Cross-sectional, comparative study of health-related quality of life across the adult lifespan in multiple sclerosis.

PURPOSE: This study examines the independent and interactive effects of age and multiple sclerosis (MS) on health-related quality of life (HRQOL). MATERIALS AND METHODS: The sample included persons with MS (n = 207) and healthy controls (HCs; n = 99) divided into three age groups (young, middle-aged, and older adults) who completed a battery of questionnaires, including the 36-item Short-Form Health Survey (SF-36) as a measure of HRQOL. The SF-36 yielded scores for the Physical Component Summary (PCS) (i.e. physical HRQOL) and Mental Component Summary (MCS) (i.e. mental HRQOL). The data were analyzed using two-way MANOVA. RESULTS: There was no interaction between age and disease status on HRQOL, but there were significant main effects of age and disease status on HRQOL. HRQOL was significantly lower in participants with MS than HCs, regardless of age. Physical HRQOL was lower, whereas mental HRQOL was higher across age groups. CONCLUSION: The findings suggest that future research should develop behavioral and rehabilitation approaches that are applicable for improving HRQOL across the lifespan in persons with MS, particularly for physical HRQOL in older adults with MS.

Do depressive and anxiety symptoms influence the construct validity of Multiple Sclerosis Walking Scale-12 scores?

PURPOSE/OBJECTIVE: Walking dysfunction, depression, and anxiety are prevalent, burdensome, and interrelated outcomes in persons with multiple sclerosis (MS). The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a common patient-reported outcome (PRO) of walking dysfunction in research and practice involving MS, but the construct validity of its scores might be influenced by symptoms of depression and anxiety. This study examined if symptoms of depression and anxiety influenced the construct validity of MSWS-12 scores. RESEARCH METHOD/DESIGN: The sample included 189 participants with MS who completed the MSWS-12, Hospital Anxiety and Depression Scale (HADS-Depression subscale [HADS-D] and HADS-Anxiety subscale [HADS-A]), 6-minute walk (6MW), and timed 25-foot walk (T25FW). We conducted bivariate correlation analysis to examine the associations between MSWS-12 scores and both the 6MW and T25FW, while controlling for HADS-D and HADS-A scores. RESULTS: MSWS-12 scores were significantly correlated with the 6MW (r = -.752), T25FW (r = .694), HADS-D (r = .405), and HADS-A (r = .235). The correlations between MSWS-12 and 6MW (pr = -.725) and T25FW (pr = .685) did not change when controlling for HADS-D and HADS-A scores. The correlations between MSWS-12 and 6MW (r = -.708 and r = -.726) and T25FW (r = .687 and r = .748) were strong in subsamples with elevated HADS-D and HADS-A scores. CONCLUSIONS/IMPLICATIONS: Our results strengthen the validity evidence for MSWS-12 scores as a PRO of walking dysfunction in MS, including among those with symptoms of depression and anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comorbid Conditions and Physical Function in Adults With Multiple Sclerosis.

OBJECTIVE: We examined the total number of comorbid conditions as a correlate of physical function in persons with multiple sclerosis (MS). We further identified the presence of common comorbid conditions and examined physical function outcomes based on presence or absence of the comorbid conditions in persons with MS. DESIGN: Cross-sectional, comparative study. SETTING: University-based laboratory. PARTICIPANTS: Two hundred seven persons with MS (N=207) completed the study. MAIN OUTCOME MEASURES: Participants provided demographic, clinical, and comorbidity information. Participants then completed the 6-minute walk (6MW), timed 25-foot walk (T25FW), timed Up and Go (TUG), and short physical performance battery (SPPB). INTERVENTIONS: Not applicable. RESULTS: The number of comorbid conditions was associated with 6MW, T25FW, TUG, and SPPB scores (all P≤.001). Persons with MS who had hypertension performed worse on the 6MW, T25FW, TUG, and SPPB than persons without hypertension. Persons who had osteoarthritis performed worse on the 6MW, T25FW, and SPPB than persons without osteoarthritis. CONCLUSIONS: The results demonstrate that persons who report more comorbid conditions have worse physical function, and this may largely be associated with hypertension or osteoarthritis. There are opportunities for the design of behavioral interventions that target physical activity and/or diet for improving physical function via comorbid conditions in persons with MS.

Systematic review and meta-analysis of sedentary behavior in persons with multiple sclerosis.

