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This study compared the effectiveness of three different therapeutic approaches (computerized cognitive training, BrainStim (BS); treadmill walking (TW); combined training (BS\u2009+\u2009TW)) on subjective and objective cognitive functioning in pwMS and CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>61 pwMS were recruited from the Department of Neurology outpatient clinic of the University Hospital D\u00fcsseldorf and neurologists in private practice. After screening for eligibility, pwMS were randomized into three treatment arms: 1) BS, 2) TW, 3) BS\u2009+\u2009TW. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>46 pwMS entered the final analysis (n\u2009=\u200915 excluded). Change scores revealed significant effects on PDQ20 total score for all three treatment groups. These effects were stable over 6\u00a0months in the BS\u2009+\u2009TW group only. Moreover, change scores revealed significant effects on the SDMT for the TW group and BS\u2009+\u2009TW group, lasting 6\u00a0months. Between-group differences were not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Comparing three different behavioral treatments, we found that exercise training (TW), computer-based cognitive training (BS), and their combination (BS\u2009+\u2009TW) 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\u2009+\u2009TW 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13535-w","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T10:46:20Z","timestamp":1768560380000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cognitive training, exercise training or combined training? 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T Monschein has participated in meetings sponsored by or received travel funding from Biogen, Celgene, Merck, Novartis, Roche, Sanofi-Genzyme and Teva. M. Filser has no relevant financial or non-financial interests to disclose. S.J B\u00e4tge has no relevant financial or non-financial interests to disclose. A. Renner has no relevant financial or non-financial interests to disclose. M.S Roth has no relevant financial or non-financial interests to disclose. O. Aktas has received personal fees from Alexion, Amgen, Bayer Healthcare, Biogen, Celgene, Horizion Therapeutics, Merck Serono, Novartis, Roche, and Zambon, outside of the submitted work. P. Albrecht reports research grants, personal fees and travel support from German Research Foundation (DFG), EFRE-NRW, and industry: Allergan\/Abbvie, Celgene, Genyzme\/Sanofi, Janssen Cilag, Lilly, Bristol Myers Squibb, Ipsen, Merck, Merz, Novartis, Roche, Sanofi and Teva. H.P Hartung received outside this work fees for serving on steering and data monitoring committees from Aurinia Pharma, BayerHealthcare, Biogen, BMS Celgene, MedDays, Merck Neuraxpharm, Novartis, Roche, TG Therapeutics. I.K Penner reports having received honoraria for consulting, and for serving on speakers' bureaus and advisory boards for Amgen, Biogen, BMS, Celgene, Genzyme, Janssen, Merck, Novartis, Roche, and Teva. She received research support from the German MS Society, Celgene, Novartis, Roche, and Teva.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"82"}}