Physical Activity, but Not Body Mass Index Is Associated With Blood Pressure in Young Children.

PURPOSE: This study examined associations between physical activity (PA) and obesity with blood pressure (BP) in young children. Furthermore, a possible moderating effect of obesity status was examined. METHODS: A cross-sectional study was completed with 121 children (3.96 [1.14] y). BP, weight, and height were measured, and body mass index (BMI) was calculated. Z scores were calculated for BMI, systolic, and diastolic values. Accelerometry measured time spent in PA intensities. Correlations and regressions examined relationships among PA intensities, BMI z scores, and BP z scores and to determine if obesity status moderated these relationships. RESULTS: On average, the children spent 52 minutes per day in moderate-to-vigorous physical activity, 31% were considered overweight/obese, and 15% were considered hypertensive. After adjusting for confounders, participation in moderate, vigorous, and moderate-to-vigorous physical activity was related with lower systolic and diastolic BP z scores (P < .05). BMI z score was not related to BP values. Obesity status did not moderate the relationships between time spent in PA and BP. CONCLUSIONS: Participation in PA, but not obesity, was related to lower BP levels in young children. The impact PA has on BP is the same regardless of obesity status. Thus, young children should be encouraged to be active in different intensities to benefit the cardiovascular system.

Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults.

CONTEXT: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18-25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. DESIGN: Retrospective, cross-sectional study design. METHODS: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). RESULTS: When controlling for age, there were no statistically significant differences in physical literacy (F2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). CONCLUSIONS: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

Feasibility of the Mothers and Daughters Moving Together Physical Activity Intervention.

PURPOSE: Preschool-aged children, especially girls, have low levels of physical activity that may be influenced through parent role modeling. Evidence for mother-daughter interventions that include preschool-aged children is sparse. The primary purpose of this study was to examine the feasibility of recruitment procedures, protocol compliance, and participant retention for the Mothers and Daughters Moving Together intervention. The secondary aim was to provide initial estimates of the intervention effect on mother-daughter and family physical activity co-participation, moderate to vigorous physical activity, and maternal physical activity enjoyment and support. METHOD: This nonrandomized feasibility study included mother-daughter (2-5 y) dyads who self-selected into the intervention (n = 21 dyads) or comparison (n = 10 dyads) group. RESULTS: The recruitment rate was 41.9% (31 enrolled/74 interested). Intervention group mother-daughter dyads attended 57% of intervention sessions. Among the whole sample, 70% to 80% of participants (mothers and daughters) had at least 4 valid days of accelerometer data at preintervention and postintervention. The retention rate was 90% (28/31 dyads completed the study). Initial estimates of intervention effect indicated small, positive changes for mother-daughter physical activity co-participation, and maternal physical activity support and enjoyment. CONCLUSIONS: This study provides valuable information that should be confirmed using an adequately powered and randomized study design.

Promoting Strength Training Among Baby Boomers: Message Framing Effects on Motivation and Behavior.

BACKGROUND: Regular participation in strength training significantly enhances older adults' physical and functional health, yet only 14% of adults over age 50 report engaging in strength training at least twice per week. Exercise messages about why and how older adults should engage in strength training could influence their perceptions of and participation in the behavior. This study was designed to promote strength training among adults aged 50-70 and to determine whether the message frame accompanying a brief workout would have an impact on participants' motivation, self-efficacy, and/or physical activity behavior. METHODS: Participants (N = 308) were randomly assigned to one of four message conditions: Easy Intrinsic, Hard Intrinsic, Easy Extrinsic, or Hard Extrinsic. Immediately after completing baseline measures of motivation and physical activity, participants received the recommended strength training workout and corresponding motivational message. They completed follow-up measures of motivation and physical activity 2 weeks later. RESULTS: Controlled regulation was higher at follow-up among participants exposed to an extrinsic message relative to an intrinsic message (F(3,208) = 3.08, p = .03). Strength training (Z = - 5.95, p < .001) and moderate physical activity (Z = - 3.23, p = .001) increased among participants not engaging in regular strength training at baseline. CONCLUSIONS: These results suggest message framing may have a short-term impact on Baby Boomers' physical activity motivation, such that emphasizing extrinsic goals (i.e., weight loss and appearance) may contribute to controlled motivation. However, repeated measurements are needed to determine the longer-term maintenance and influence of these effects.

