PURPOSE We determined if a high-intensity aerobic exercise program would be safe, improve expected fitness and clinical outcomes, and alter exploratory phosphorous magnetic resonance spectroscopy (31P MRS) outcomes in persons with multiple sclerosis (PwMS). METHODS This open-label prospective pilot study compared 2 cohorts of ambulatory PwMS matched for age, sex and VO2max. Cohorts underwent 8-weeks of high-intensity aerobic exercise (MS-Ex, n=10) or guided stretching (MS-Ctr, n=7). Aerobic exercise consisted of four 30-minute sessions per week while maintaining >70% maximal heart rate. Changes in cardiorespiratory fitness, clinical outcomes, and 31P MRS of tibialis anterior muscle (TA) and brain were compared. Cross-sectional 31P MRS comparisons were made between all MS participants and a separate matched healthy control (HC) population. RESULTS The MS-Ex cohort achieved target increases in VO2max (mean +12.7%, p=
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