BACKGROUND: Persons with multiple sclerosis (MS) engage in less physical activity than the general population, and the disease manifestations and comorbidity conditions might further predispose them toward sedentary behavior (SB) among this population. We performed a systematic review with meta-analysis of studies that compared SB in persons with MS and non-MS controls, and examined factors that may moderate the difference in SB between the two groups. METHODS: We conducted a systematic search using PubMed, PsycINFO, Scopus, and CINAHL from inception up to August 2022, and identified studies that involved group comparison of SB outcomes between MS and non-MS controls. Effect sizes were calculated as standardized mean differences (SMDs) using Hedge's g. We generated a multilevel random-effects model for estimating an overall effect, and performed moderator analyses. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). RESULTS: Eleven studies were included (1403 MS vs. 449 controls) and yielded 17 effects for meta-analysis. Results indicated an overall small, but significant effect (SMD [95% CI] = 0.27 [0.02, 0.53], p = 0.03) with significant heterogeneity (Q16 = 72.2, p < 0.01; I2total = 75.8%). There were larger effects when the MS sample had a higher proportion of females, or when SB was reported as percent sedentary time per day compared with other SB outcomes (p = 0.03 and 0.05, respectively). The included studies achieved fairly good quality (91.4%) using the AXIS tool. CONCLUSIONS: The cumulative evidence supports that persons with MS engage in more SB than non-MS controls. Our findings may support the design of targeted behavioral change interventions for reducing SB and improving health and function in the MS population.

Free-Living Peak Cadence in Multiple Sclerosis: A New Measure of Real-World Walking?

BACKGROUND: Physical function and walking performance have become important outcomes in clinical trials and rehabilitation involving persons with multiple sclerosis (MS). However, assessments conducted in controlled settings may not reflect real-world capacity and movement in a natural environment. Peak cadence via accelerometry might represent a novel measure of walking intensity and prolonged natural effort under free-living conditions. OBJECTIVE: We compared peak 30-minute cadence, peak 1-minute cadence, and time spent in incremental cadence bands between persons with MS and healthy controls, and examined the associations between peak cadence and laboratory-assessed physical function and walking performance. METHODS: Participants (147 MS and 54 healthy controls) completed questionnaires on disability status and self-reported physical activity, underwent the Short Physical Performance Battery, Timed 25-Foot Walk, Timed Up and Go, and 6-Minute Walk, and wore an accelerometer for 7 days. We performed independent samples t-tests and Spearman bivariate and partial correlations adjusting for daily steps. RESULTS: The MS sample demonstrated lower physical function and walking performance scores, daily steps, and peak cadence (P < .001), and spent less time in purposeful steps and slow-to-brisk walking (40-119 steps/minutes), but accumulated more incidental movement (1-19 steps/minutes) than healthy controls. The associations between peak cadence and performance outcomes were strong in MS (|rs| = 0.59-0.68) and remained significant after controlling for daily steps (|prs| = 0.22-0.44), P-values < .01. Peak cadence was inversely correlated with age and disability, regardless of daily steps (P < .01). CONCLUSIONS: Our findings provide preliminary evidence for the potential use of peak cadence with step-based metrics for comprehensively evaluating free-living walking performance in MS.

Vascular dysfunction in multiple sclerosis: Scoping review of current evidence for informing future research directions.

BACKGROUND: The research involving vascular comorbidity in people with multiple sclerosis (MS) could be advanced through investigations applying measurements of vascular function such as pulse wave velocity or flow mediated dilation as mechanistic endpoints in the study of physical comorbidity management in MS across the lifespan. We conducted a scoping review of research on vascular function parameters and outcomes in MS and developed a research agenda for future inquiry. METHODS: We searched PubMed from inception through February 2023 for articles involving relevant central and peripheral vascular function data or correlates of vascular function (arterial stiffness, endothelial function, blood pressure parameters, etc.) in conjunction with relevant outcomes (walking function, cognition, etc.) in MS. Studies were limited to English-language and primary research articles. RESULTS: Our search and subsequent screening identified 10 relevant articles. Four papers focused on arterial stiffness and reported pulse wave velocity and arterial compliance in MS compared with controls. Two papers focused on endothelial function and reported flow-mediated dilation in MS compared with controls. There was evidence that arterial stiffness and endothelial function were associated with cognition and disease progression in MS, respectively. One paper reported that physical activity was associated with arterial stiffness in MS. There was one protocol paper examining the effect of a home-based exercise program on markers of subclinical atherosclerosis; however, the results are unpublished, and there was no literature beyond this surrounding the impact of lifestyle behavior (e.g., diet) or exercise interventions on vascular function. CONCLUSION: There is emerging evidence for vascular dysfunction in MS, and this is associated with cognition and disease progression; we know very little about approaches for managing vascular dysfunction in MS. To that end, we offer an agenda for research on measurements and outcomes of vascular function in relation to MS and disease attributes, along with proposed mechanisms and lifestyle changes that could aid in managing vascular dysfunction.

