorespiratory fitness</measure>
    <time_frame>Baseline and week 15</time_frame>
    <description>Peak oxygen consumption (VO2 peak) will be measured via a maximal exercise test tailored for this patient population (Heine et al., 2014).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in mood</measure>
    <time_frame>Baseline, weeks 5, 10, 15 and follow up (week 20)</time_frame>
    <description>Mood will be assessed by the hospital anxiety and depression scale (HADS). HADS is a 14 item questionnaire designed to analyse self-reported indicators of anxiety and depression.</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Anticipated">63</enrollment>
  <condition>Multiple Sclerosis</condition>
  <arm_group>
    <arm_group_label>High intensity exercise</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>High intensity exercise Participants will exercise at high intensity (70% VO2 peak) intermittently (30 seconds on, 30 seconds off) for 15 minutes, twice weekly for 15 weeks.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Moderate intensity exercise</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants exercise at moderate intensity (35% VO2 peak) continuously for 15 minutes, twice weekly for 15 weeks.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Usual Care</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Participants receive usual medical care.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>High intensity exericse</intervention_name>
    <description>Participants will exercise at high intensity (70% VO2 peak) intermittently (30 seconds on, 30 seconds off) for 15 minutes, twice weekly for 15 weeks. Workload may increase as the study progresses based on heart rate response.</description>
    <arm_group_label>High intensity exercise</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Moderate intensity exericse</intervention_name>
    <description>Participants exercise at moderate intensity (35% VO2 peak) continuously for 15 minutes, twice weekly for 15 weeks. Workload may increase as the study progresses based on heart rate response.</description>
    <arm_group_label>Moderate intensity exercise</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Clinically confirmed MS (according to the revised 2010 McDonald criteria) (Polman et&#xD;
             al., 2011)&#xD;
&#xD;
          -  Expanded disability status scale (EDSS) 3.0-5.0&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Unable to consent due cognitive impairment or mental illness&#xD;
&#xD;
          -  Immunomodulatory therapy in past 3 months&#xD;
&#xD;
          -  Steroid therapy in the past 6 weeks&#xD;
&#xD;
          -  Existence of medical contraindications for exercise i.e. cardiovascular or orthopaedic&#xD;
             disease.&#xD;
&#xD;
          -  Compounding neurological condition other than MS&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>60 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Ryan Bell, MSc</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of the West of Scotland</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Paul Mattison, MD</last_name>
    <phone>441294323031</phone>
    <email>drmattison@aaaht.scot.nhs.uk</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Ryan Bell, MSc</last_name>
    <phone>447593052652</phone>
    <email>ryan.bell@uws.ac.uk</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital</name>
      <address>
        <city>Irvine</city>
        <state>Ayrshire</state>
        <zip>KA12 8SS</zip>
        <country>United Kingdom</country>
      </address>
    </facility>
    <contact>
      <last_name>Paul Mattison, MD</last_name>
      <phone>441294323031</phone>
      <email>drmattison@aaaht.scot.nhs.uk</email>
    </contact>
    <investigator>
      <last_name>Ryan Bell, MSc</last_name>
      <role>Principal Investigator</role>
    </investigator>
  </location>
  <location_countries>
    <country>United Kingdom</country>
  </location_countries>
  <reference>
    <citation>Heine M, Hoogervorst EL, Hacking HG, Verschuren O, Kwakkel G. Validity of maximal exercise testing in people with multiple sclerosis and low to moderate levels of disability. Phys Ther. 2014 Aug;94(8):1168-75. doi: 10.2522/ptj.20130418. Epub 2014 Mar 27.</citation>
    <PMID>24677255</PMID>
  </reference>
  <reference>
    <citation>Collett J, Dawes H, Meaney A, Sackley C, Barker K, Wade D, Izardi H, Bateman J, Duda J, Buckingham E. Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities. Mult Scler. 2011 May;17(5):594-603. doi: 10.1177/1352458510391836. Epub 2011 Jan 19.</citation>
    <PMID>21247971</PMID>
  </reference>
  <verification_date>October 2014</verification_date>
  <study_first_submitted>October 8, 2014</study_first_submitted>
  <study_first_submitted_qc>October 8, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">October 15, 2014</study_first_posted>
  <last_update_submitted>October 8, 2014</last_update_submitted>
  <last_update_submitted_qc>October 8, 2014</last_update_submitted_qc>
  <last_update_posted type="Estimate">October 15, 2014</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of the West of Scotland</investigator_affiliation>
    <investigator_full_name>Ryan Bell</investigator_full_name>
    <investigator_title>Postgraduate Student</investigator_title>
  </responsible_party>
  <keyword>MS</keyword>
  <keyword>Exercise</keyword>
  <keyword>Training</keyword>
  <keyword>Multiple sclerosis</keyword>
  <keyword>Immune response</keyword>
  <keyword>Neurotrophin</keyword>
  <keyword>Cytokine</keyword>
  <keyword>Fatigue</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Multiple Sclerosis</mesh_term>
    <mesh_term>Sclerosis</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02264704
secondary id: 157624
nct id: NCT02264704
lead sponsor: 
collaborator: 
has dmc: Yes
This study aims to determine the effect of exercise intensity within a 15 week programme in
      moderately disabled people with multiple sclerosis (MS). Although earlier research has shown
      that exercise is safe and may improve health related factors such as mobility and fatigue,
      the intensity at which exercise offers the most benefit has not yet been defined.