Physical Activity Coparticipation Among Parent-Young-Child Dyads.

PURPOSE: This study examined patterns of physical activity coparticipation among parent-child (2-5 y) dyads. METHOD: The dyads (N = 47; 51% mother-child) each wore a Bluetooth-enabled accelerometer for 8 days to measure physical activity and physical activity coparticipation. The parents completed demographic and self-reported family physical activity questionnaires. RESULTS: The parent-child dyads spent 145 (79) minutes per day in-proximity according to the Bluetooth-enabled accelerometers. The majority (90%) of parent-child in-proximity time was spent with the parent and child engaged in some combination of sedentary or light activities. Child light, moderate, and vigorous physical activity was not associated with parent light (P = .12) or moderate to vigorous physical activity (P = .45), but was positively associated with parent-child in-proximity active minutes (light, moderate, and vigorous) (P < .01). Children in the highest tertile of parent-child physical activity coparticipation engaged in more daily moderate to vigorous physical activity compared with children in the lowest tertile (72.7 vs 50.3 min). There was a positive, statistically significant association between self-reported and objective measures of physical activity coparticipation (r = .47, P = .001). CONCLUSION: Children who engaged in the most physical activity with their parent had the highest moderate to vigorous physical activity. Future studies should continue to provide contextual information about how parents and children spend their time together to improve family-based physical activity interventions.

Collective Efficacy, Physical Activity, and Health Outcomes Among Mothers.

Motherhood is associated with low rates of physical activity that increase disease risk. Most theory-based approaches to increasing physical activity focus on personal rather than social factors. The purpose of this study was to examine the associations among perceptions of community collective efficacy and objectively measured physical activity, self-efficacy, social support, and health. Mothers completed questionnaires and wore a pedometer for 7 days. There was a significant, positive association between physical activity and collective efficacy-social cohesion subscale. In the regression analysis, only age and social support were independent predictors of physical activity. Future studies should examine relationships among collective efficacy and social support and physical activity.

Overcoming barriers to exercise among parents: a social cognitive theory perspective.

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.

Internet-delivered lifestyle physical activity intervention improves body composition in multiple sclerosis: preliminary evidence from a randomized controlled trial.

OBJECTIVE: To examine the efficacy of a physical activity behavioral intervention for improving outcomes of body composition in persons with multiple sclerosis (MS). DESIGN: Secondary analysis of data from a randomized controlled trial. SETTING: University research laboratory. PARTICIPANTS: Ambulatory persons with MS (N=82). INTERVENTION: A 6-month, internet-delivered physical activity behavioral intervention designed to increase lifestyle physical activity, primarily walking. The behavioral intervention was based on principles of social cognitive theory. MAIN OUTCOME MEASURES: Whole-body bone mineral content (BMC), bone mineral density (BMD), and soft tissue composition, using dual-energy x-ray absorptiometry. RESULTS: There were no significant differences between conditions posttrial on body composition outcomes using the adjusted critical value (P<.008). There was a significant effect of the intervention on whole-body BMC (P=.04, ω(2)<.001) and BMD (P=.01, ω(2)=.003) using the unadjusted critical value (P<.05). The effect of the intervention on percent body fat (P=.09, ω(2)=.001) and whole-body fat mass (P=.05, ω(2)=.003) approached significance using unadjusted criteria. There was not a significant effect on whole-body lean soft tissue (P=.28, ω(2)<.001) or body mass index (P=.86, ω(2)<.001). CONCLUSIONS: Our results provide preliminary evidence that an internet-delivered lifestyle physical activity intervention might improve bone health and body composition in MS. Such findings are important considering that physical activity is a modifiable behavior with the potential to confer long-term benefits for the prevention and management of fracture risk and comorbidities among those with MS.