An updated systematic review and quantitative synthesis of physical activity levels in multiple sclerosis.

OBJECTIVE: This paper provided an updated quantitative synthesis of physical activity levels in persons with multiple sclerosis (MS) compared with controls and other clinical populations. DESIGN: A systematic search through PubMed, Scopus, and PsycINFO was conducted for articles published between August, 2016 and July, 2022. Articles that included a group comparison of at least one measurement of physical activity between adults with MS and controls or other clinical populations were included in the meta-analysis. RESULTS: Twenty-four studies met the inclusion criteria and yielded a total of 119 comparisons. There was a moderate difference in physical activity levels between persons with MS and controls (effect size [ES] = -0.56,p < 0.01), but no significant difference between persons with MS and other clinical populations (ES = 0.01,p = 0.90). The pooled ESs comparing MS with controls (Q104 = 457.9,p < 0.01) as well as with clinical populations (Q13 = 108.4,p < 0.01) were heterogeneous. Moderating variables included sex, disability status, measurement method, outcome, intensity, and application of an MS-specific cut-point. CONCLUSION: Physical activity levels remain significantly lower in persons with MS compared with controls, but the magnitude of difference has become smaller over the past decade. There is a need for continued development of effective physical activity programs that can reach the greater community with MS.

Effects of aerobic, resistance, and combined exercise training on health-related quality of life in multiple sclerosis: Systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease of the central nervous system that manifests in symptoms that compromise health-related quality of life (HRQOL). HRQOL focuses on a person's overall, subjective evaluation of health status primarily in the physical and mental domains. Exercise training is a form of rehabilitation for managing MS-related outcomes that might influence HRQOL. Reviews on exercise training are available, but we are unaware of a recent comprehensive review and meta-analysis of exercise effects for improving physical and mental domains of HRQOL. This analysis provides an updated review and meta-analysis of randomized controlled trials (RCTs) examining interventions consisting of aerobic, resistance and combined exercise training for improving HRQOL in persons with MS. This systematic review 1) assessed the overall strength of evidence for exercise interventions on HRQOL, 2) evaluated the relative effect of exercise interventions on physical and mental domains of HRQOL, and 3) determined moderators of exercise intervention effects on HRQOL. METHODS: Seven databases were searched for RCTs evaluating physical and/or mental domains of HRQOL with adults diagnosed with MS and undergoing an intervention of aerobic, resistance or combined exercise training compared with a non-exercise comparator. Data extraction included participant and intervention characteristics, and pre- and post-intervention HRQOL outcome data. Effect sizes (ESs) were calculated as standardized mean differences (SMDs) and a multilevel random-effects model was used to generate an aggregated SMD that compared exercise with non-exercise control conditions. RESULTS: Twelve RCTs met the inclusion criteria and yielded 23 ESs to be analyzed. Participants (N = 593; 308 intervention vs. 285 control conditions) had a mean (±standard deviation) age of 42.4 (6.5) years and 80% (18.3%) were female. Results generated a medium effect of exercise for improving overall HRQOL (ES=0.64, p = 0.0001) with high heterogeneity (Q11=58.8, I2=86.7%). Exercise training yielded a large effect on the physical domain (k = 12, ES=0.82, p<0.0009) and a medium effect on the mental domain (k = 11, ES=0.41, p<0.0001). Moderator analyses identified exercise modality, supervision level, intervention delivery and length, HRQOL tool, and number of participants with relapsing-remitting MS as significant influences of ES for HRQOL. CONCLUSIONS: Exercise training is clinically effective for improving overall HRQOL in MS and produces greater improvements in the physical domain of HRQOL than the mental domain. The moderator analysis suggests that supervised, aerobic, and group-delivered exercise training of ≥3 months yields the most influence on HRQOL. Such results may have major implications for MS treatment and care.