      Participants will be randomly assigned to one of three groups - high intensity, moderate
      intensity or usual care. Participants in the exercising groups (high and moderate intensity)
      will take part in a supervised 15 week cycling exercise programme based in the Douglas Grant
      Rehabilitation Centre. Those assigned to the usual care (control) group will continue to
      receive their usual medical care and will not participate in the exercise programme. The
      acute immune response to exercise will also be measured.

      Participants from all three groups will be monitored regularly. Clinical outcomes of the
      study include immunological markers, exercise capacity, mobility, fatigue, quality of life
      and cognitive ability. These will be measured by a combination of blood tests, physical
      assessments and questionnaires.

      It is hypothesised that high intensity exercise will cause a favourable, anti-inflammatory
      response which will be associated with greater improvements in physical and psychological
      outcomes than both moderate intensity exercise and usual care.
Recruited patients will initially undergo baseline measurements including BMI. Neurotrophin
      (BDNF and NGF) and cytokine (IFN-Y and IL-4) concentration will be measured from participant
      serum using commercially available ELISA kits (R&D systems).

      Assessments of cognitive ability, mood, fatigue and quality of life will also be performed
      using psychometric tests as described in outcomes. Exercise capacity and mobility will be
      also be measured.

      Participants will also undergo a maximal exercise test, recently validated for use in this
      patient population (Heine et al., 2014). Briefly, rested participants will initially cycle at
      a power of 25W whilst maintaining a minimum cadence of 60rpm as a 5 minute warm-up. This
      leads directly into the testing period, during which the power is increased incrementally
      (15W per minute) until the point of volitional termination or a drop in cadence of 10rpm
      below the minimum (60 rpm). Peak oxygen consumption (VO2 peak) is used as a measure of
      cardiorespiratory fitness.

      Participants will be randomly assigned to one of three groups - high intensity (HI), moderate
      intensity (MI) or usual care (UC). Exercising groups will take part in a 15 week programme.
      All exercise will be performed on a cycle ergometer and will be carried out twice per week
      for 15 weeks (30 sessions) at the Douglas Grant Rehabilitation Centre, Irvine. In all
      sessions HI participants will exercise intermittently (30 seconds on 30 seconds off) at 80%
      of the peak power (based on maximal exercise test) for 15 minutes. MI participants will
      exercise continuously at 40% peak power for 15 minutes. To ensure exercise intensity remains
      consistent throughout the programme the workload will progressively increase over time to
      accommodate any increases in participant fitness levels as measured by %HR. UC participants
      will not participate in the supervised exercise programme but will continue to receive their
      usual care.

