{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:14:11Z","timestamp":1784204051093,"version":"3.55.0"},"reference-count":86,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eunice Kennedy Shiver National Institute of Child Health and Development","award":["1F31HD117697-01A1"],"award-info":[{"award-number":["1F31HD117697-01A1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There is increasing interest in exercise training (ET) as a behavior with potential disease-modifying properties in people with multiple sclerosis (MS), as ET has beneficial effects on relapses, lesions, disability, and cognitive-processing speed (CPS) as markers of MS disease progression. There is limited evidence for ET as a behavior that may have disease-modifying properties based on its association with body fluid biomarkers of neuroaxonal injury in MS. This paper involved a narrative review for building a rationale that supports focusing on ET and body fluid biomarkers of neuroaxonal injury in MS, namely, neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP). We searched the PubMed, EBSCOhost (Medline Ultimate), and EMBASE databases from inception through February 2026 for articles aligning with the focus of this narrative review. The articles indicated that sNfL and sGFAP levels were notably higher in MS than in controls; differed across demographic and clinical variables; and responded beneficially with disease-modifying therapy usage in MS. We further located two meta-analyses examining ET effects on sNfL and sGFAP in MS, and there were significant positive effects on sNfL, but not sGFAP. Researchers should adopt discovery models and experimental medicine frameworks for guiding future randomized controlled trials of ET and biomarkers of neuroaxonal injury in MS.<\/jats:p>","DOI":"10.3390\/ijerph23030380","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:42:16Z","timestamp":1773751336000},"page":"380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exercise Training and Biomarkers of Neuroaxonal Injury in Multiple Sclerosis: Narrative Review"],"prefix":"10.3390","volume":"23","author":[{"given":"Trevor B.","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah G.","family":"Dubose","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Motl","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1029","DOI":"10.1212\/WNL.0000000000007035","article-title":"The prevalence of MS in the United States: A population-based estimate using health claims data","volume":"92","author":"Wallin","year":"2019","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1146\/annurev.neuro.30.051606.094313","article-title":"Multiple sclerosis: An immune or neurodegenerative disorder?","volume":"31","author":"Trapp","year":"2008","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00019052-200106000-00003","article-title":"Axonal and neuronal degeneration in multiple sclerosis: Mechanisms and functional consequences","volume":"14","author":"Bjartmar","year":"2001","journal-title":"Curr. Opin. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2174\/187152709789824598","article-title":"Disease-modifying agents in the treatment of multiple sclerosis: A review of long-term outcomes","volume":"8","author":"Katrych","year":"2009","journal-title":"CNS Neurol. Disord. Drug Targets"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.coph.2021.09.006","article-title":"MedXercise: A promising strategy to promote remyelination","volume":"61","author":"Wuerch","year":"2021","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1177\/13524585211061651","article-title":"Physical exercise in multiple sclerosis is not just a symptomatic therapy: It has a disease-modifying effect\u2014Yes","volume":"28","author":"Motl","year":"2022","journal-title":"Mult. Scler."},{"key":"ref_7","first-page":"126","article-title":"Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research","volume":"100","author":"Caspersen","year":"1985","journal-title":"Public Health Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/S1474-4422(17)30281-8","article-title":"Exercise in patients with multiple sclerosis","volume":"16","author":"Motl","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/ene.13929","article-title":"Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: A systematic review of intervention studies","volume":"26","author":"Negaresh","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jneuroim.2014.06.014","article-title":"Effects of exercise in experimental autoimmune encephalomyelitis (an animal model of multiple sclerosis)","volume":"274","author":"Klaren","year":"2014","journal-title":"J. Neuroimmunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105809","DOI":"10.1016\/j.msard.2024.105809","article-title":"The interaction between exercise and neurofilament light chain in multiple sclerosis: A systematic review and meta-analysis","volume":"90","author":"Salamatullah","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e982","DOI":"10.1212\/NXI.0000000000000982","article-title":"Exercise Diminishes Plasma Neurofilament Light Chain and Reroutes the Kynurenine Pathway in Multiple Sclerosis","volume":"8","author":"Joisten","year":"2021","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Paoletti, I., and Coccurello, R. (2024). Irisin: A Multifaceted Hormone Bridging Exercise and Disease Pathophysiology. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252413480"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"122393","DOI":"10.1016\/j.lfs.2023.122393","article-title":"Irisin: An unveiled bridge between physical exercise and a healthy brain","volume":"339","author":"Sadier","year":"2024","journal-title":"Life Sci."},{"key":"ref_15","first-page":"177","article-title":"The time course of irisin release after an acute exercise: Relevant implications for health and future experimental designs","volume":"34","author":"Tommasini","year":"2024","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113028","DOI":"10.1016\/j.exger.2026.113028","article-title":"Irisin and the muscle\u2013brain axis: Mechanisms and translational potential","volume":"214","author":"Arosio","year":"2026","journal-title":"Exp. Gerontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e12352","DOI":"10.1016\/j.heliyon.2022.e12352","article-title":"Irisin: A bridge between exercise and neurological diseases","volume":"8","author":"Zhang","year":"2022","journal-title":"Heliyon"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1178646920938688","DOI":"10.1177\/1178646920938688","article-title":"Physical Exercise as Kynurenine Pathway Modulator in Chronic Diseases: Implications for Immune and Energy Homeostasis","volume":"13","author":"Joisten","year":"2020","journal-title":"Int. J. Tryptophan Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.physbeh.2018.07.015","article-title":"Acute and chronic effects of exercise on the kynurenine pathway in humans\u2014A brief review and future perspectives","volume":"194","author":"Metcalfe","year":"2018","journal-title":"Physiol. Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.mayocp.2013.11.013","article-title":"Exercise Biology and Medicine: Innovative Research to Improve Global Health","volume":"89","author":"Bamman","year":"2014","journal-title":"Mayo Clin. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"105633","DOI":"10.1016\/j.msard.2024.105633","article-title":"Focusing on neural mechanisms of exercise training benefits in multiple sclerosis","volume":"86","author":"Sandroff","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e2503051122","DOI":"10.1073\/pnas.2503051122","article-title":"Comparing conventional and alternative mechanisms of discovering and accessing the scientific literature","volume":"122","author":"Walters","year":"2025","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/s41582-024-00955-x","article-title":"Neurofilaments as biomarkers in neurological disorders\u2014Towards clinical application","volume":"20","author":"Khalil","year":"2024","journal-title":"Nat. Rev. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Thebault, S., Booth, R.A., and Freedman, M.S. (2020). Blood Neurofilament Light Chain: The Neurologist\u2019s Troponin?. Biomedicines, 8.","DOI":"10.3390\/biomedicines8110523"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.pneurobio.2017.08.007","article-title":"Lymphatic drainage system of the brain: A novel target for intervention of neurological diseases","volume":"163\u2013164","author":"Sun","year":"2018","journal-title":"Prog. Neurobiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1515\/cclm-2015-1195","article-title":"Comparison of three analytical platforms for quantification of the neurofilament light chain in blood samples: ELISA, electrochemiluminescence immunoassay and Simoa","volume":"54","author":"Kuhle","year":"2016","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.tins.2015.04.003","article-title":"Glial fibrillary acidic protein: From intermediate filament assembly and gliosis to neurobiomarker","volume":"38","author":"Yang","year":"2015","journal-title":"Trends Neurosci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ceb.2015.02.004","article-title":"Glial fibrillary acidic protein (GFAP) and the astrocyte intermediate filament system in diseases of the central nervous system","volume":"32","author":"Hol","year":"2015","journal-title":"Curr. Opin. Cell Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.tins.2009.08.002","article-title":"Molecular dissection of reactive astrogliosis and glial scar formation","volume":"32","author":"Sofroniew","year":"2009","journal-title":"Trends Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1136\/jnnp-2018-319190","article-title":"Cerebrospinal fluid neurofilament light chain in multiple sclerosis and its subtypes: A meta-analysis of case\u2013control studies","volume":"90","author":"Martin","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"29135","DOI":"10.1038\/s41598-024-75290-8","article-title":"The combination of CSF neurofilament light chain and glial fibrillary acidic protein improves the prediction of long-term confirmed disability worsening in multiple sclerosis","volume":"14","author":"Thebault","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105644","DOI":"10.1016\/j.msard.2024.105644","article-title":"Evaluating the utility of serum NfL, GFAP, UCHL1 and tTAU as estimates of CSF levels and diagnostic instrument in neuroinflammation and multiple sclerosis","volume":"87","author":"Koerbel","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e000143","DOI":"10.1136\/bmjno-2021-000143","article-title":"Correlation between CSF and blood neurofilament light chain protein: A systematic review and meta-analysis","volume":"3","author":"Alagaratnam","year":"2021","journal-title":"BMJ Neurol. Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"19982","DOI":"10.1038\/s41598-020-77098-8","article-title":"Serum neurofilament light chain withstands delayed freezing and repeated thawing","volume":"10","author":"Altmann","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ning, L., and Wang, B. (2022). Neurofilament light chain in blood as a diagnostic and predictive biomarker for multiple sclerosis: A systematic review and meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0274565"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Shaygannejad, A., Rafiei, N., Vaheb, S., Yazdan Panah, M., Shaygannejad, V., and Mirmosayyeb, O. (2024). The Role of Glial Fibrillary Acidic Protein as a Biomarker in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis. Medicina, 60.","DOI":"10.3390\/medicina60071050"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.1212\/WNL.0000000000004683","article-title":"Monitoring disease activity in multiple sclerosis using serum neurofilament light protein","volume":"89","author":"Novakova","year":"2017","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1038\/s41582-021-00616-3","article-title":"Blood GFAP as an emerging biomarker in brain and spinal cord disorders","volume":"18","author":"Abdelhak","year":"2022","journal-title":"Nat. Rev. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"14798","DOI":"10.1038\/s41598-018-33158-8","article-title":"Serum GFAP as a biomarker for disease severity in multiple sclerosis","volume":"8","author":"Abdelhak","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1001\/jamaneurol.2022.5250","article-title":"Serum Glial Fibrillary Acidic Protein Compared With Neurofilament Light Chain as a Biomarker for Disease Progression in Multiple Sclerosis","volume":"80","author":"Meier","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Thebault, S., Booth, R.A., Rush, C.A., MacLean, H., and Freedman, M.S. (2021). Serum Neurofilament Light Chain Measurement in MS: Hurdles to Clinical Translation. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.654942"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S1474-4422(22)00009-6","article-title":"NfL Reference Database in the Swiss Multiple Sclerosis Cohort Study Group. Serum neurofilament light chain for individual prognostication of disease activity in people with multiple sclerosis: A retrospective modelling and validation study","volume":"21","author":"Benkert","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e200279","DOI":"10.1212\/NXI.0000000000200279","article-title":"Neurofilament Light Chain Serum Levels Mirror Age and Disability in Secondary Progressive Multiple Sclerosis: A Cross-Sectional Study","volume":"11","author":"Husseini","year":"2024","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1007\/s00415-010-5863-2","article-title":"Glial fibrillary acidic protein: A potential biomarker for progression in multiple sclerosis","volume":"258","author":"Axelsson","year":"2011","journal-title":"J. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"104970","DOI":"10.1016\/j.ebiom.2024.104970","article-title":"Guidance for use of neurofilament light chain as a cerebrospinal fluid and blood biomarker in multiple sclerosis management","volume":"101","author":"Freedman","year":"2024","journal-title":"eBioMedicine"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Coppens, S., Lehmann, S., Hopley, C., and Hirtz, C. (2023). Neurofilament-Light, a Promising Biomarker: Analytical, Metrological and Clinical Challenges. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241411624"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1002\/acn3.51524","article-title":"Development of an age-adjusted model for blood neurofilament light chain","volume":"9","author":"Harp","year":"2022","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/acn3.50972","article-title":"Confounding effect of blood volume and body mass index on blood neurofilament light chain levels","volume":"7","author":"Manouchehrinia","year":"2020","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1111\/ene.15742","article-title":"High serum neurofilament light chain levels correlate with brain atrophy and physical disability in multiple sclerosis","volume":"30","author":"Buchmann","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"111019","DOI":"10.1016\/j.ejrad.2023.111019","article-title":"Serum neurofilament light chain is more strongly associated with T2 lesion volume than with number of T2 lesions in patients with multiple