Physical function across the lifespan in adults with multiple sclerosis: An application of the Short Physical Performance Battery.

BACKGROUND: Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the strongest correlates of SPPB summary scores. METHODS: The study involved secondary analysis of cross-sectional data from multiple studies. Ambulatory adults with MS who were relapse-free for the last 30 days were recruited, and controls were recruited based on similar criteria to adults with MS except without the diagnosis of MS or relapses. The sample of 345 persons with MS and 174 controls completed questionnaires regarding demographic and clinical information and underwent assessments of physical and cognitive function including the SPPB, 6-Minute Walk, Timed 25-Foot Walk, Symbol Digit Modalities Test, California Verbal Learning Test-Second Edition, and Brief Visuospatial Memory Test-Revised. RESULTS: The two-way ANOVA indicated a main effect of MS status (F(5,500)=34.74, p<.01, η2=0.065), a main effect of age (F(1,500)=3.88, p<.01, η2=0.037), and no MS status by age interaction (F(5,500)=1.20, p=.31, η2=0.012) on SPPB scores. The bivariate correlation analysis indicated that summary SPPB scores were associated with component SPPB scores in the overall samples of persons with MS (rs=0.71 to 0.83) and controls (rs=0.42 to 0.91) as well as within most age groups of MS (rs=0.63 to 0.91) and controls (rs=0.34 to 1.00). The associations between SPPB scores and physical function outcomes were larger in the sample of persons with MS (rs=-0.72 to 0.76) than controls (rs=-0.47 to 0.48). SPPB scores were further significantly associated with scores on cognitive outcomes in persons with MS (rs=0.31 to 0.43), whereas these associations were weaker in controls (rs=0.09 to 0.32). Overall, the associations between SPPB scores and physical function outcomes were stronger than the associations between SPPB scores and cognitive function outcomes. CONCLUSION: Overall, MS status and aging have additive effects on physical function, and the summary SPPB score may be driven by a specific component within each age group. SPPB scores may be driven more by mobility rather than cognition, and are consistent with cognitive-motor coupling in MS. The novelty of this study provides evidence of worsening physical function based on the application of the SPPB and its scores across the lifespan in persons with MS and controls, and this has important implications particularly given the increasing prevalence of older adults with MS.

Validity of the 30-Second Sit-to-Stand test as a measure of lower extremity function in persons with multiple sclerosis: Preliminary evidence.

BACKGROUND: The 30-Second Sit-To-Stand (30SSTS) is a quick, inexpensive, safe, and widely used clinical measure of lower extremity function. To date, there is limited evidence regarding the use of 30SSTS in multiple sclerosis (MS). The purpose of this study was to examine the construct validity of the 30SSTS test in persons with MS compared with non-MS healthy controls. METHODS: Twenty ambulatory persons with MS and twenty age- and sex-matched healthy controls completed the 30SSTS, Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), Six-Minute Walk (6MW), and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Persons with MS also completed the Patient Determined Disease Steps (PDDS) and 12-item MS Walking Scale (MSWS-12). RESULTS: Persons with MS had significantly worse performance on the TUG (mean difference [95% confidence interval] = 1.4 [0.5, 2.3] sec) and 6MW (-259.2 [-450.8, -67.6] ft), but not on the 30SSTS (-1.6 [-1.5, 4.6] reps) and T25FW (-0.59 [-0.1, 1.2] ft/sec) compared with controls. There were significant moderate-to-strong correlations between the 30SSTS with T25FW, TUG, and 6MW scores in persons with MS (r = 0.48, -0.65 and 0.61, respectively), whereas the 30SSTS was only significantly associated with 6MW scores (r = 0.43) in controls. The 30SSTS was negatively associated with MS-related walking disability assessed by the PDDS and MSWS-12 (rs = -0.52 and -0.64, respectively), but was not significantly associated with the GLTEQ in MS and controls (r = 0.30 and 0.17, respectively). CONCLUSION: This study provides initial support for the construct validity of the 30SSTS as a measure of lower extremity function in persons with MS. Our findings warrant the inclusion of the 30SSTS as a feasible and valid measure of physical function in clinical research and practice involving persons with MS.

Diet, Physical Activity, and Stress Among Wheelchair Users With Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors.