      5 weeks after completion of the exercise programme, a follow-up testing session will occur.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Supportive Care
masking: None (Open Label)
measure: Change in serum brain-derived neurotrophic factor (BDNF) level
time frame: Chronic - Baseline, week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise
description: The level of brain-derived neurotrophic factor in participant serum will be determined by analysing blood samples using commercially available ELISA assays.
measure: Change in serum nerve growth factor (NGF) level
time frame: Chronic - Baseline, week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise
description: The level of nerve growth factor in participant serum will be determined by analysing blood samples using commercially available ELISA assays.
measure: Change in serum interleukin-4 (IL-4) level
time frame: Chronic - Baseline (week 0), week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise
description: The level of interleukin-4 in participant serum will be determined by analysing blood samples using commercially available ELISA assays.
measure: Change in serum interferon gamma (IFN-γ) level
time frame: Chronic - Baseline (week 0), week 7, week 15 and follow-up (week 20). Acute - 15 mins, 30 mins and 1 hour post-exercise
description: The level of interferon gamma in participant serum will be determined by analysing blood samples using commercially available ELISA assays.
measure: Change in mobility
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: Participant mobility and balance will be assessed by the timed up and go test (TUG). Individuals safely rise from a standard armchair, walk a distance of 3 metres, turn around and return to a seated position. Usual walking aids may be used however personal assistance is not permitted.
measure: Change in exercise capacity
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: Exercise capacity will be assessed by the six minute walk test (6MWT). Participants walk continuously, turning at a defined distance, until six minutes have passed. Total distance travelled is the measured outcome.
measure: Change in fatigue
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: Self-reported fatigue will be assessed by the 21 item modified fatigue impact scale (MFIS) which has been previously validated for use in this patient population.
measure: Change in health-related quality of life
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: Health-related quality of life will be assessed by the 29 item multiple sclerosis impact scale questionnaire (MSIS-29). MSIS-29 analyses both mental and physical aspects of quality of life.
measure: Change in cognitive ability
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: The brief international cognitive assessment for multiple sclerosis (BICAMS) is a short test battery which assesses information processing speed, visual memory and verbal learning ability.
measure: Number of sessions attended
time frame: 15 weeks
description: Adherence will be measured by number of exercise sessions attended across the 15 week intervention (30 sessions).
measure: Change in cardiorespiratory fitness
time frame: Baseline and week 15
description: Peak oxygen consumption (VO2 peak) will be measured via a maximal exercise test tailored for this patient population (Heine et al., 2014).
measure: Change in mood
time frame: Baseline, weeks 5, 10, 15 and follow up (week 20)
description: Mood will be assessed by the hospital anxiety and depression scale (HADS). HADS is a 14 item questionnaire designed to analyse self-reported indicators of anxiety and depression.
arm group label: High intensity exercise
arm group type: Experimental
description: High intensity exercise Participants will exercise at high intensity (70% VO2 peak) intermittently (30 seconds on, 30 seconds off) for 15 minutes, twice weekly for 15 weeks.
arm group label: Moderate intensity exercise
arm group type: Experimental
description: Participants exercise at moderate intensity (35% VO2 peak) continuously for 15 minutes, twice weekly for 15 weeks.
arm group label: Usual Care
arm group type: No Intervention
description: Participants receive usual medical care.
intervention type: Other
intervention name: High intensity exericse
description: Participants will exercise at high intensity (70% VO2 peak) intermittently (30 seconds on, 30 seconds off) for 15 minutes, twice weekly for 15 weeks. Workload may increase as the study progresses based on heart rate response.
arm group label: High intensity exercise
intervention type: Other
intervention name: Moderate intensity exericse
description: Participants exercise at moderate intensity (35% VO2 peak) continuously for 15 minutes, twice weekly for 15 weeks. Workload may increase as the study progresses based on heart rate response.
arm group label: Moderate intensity exercise
criteria: 
gender: All
minimum age: 18 Years
maximum age: 60 Years
healthy volunteers: No
last name: Ryan Bell, MSc
role: Principal Investigator
affiliation: University of the West of Scotland
last name: Paul Mattison, MD
phone: 441294323031
email: drmattison@aaaht.scot.nhs.uk
last name: Ryan Bell, MSc
phone: 447593052652
email: ryan.bell@uws.ac.uk
facility: 
contact: 
investigator: 
country: United Kingdom
citation: Heine M, Hoogervorst EL, Hacking HG, Verschuren O, Kwakkel G. Validity of maximal exercise testing in people with multiple sclerosis and low to moderate levels of disability. Phys Ther. 2014 Aug;94(8):1168-75. doi: 10.2522/ptj.20130418. Epub 2014 Mar 27.
PMID: 24677255
citation: Collett J, Dawes H, Meaney A, Sackley C, Barker K, Wade D, Izardi H, Bateman J, Duda J, Buckingham E. Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities. Mult Scler. 2011 May;17(5):594-603. doi: 10.1177/1352458510391836. Epub 2011 Jan 19.
PMID: 21247971
responsible party type: Principal Investigator
investigator affiliation: University of the West of Scotland
investigator full name: Ryan Bell
investigator title: Postgraduate Student
mesh term: Multiple Sclerosis
mesh term: Sclerosis