Validity of minimal clinically important difference values for the multiple sclerosis walking scale-12?

BACKGROUND AND OBJECTIVE: Minimal clinically important difference (MCID) values of 4 and 6 points have been proposed for interpreting meaningful change in Multiple Sclerosis Walking Scale-12 (MSWS-12) scores. This study examined the validity of those MCID values based on capturing corresponding changes in other walking outcomes in persons with multiple sclerosis (MS). METHODS: On 2 occasions separated by 6 months, 82 persons with MS completed the MSWS-12, timed 25-ft walk (T25FW), 6-min walk (6MW), and gait analysis, and then wore an accelerometer over a 7-day period. We generated change scores for the MSWS-12 and formed groups of stable, worsened, and improved perceived walking based on both 4- and 6-point changes. The groups were compared for corresponding changes in other walking measures over time using mixed-model ANOVAs. RESULTS: The mixed-model ANOVAs did not identify statistically significant group-by-time interactions on the T25FW (p = 0.98 and p = 0.67), the 6MW (p = 0.89 and p = 0.72), gait (p = 0.54 and p = 0.21), or accelerometry (p = 0.40 and p = 0.68) for MCID values of 4- or 6-point changes in MSWS-12 scores. CONCLUSIONS: We did not confirm that MCID values of 4 and 6 points for the MSWS-12 correspond with changes in performance, gait, and free-living assessments of walking in MS.

Physical inactivity among American single-female caregivers: An analysis of the 2020 behavioral risk factor surveillance system.

BACKGROUND: Many adults in the United States do not reach the recommended levels of activity needed for health benefits. Single-female caregivers present a unique and vulnerable population that is often less active than their partnered peers or single-male caregivers. OBJECTIVE: The primary objective of this cross-sectional investigation was to identify the prevalence of physical inactivity in single-family, female-led households and determine differences in personal factors and social characteristics between physically active and not physically active single-female caregivers. A secondary objective was to examine associations among the social characteristic variables and physical inactivity in single-female caregiver households. Finally, we examined the odds single-female caregivers who are physically inactive reported chronic health conditions. DESIGN: Cross-sectional survey design. METHODS: We used the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data. Participants were selected based on pre-determined criteria for inclusion. RESULTS: There was a 39.3% prevalence of physical inactivity among single-female caregivers in the sample. Single-female caregivers who were physically inactive had greater odds of having a history of multiple chronic health conditions. CONCLUSION: Healthcare providers and other community stakeholders should explore existing physical activity promotion strategies to increase physical activity in single-female caregivers. Future research should employ more rigorous, prospective research designs to determine if these chronic conditions and various social characteristics are caused by physical inactivity.

The reliability, precision and clinically meaningful change of walking assessments in multiple sclerosis.

BACKGROUND: Assessing walking impairment in those with multiple sclerosis (MS) is common, however little is known about the reliability, precision and clinically important change of walking outcomes. OBJECTIVE: The purpose of this study was to determine the reliability, precision and clinically important change of the Timed 25-Foot Walk (T25FW), Six-Minute Walk (6MW), Multiple Sclerosis Walking Scale-12 (MSWS-12) and accelerometry. METHODS: Data were collected from 82 persons with MS at two time points, six months apart. Analyses were undertaken for the whole sample and stratified based on disability level and usage of walking aids. Intraclass correlation coefficient (ICC) analyses established reliability: standard error of measurement (SEM) and coefficient of variation (CV) determined precision; and minimal detectable change (MDC) defined clinically important change. RESULTS: All outcome measures were reliable with precision and MDC varying between measures in the whole sample: T25FW: ICC=0.991; SEM=1 s; CV=6.2%; MDC=2.7 s (36%), 6MW: ICC=0.959; SEM=32 m; CV=6.2%; MDC=88 m (20%), MSWS-12: ICC=0.927; SEM=8; CV=27%; MDC=22 (53%), accelerometry counts/day: ICC=0.883; SEM=28450; CV=17%; MDC=78860 (52%), accelerometry steps/day: ICC=0.907; SEM=726; CV=16%; MDC=2011 (45%). Variation in these estimates was seen based on disability level and walking aid. CONCLUSION: The reliability of these outcomes is good and falls within acceptable ranges. Precision and clinically important change estimates provide guidelines for interpreting these outcomes in clinical and research settings.