OBJECTIVE: This study examined individual and co-occurring behavioral risk factors (diet, exercise, and stress) in wheelchair users with multiple sclerosis (MS) and potential association with MS symptoms (ie, fatigue, depression, anxiety, pain, sleep, and health-related quality of life [HRQOL]). DESIGN: Survey. SETTING: General Community. PARTICIPANTS: One hundred twenty-three wheelchair users with MS completed this study (N=123). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were mailed instructions for accessing online questionnaires (demographic and clinical characteristics, Godin Leisure-Time Exercise Questionnaire, Perceived Stress Scale, Automated Self-Administered 24-Hour Dietary Assessment Tool, and MS symptoms). RESULTS: Standard cut-points were used to categorize behavioral risk factors and then identify the extent and distribution of these behaviors both individually and co-occurring. We then analyzed the associations between behavioral risk factors and MS symptoms using bivariate correlation analyses and Mann-Whitney U tests. The mean age of participants was 60.6±10.0 years, 76% identified as women, 82% had a progressive disease course, and the mean MS duration was 23.0±9.7 years. Seven participants were classified as having 0 negative health behaviors, 41 participants had 1 negative health behavior, 49 participants had 2 negative health behaviors, and 26 participants had 3 negative health behaviors. The number of negative health behaviors was significantly correlated with HRQOL (physical, r=.30; psychological, r=.47), sleep (r=.25), depressive symptoms (r=.36), and anxiety (r=.43). Mann-Whitney U tests indicated greater fatigue, depression, and anxiety as well as lower sleep quality and HRQOL among participants who reported 2 or 3 behavioral risk factors compared with 0 or 1 behavioral risk factor. CONCLUSIONS: Future research should examine the design and implementation of multiple health behavior change interventions targeting co-occurring behavioral risk factors among wheelchair users with MS.

Oxygen cost of walking and its relationship with body composition in multiple sclerosis.

BACKGROUND/OBJECTIVES: This cross-sectional study examined the relationship between the oxygen (O2) cost of walking and body composition metrics, while considering potential covariates such as disability status, step length, and cadence, in persons with multiple sclerosis (MS). SUBJECTS/METHODS: The sample included 63 persons with MS across a wide distribution of body mass index (BMI). O2 cost of walking was assessed using portable, indirect calorimetry, and percent body fat (%Fat), fat-free mass (FFM), bone mineral content, bone mineral density (BMD), and weight/FFM were determined from dual-energy x-ray absorptiometry. Other outcome measures included step length, cadence, physical activity, and disability status. RESULTS: The O2 cost of walking had small-to-moderate associations with BMI (rs = -31, p = 0.015), %Fat (rs = -0.26, p = 0.041), and BMD (rs = -0.31, p = 0.013). O2 cost of walking was significantly associated with these outcomes even after controlling for age, sex, disability status, and gait outcomes. The O2 cost of walking was further significantly associated with shorter step length (rs = -0.40, p = 0.001), slower cadence (rs = -0.38, p = 0.002), and higher disability status (rs = 0.44, p < 0.001), but not physical activity. Body composition metrics were not associated with gait parameters, physical activity or disability status in our sample of persons with mild-to-moderate MS. CONCLUSIONS: The results indicated that higher O2 cost of walking was associated with lower fat and worse bone health after taking factors such as disability status into consideration. Researchers may focus on interventions that change body composition, or perhaps gait profiles, as possible approaches for changing O2 cost of walking and its consequences such as disability status in persons with MS.

No association between body composition and walking outcomes in multiple sclerosis.