sclerosis","volume":"166","author":"Wenger","year":"2023","journal-title":"Eur. J. Radiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e1007","DOI":"10.1212\/WNL.0000000000007032","article-title":"Blood neurofilament light chain as a biomarker of MS disease activity and treatment response","volume":"92","author":"Kuhle","year":"2019","journal-title":"Neurology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"10923","DOI":"10.1038\/s41598-020-67934-2","article-title":"Serum GFAP in multiple sclerosis: Correlation with disease type and MRI markers of disease severity","volume":"10","author":"Ayrignac","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.1093\/brain\/awy154","article-title":"Serum neurofilament as a predictor of disease worsening and brain and spinal cord atrophy in multiple sclerosis","volume":"141","author":"Barro","year":"2018","journal-title":"Brain"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"104695","DOI":"10.1016\/j.msard.2023.104695","article-title":"Early neurofilament light and glial fibrillary acidic protein levels improve predictive models of multiple sclerosis outcomes","volume":"74","author":"Bose","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e200427","DOI":"10.1212\/NXI.0000000000200427","article-title":"Exploring the Clinical Utility of Neurofilament Light Chain Assays in Multiple Sclerosis Management","volume":"12","author":"Nicholas","year":"2025","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/ana.24954","article-title":"Serum Neurofilament light: A biomarker of neuronal damage in multiple sclerosis","volume":"81","author":"Disanto","year":"2017","journal-title":"Ann. Neurol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1002\/acn3.52187","article-title":"Serum glial fibrillary acidic protein predicts disease progression in multiple sclerosis","volume":"11","author":"Madill","year":"2024","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e737","DOI":"10.1212\/NXI.0000000000000737","article-title":"Serum neurofilament light chain and optical coherence tomography measures in MS: A longitudinal study","volume":"7","author":"Tavazzi","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1177\/13524585211028831","article-title":"Optical coherence tomography angiography indicates subclinical retinal disease in neuromyelitis optica spectrum disorders","volume":"28","author":"Aly","year":"2022","journal-title":"Mult. Scler."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"105478","DOI":"10.1016\/j.msard.2024.105478","article-title":"Combination of serum markers with optical coherence tomography angiography for evaluating neuromyelitis optica spectrum disorders and multiple sclerosis","volume":"85","author":"Liu","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1177\/13524585251360972","article-title":"Serum neurofilament light chain and glial fibrillary acidic protein levels are associated with inner retinal layer thinning in multiple sclerosis","volume":"31","author":"Krajnc","year":"2025","journal-title":"Mult. Scler."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"105035","DOI":"10.1016\/j.neubiorev.2023.105035","article-title":"Molecular biomarkers and cognitive impairment in multiple sclerosis: State of the field, limitations, and future direction\u2014A systematic review and meta-analysis","volume":"146","author":"Rademacher","year":"2023","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1177\/13524585221114441","article-title":"Serum neurofilament light and MRI predictors of cognitive decline in patients with secondary progressive multiple sclerosis: Analysis from the MS-STAT randomised controlled trial","volume":"28","author":"Williams","year":"2022","journal-title":"Mult. Scler."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1177\/13524585221137697","article-title":"Serum NfL but not GFAP predicts cognitive decline in active progressive multiple sclerosis patients","volume":"29","author":"Barro","year":"2023","journal-title":"Mult. Scler."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1001\/jama.2020.26858","article-title":"Diagnosis and Treatment of Multiple Sclerosis: A Review","volume":"325","author":"McGinley","year":"2021","journal-title":"JAMA"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Sainz-Amo, R., Rodero-Romero, A., Monreal, E., Chico-Garc\u00eda, J.L., Rodr\u00edguez-Jorge, F., Fern\u00e1ndez-Velasco, J.I., Villarrubia, N., Veiga-Gonz\u00e1lez, J.L., de la Maza, S.S., and Masjuan, J. (2024). Effect of Natalizumab on sNfL and sGFAP Levels in Multiple Sclerosis Patients. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252313153"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Sainz-Amo, R., Rodero Romero, A., Monreal, E., Chico Garc\u00eda, J.L., Fern\u00e1ndez Velasco, J.I., Villarrubia, N., Veiga Gonz\u00e1lez, J.L., Sainz de la Maza, S., Rodr\u00edguez Jorge, F., and Masjuan, J. (2024). Effect of alemtuzumab over sNfL and sGFAP levels in multiple sclerosis. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1454474"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/PHM.0000000000001174","article-title":"Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis","volume":"98","author":"Kim","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"104489","DOI":"10.1016\/j.msard.2022.104489","article-title":"Brain-derived neurotrophic factor, neurofilament light and glial fibrillary acidic protein do not change in response to aerobic training in people with MS-related fatigue\u2014A secondary analysis of a randomized controlled trial","volume":"70","author":"Gravesteijn","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"103219","DOI":"10.1016\/j.msard.2021.103219","article-title":"The effect of aerobic exercise on Neurofilament light chain and glial Fibrillary acidic protein level in patients with relapsing remitting type multiple sclerosis","volume":"55","author":"Ercan","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1007\/s10072-023-06896-5","article-title":"Effect of resistance exercise training on plasma neurofilaments in multiple sclerosis: A proof of concept for future designs","volume":"44","author":"Mulero","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"55","DOI":"10.61186\/mlj.17.3.55","article-title":"Decreased Serum Neurofilament Light Chain and Fatigue Severity in Patients with Multiple Sclerosis after Home-Based and Outdoor Pilates Training","volume":"17","author":"Askari","year":"2023","journal-title":"Med. Lab. J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"33","DOI":"10.52547\/mlj.15.4.33","article-title":"Effect of eight weeks of resistance training on serum levels of neurofilament light chain and tau protein in women with multiple sclerosis","volume":"15","author":"Amiri","year":"2021","journal-title":"Med. Lab. J."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Maroto-Izquierdo, S., Mulero, P., Men\u00e9ndez, H., Pinto-Fraga, J., Lista, S., Santos-Lozano, A., and T\u00e9llez, N. (2024). Pumping up the Fight against Multiple Sclerosis: The Effects of High-Intensity Resistance Training on Functional Capacity, Muscle Mass, and Axonal Damage. Healthcare, 12.","DOI":"10.3390\/healthcare12080837"},{"key":"ref_76","first-page":"e203","article-title":"Efficacy of High-Intensity Aerobic Exercise on Brain MRI Measures in Multiple Sclerosis","volume":"96","author":"Nygaard","year":"2021","journal-title":"Neurology"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"106411","DOI":"10.1016\/j.msard.2025.106411","article-title":"Effects of 16-week progressive resistance training on neurodegeneration in people with progressive multiple sclerosis: An extended baseline within-person trial","volume":"98","author":"Gravesteijn","year":"2025","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Bl\u00e1zquez-Fern\u00e1ndez, A., Navarro-L\u00f3pez, V., Marcos-Ant\u00f3n, S., and Cano-de-la-Cuerda, R. (2025). Effects of Physical Exercise on Neurofilament Light Chain and Glial Fibrillary Acidic Protein Level in Patients with Multiple Sclerosis: A Systematic Review and Bayesian Network Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030839"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1038\/s41467-020-14612-6","article-title":"Serum neurofilament light levels in normal aging and their association with morphologic brain changes","volume":"11","author":"Khalil","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"106166","DOI":"10.1016\/j.msard.2024.106166","article-title":"Neurofilament light in serum: Reference values and effect of risk factors for multiple sclerosis","volume":"92","author":"Olsson","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Nociti, V., and Romozzi, M. (2023). The Role of BDNF in Multiple Sclerosis Neuroinflammation. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24098447"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s10571-025-01596-4","article-title":"Kynurenine Pathway Modulation by Exercise in Multiple Sclerosis: Implications for Neuroprotection and Inflammation","volume":"45","author":"Hoseini","year":"2025","journal-title":"Cell Mol. Neurobiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1136\/bmj.1.4667.1383","article-title":"Stress and the general adaptation syndrome","volume":"1","author":"Selye","year":"1950","journal-title":"Br. Med. J."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.3233\/JAD-190615","article-title":"Neurofilament Light Chain in Cerebrospinal Fluid and Blood as a Biomarker for Neurodegenerative Diseases: A Systematic Review and Meta-Analysis","volume":"72","author":"Wang","year":"2019","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e22363","DOI":"10.1097\/MD.0000000000022363","article-title":"Neurofilament light chain level in traumatic brain injury: A system review and meta-analysis","volume":"99","author":"Gao","year":"2020","journal-title":"Medicine"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/380\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:46:24Z","timestamp":1773751584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":86,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijerph23030380"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23030380","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]}}}