Steps per day among persons with multiple sclerosis: variation by demographic, clinical, and device characteristics.

OBJECTIVES: To identify steps per day in a large sample of persons with multiple sclerosis (MS) and to describe variation by demographic and clinical characteristics and device type. DESIGN: Cross-sectional design. SETTING: General community. PARTICIPANTS: Convenience sample of persons with multiple sclerosis (N=645) recruited from the general community who were ambulatory and relapse free for 30 days. Mean age ± SD of the participants was 46.3 ± 10.6 years old. Participants were mostly women (85%), white (93%), and employed (64%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Step counts measured by a motion sensor during a 7-day period. RESULTS: The average value for the entire sample was 5,903 ± 3,185 steps per day. This value varied by demographic and clinical characteristics, but not device type, and indicated that men, participants who were unemployed, had a high school education or less, progressive MS, a longer disease duration, and higher disability were less physically active based on the metric of steps per day. CONCLUSIONS: This study provides an expected value for average steps per day among persons with MS. Such an expected value for this population is an important first step to help researchers and clinicians interested in improving the overall health of persons with MS through physical activity promotion.

Objectively quantified physical activity in persons with multiple sclerosis.

OBJECTIVES: To investigate levels of moderate-to-vigorous physical activity (MVPA) in a large sample of persons with multiple sclerosis (MS) and controls using accelerometry as a measure of physical activity, and to compare the rates of meeting public health guidelines for MVPA (ie, 30min/d) between persons with MS and controls. DESIGN: Secondary analysis of a combined data set of persons with MS and healthy controls from 13 previous investigations of physical activity over a 8-year period (2005-2013). SETTING: University. PARTICIPANTS: Participants with MS (n=800) were recruited primarily within Illinois through multiple sources, including print and e-mail flyers and an online advertisement on the National Multiple Sclerosis Society website. Healthy controls (n=137) were recruited via public e-mail postings delivered across the university community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Levels of MVPA and meeting public health guidelines for MVPA between persons with MS and controls. RESULTS: After controlling for covariates (ie, age, sex, education, race, income), there was a moderate (d=.68) and statistically significant (F=47.2, P<.001) difference of 13.1 minutes of MVPA per day (95% confidence interval, 9.4-16.8) between MS and controls. There was a difference in the rates of meeting public health guidelines for MVPA (χ(2)=50.7, P<.001) between MS patients (20%) and controls (47%). Among those with MS, minutes of MVPA significantly differed as a function of education, employment status, clinical course, disease duration, and disability status. CONCLUSIONS: We provide data using an objective physical activity measure and a large sample to indicate that only a small proportion of persons with MS are achieving adequate amounts of daily MVPA.

Further validation of multiple sclerosis walking scale-12 scores based on spatiotemporal gait parameters.

OBJECTIVE: To examine the association between Multiple Sclerosis Walking Scale-12 (MSWS-12) scores and spatiotemporal parameters of gait as indicators of gait quality among ambulatory persons with multiple sclerosis (MS). DESIGN: Cross-sectional study. SETTING: University research laboratory. PARTICIPANTS: Community-residing persons with MS (N=268). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Main outcome measures included the MSWS-12 and spatial and temporal gait parameters (walking speed, cadence, step length, step time, base of support [ie, the distance between 1 footfall and the line of progression of the opposing foot], and percentage of gait cycle spent in double support). Secondary outcomes included the timed 25-foot walk (T25FW), 6-minute walk (6MW), and Patient-Determined Disease Steps scale. RESULTS: MSWS-12 scores were significantly correlated with walking speed (r=-.59), cadence (r=-.50), step length (r=-.53), step time (r=.46), base of support (r=.29), and percentage of the gait cycle spent in double support (r=.54). MSWS-12 scores further were significantly correlated with T25FW (r=.57) and 6MW (r=-.75) scores. CONCLUSIONS: Such findings suggest that the MSWS-12 captures aspects of walking quality, assessed as spatiotemporal parameters of gait, in addition to walking speed and endurance in persons with MS.