BACKGROUND: One major concern of excess body weight is diminished physical function. The excess body weight associated with obesity can bring about challenges for physical function, particularly walking performance, among persons living with the consequences of a chronic, neurological disease. There is evidence that persons with multiple sclerosis (MS) have significantly reduced walking performance compared with controls; however, the relationship between body composition and walking outcomes has not been well-defined in persons with MS. To that end, the study examined the associations between body composition metrics and a comprehensive battery of walking outcomes in persons with MS recruited across a wide distribution of body mass index. METHODS: Ambulatory participants with MS (n=64) underwent an assessment of neurological disability status using the Expanded Disability Status Scale (EDSS) and body composition metrics (i.e., percent body fat, fat mass, lean mass, bone mineral content and density) using dual-energy x-ray absorptiometry. Participants then completed the Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), 6-Minute Walk (6MW), and 12-Item Multiple Sclerosis Walking Scale (MSWS-12). We examined Spearman rank-order bivariate correlations among percent body fat, fat mass, lean mass, bone mineral content and density, T25FW, TUG, 6MW, MSWS-12, and EDSS. RESULTS: Body composition metrics were not significantly associated with T25FW (rs=-.11, .12), TUG (rs=-.04, .11), 6MW (rs=-.01, .20), and MSWS-12 (rs=-.16, .03). Of note, body composition metrics were not correlated with disability status based on EDSS (rs=-.11, .03). Body composition metrics were not associated with walking outcomes even after controlling for EDSS. CONCLUSION: Our data indicated that worse body composition profiles are not necessarily associated with worse walking performance, greater perception of MS-related walking impairment, or more severe disability status in MS. Future research may consider examining other health-related or disease outcomes of overweight or obesity in MS. Overall, our findings suggest that optimization of body composition may not be a target of interventions for improving walking outcomes, and future research might explore other factors that influence lower physical function in MS.

Sedentary Behavior and Lower-Extremity Physical Function across the Lifespan of Adults with Multiple Sclerosis.

One outcome of aging with multiple sclerosis (MS) involves the decline in physical function, including compromised balance, reduced walking speed, and lower-extremity strength. Sedentary behavior, the other end of the activity continuum, may be targeted for improvements in physical function among adults with MS, but less is known about the relationship between sedentary behavior and physical function with increasing age in MS. This study examined the associations between device-measured volume and pattern of sedentary behavior and physical function based on SPPB (Short Physical Performance Battery) of ambulatory persons with MS across the lifespan. We categorized participants (N = 216) into young (20-39 years), middle-aged (40-59 years), and older (60-79 years) age groups. Participants completed the SPPB during a single visit to the laboratory and wore an accelerometer for a 7-day period. The one-way analysis of variance indicated no differences in volume and pattern of sedentary behavior among the three age groups, except for average sedentary bout length. Spearman bivariate correlations indicated that pattern, but not volume, of sedentary behavior was associated with physical function in young, middle-aged, and older adults, and the magnitude of these associations varied by age group. Future interventions may reduce and break up prolonged periods of sedentary behavior for improvements in physical function and possibly other consequences in persons with MS.

Does physical activity timing differentially correlate with symptoms of restless legs syndrome in adults with multiple sclerosis?

OBJECTIVE/BACKGROUND: The present study examined the associations among physical activity during different times of the day(i.e., morning, midday,evening) and days of the week(i.e., weekdays, weekend days) with restless legs syndrome(RLS) severity and sleep quality in adults with multiple sclerosis(MS). PATIENTS/METHODS: Participants(N = 39) completed the International Restless Legs Syndrome Study Group Scale and the Pittsburgh Sleep Quality Index as measures of RLS severity and global sleep quality, respectively, and wore an ActiGraph GT3X + on the non-dominant hip for seven days for measuring physical activity(i.e., light physical activity[LPA], moderate-to-vigorous physical activity[MVPA], and steps). RESULTS: There was a significant effect of time of day wherein participants had more midday activity compared with morning or evening for LPA, MVPA, and steps; there was no effect of day of the week. Spearman's rho correlations across the week indicated higher evening LPA, evening steps, and overall daily steps (ρ = -0.42,ρ = -0.51,ρ = -0.40,respectively) were associated with lower RLS severity. Similar associations were demonstrated for weekdays(ρ = -0.39,ρ = -0.50,ρ = -0.41,respectively) and weekend days(ρ = -0.44,ρ = -0.51,ρ = -0.39,respectively). Higher evening MVPA on weekend days(ρ = -0.42) was associated with lower RLS severity. Higher morning and overall daily LPA(ρ = 0.34,ρ = 0.33,respecitvely) were associated with worse sleep quality. Similar associations were demonstrated on weekdays(ρ = 0.33,ρ = 0.37,respectively) and more evening MVPA(ρ = 0.32) was associated with worse sleep quality. On weekend days, more morning MVPA(ρ = 0.42) was associated with worse sleep quality. CONCLUSIONS: Our results suggest that undertaking physical activity, particularly LPA and steps, in evenings may be important for managing symptoms of RLS without worsening sleep quality.

Association of disease outcomes with physical activity in multiple sclerosis: A cross-sectional study.