Marital status and motherhood: implications for physical activity.

Single motherhood has been associated with negative health consequences, such as increased risk for cardiovascular disease and depression, which might be accompanied by reduced levels of physical activity. This pilot study aimed to compare the magnitude of differences in physical activity between unmarried mothers, married mothers, and non-mothers. Participants (N = 66) in three equal-sized groups (n = 22) completed a battery of physical activity questions and wore an accelerometer for one week in March to May of 2012. Analyses of covariance controlling for group differences in demographic characteristics and Bonferroni post-hoc comparisons were conducted to detect differences in physical activity between groups. Compared to unmarried mothers, married mothers and non-mothers had significantly greater leisure time activity as measured by the Godin leisure-time exercise questionnaire (F(2,61) = 6.11, p = .004), overall activity in the previous year measured by the modifiable activity questionnaire scores (F(2, 61) = 8.65, p = .001), and minutes spent in moderate-to-vigorous physical activity from the accelerometer (F(2,58) = 4.39, p = .02). No statistically significant differences were observed among groups for international physical activity questionnaire scores or accelerometer activity and step counts. Overall, unmarried mothers were less physically active when compared to married mothers and non-mothers. Future studies should explore the correlates and health outcomes associated with physical activity among unmarried mothers.

Self-Reported Physical Activity and Perception of Athleticism in American Equestrian Athletes.

BACKGROUND: Over 75% of American adults are not meeting aerobic and muscular physical activity recommendations, with the majority being females. Equestrian activities are a potential avenue to increase physical activity, especially in females who account for approximately 90% of sport participants. This study describes perceptions of equestrian activities and establishes the patterns of self-reported equestrian, barn work, and nonequestrian physical activity engagement to understand participation in activities that may sustain physical activity across the lifespan. METHODS: American equestrians (n = 2551) completed an anonymous online survey with questions about perceptions and benefits of equestrian activities, demographics, and engagement in equestrian activities, barn work, and nonequestrian activities. RESULTS: There were 2039 completed responses, (95.6% female), with representation from all regions of the United States. Professionals (20.6%), amateurs (39.1%), and recreational (40.3%) comprised participation status. Significantly fewer recreational participants perceived equestrian as physical activity and as a sport than amateurs (P < .05) and professionals (P < .05). Engagement in equestrian and barn work physical activity was significantly higher in professionals (P < .0001), followed by amateurs (P < .0001), with the lowest in recreational equestrians (P = .001). Professional and amateur equestrians engaged in significantly more nonequestrian physical activity than recreational participants (P < .05). CONCLUSIONS: Equestrian physical activity engagement is dependent on the status of participation. Equestrian, barn work, and nonequestrian physical activity do meet physical activity aerobic and muscular recommendations and should be encouraged as a physical activity for females across the lifespan.

Youth sport participation, injury history, and current physical activity among young adults.

Objective: To examine the interaction between high school (HS) sports participation and injury history with current moderate-to-vigorous physical activity (MVPA) among young adults. Participants: Participants (N = 236) were 18-25 years old, not currently injured, and reported no physical activity limitations. Methods: Participants completed online demographic, injury history, and physical activity surveys. A two-way analysis of covariance was used to test the interaction between HS athlete status and previous injury severity on current self-reported MVPA. Results: Participants were 22.2 ± 2.1 years, primarily White (81.8%) or Asian (6.4%), and female (77.5%). After including body mass index and race as covariates, there was a statistically significant interaction between HS athlete status and previous injury history such that current MVPA was higher among former HS athletes compared to HS recreational/nonathletes when individuals reported no injuries or mild injury severity. MVPA was similar across athlete status groups when participants reported high levels of injury severity. Conclusions: Future studies should examine whether young adults who have experienced multiple and/or severe injuries as competitive HS athletes have unique physical activity barriers.

Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study.

BACKGROUND AND PURPOSE: The disabling consequences of multiple sclerosis (MS) emphasize the significance of developing physiologically relevant strategies for rehabilitation of function. This pilot study examined changes in walking function associated with combined exercise training consisting of aerobic, resistance, and balance activities in persons with MS who had recent onset of gait impairment. METHODS: Thirteen participants with significant disability due to MS (Expanded Disability Status Scale range = 4.0-6.0) completed the Multiple Sclerosis Walking Scale-12, 2 trials of the Timed 25-Foot Walk, the Timed Up & Go, and functional ambulation profile score derived from 4 walking trials on an instrumented walkway (GaitRite) before and after an 8-week training period. The training program was designed by a physical therapist and was performed 3 days per week under the supervision of an exercise specialist. In week 1, the session was 15 minutes in duration (ie, 5 minutes of each mode of exercise), session durations were increased by approximately 5 minutes per week up to a maximum of 60 minutes in week 8 (ie, 20 minutes of each mode of exercise). RESULTS: There were significant improvements in Multiple Sclerosis Walking Scale-12 scores (Mpre = 56.0, Mpost = 46.7, P = 0.03, d = 0.56), Timed 25-Foot Walk (Mpre = 11.7, Mpost = 9.8, P = 0.004, d = 0.90) and Timed Up & Go (Mpre = 16.0, Mpost = 13.0, P = 0.01, d = 0.72) performance, and functional ambulation profile score (Mpre = 72.8, Mpost = 77.6, P = 0.02, d = 0.65). DISCUSSION AND CONCLUSION: These results suggest that a moderately intense, comprehensive, combined exercise training program represents a rehabilitation strategy that is associated with improved walking mobility in a small sample of persons with MS who have recent onset of gait impairment.

Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes.

Physical activity is associated with many benefits, but persons with multiple sclerosis (MS) are less physically active than the general population. There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population. This randomized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS. Physically inactive, ambulatory persons with MS (N = 45) were randomly assigned to intervention (n = 22) or control (n = 23) conditions and completed a battery of questionnaires before, after, and three months after a 12-week intervention period. Data analyses were conducted in PASW 18.0. Partial eta squared ([Formula: see text]) effect size indicated that there was a large, statistically significant condition-by-time interaction on physical activity ([Formula: see text]). Cohen's d effect sizes indicated that the intervention group had a large increase in physical activity after the 12-week trial (d = .98) that was sustained over a three-month follow-up (d = .79). The current study supports the efficacy of a behavioral intervention for increasing and sustaining physical activity in a sample of persons with MS.

Physical activity, social support, and depression: possible independent and indirect associations in persons with multiple sclerosis.

The present study examined the pattern of associations among physical activity, social support, mobility disability, perceived stress, and depressive symptoms in relapsing-remitting MS (RRMS). Persons (N = 218) with RRMS completed a battery of questionnaires that was sent and returned through the United States Postal Service (USPS). Bivariate correlation analysis indicated that physical activity and social support were both inversely associated with depressive symptoms (r's = -0.288 and -0.386, p ≤ 0.05, respectively). Multiple linear regression analysis indicated that physical activity (ß = -0.21, p = 0.002) and social support (ß = -0.37, p = 0.0001) were independently associated with depressive symptoms. Path analysis confirmed that the associations between physical activity and social support with depressive symptoms were indirect via mobility disability and perceived stress. Collectively, the evidence indicates that physical activity and social support are independently and indirectly associated with depression via mobility disability and perceived stress in relapsing-remitting MS. This supports the design of interventions and programs that target physical activity and social support for reducing depressive symptoms among persons with MS.