Purpose/Objective Research: This study examined combinations of disease outcomes (i.e., walking, cognition, and symptoms) as correlates of physical activity subgroups (insufficiently active vs. sufficiently active) in persons with multiple sclerosis (MS). RESEARCH METHOD/DESIGN: This study included 213 participants who completed walking and cognitive function tests and self-report measures of symptoms and physical activity. Multivariate analysis of variance and discriminant function analysis identified combinations of MS outcomes associated with physical activity. RESULTS: The sample had a mean age of 49.6 years (SD = 13.2), a 3:1 female:male ratio, and a Patient Determined Disease Steps median (interquartile range) score of 1.0 (3.0). Multivariate analysis of variance demonstrated that MS outcome clusters were significantly associated with physical activity, namely walking (i.e., Six-Minute Walk, Timed Up and Go, and MS Walking Scale), Pillai's trace V = .16, F(3, 180) = 11.43, η² = .16; cognition (i.e., Symbol Digits Modalities Test, California Verbal Learning Test-Second Edition, Brief Visuospatial Memory Test-Revised), Pillai's trace V = .04, F(3, 204) = 2.79, η² = .04; and symptoms (i.e., fatigue, anxiety, depression, and pain), Pillai's trace V = .16, F(4, 199) = 9.30, η² = .16. Discriminant function analysis indicated that a significant discriminant function of walking endurance and walking limitations, depression, fatigue, and processing speed was associated with physical activity subgroups. CONCLUSION/IMPLICATIONS: The findings identified walking endurance and limitations, processing speed, depression, and fatigue as primary correlates of physical activity differences in persons with MS. These results may inform researchers and health care providers to consider these factors in behavior change interventions and clinical practices for promoting adequate physical activity levels in MS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do device-measured physical activity and sedentary behavior differ by depression symptom status in persons with multiple sclerosis?

BACKGROUND: Depression is highly prevalent and impactful in persons with multiple sclerosis (MS). There are data indicating that the volume of physical activity behavior differs by depression symptom status in MS, yet less is known about the volume of sedentary behavior and its relationship with depression. We further know little about physical activity patterns and sedentary behavior and depression in MS. OBJECTIVES: This study examined differences in the volume (i.e., minutes/day) and pattern (i.e., bouts/day or bout length) of device-measured sedentary behavior and physical activity as a function of depression symptom status in persons with MS. METHODS: The sample of adults with MS (N=441) completed the Hospital Anxiety and Depression Scale (HADS) and wore a waist-mounted ActiGraph GT3X+ accelerometer during waking hours for 7 days. Participants were divided into subgroups of elevated (n=127) or non-elevated (n=314) depression symptoms based on a cut-point for the HADS scores (i.e., 8+ as indicative of elevated depressive symptoms). We examined the effect of depression group status differences on volume and pattern of sedentary behavior and light (LPA) and moderate-to-vigorous (MVPA) physical activity between subgroups using multivariate analyses of variance (MANOVA) and then multivariate analysis of covariance (MANCOVA) controlling for demographic/clinical variables that differed between the elevated and non-elevated depression groups. RESULTS: Results of the MANOVA indicated an overall difference between subgroups in the volume, but not pattern, of physical activity and sedentary behavior. The non-elevated depression group had a significantly greater amount of steps/day (mean [M]=4584.3, standard deviation [SD]=2821.3), than the elevated depression group ([M]=3729.6, [SD]=2576.3, F=8.7; p=.003). Results of the MANCOVA revealed there was no statistically significant difference between the elevated and non-elevated depression groups in measures of volume of physical activity, and the difference in steps/day became non-significant F(1,438)= 2.13, p=.146), after controlling for disability, age, disease duration, and educations years. CONCLUSIONS: This study observed no differences in sedentary behavior and physical activity as a function of depression symptom status in persons with MS, yet there was a difference in steps/day initially. Results demonstrated that when disability, age, disease duration, and years of education are included in the MANCOVA, the difference in depression groups is no longer significant. This suggests that steps/day could be an important target of health promotion interventions among persons with MS who have higher disability and elevated depression symptoms.

Perceptions of physical activity guidelines among wheelchair users with multiple sclerosis.

Background: Physical activity guidelines provide prescriptive resources for population-level promotion of behavior change to improve health outcomes. The National Multiple Sclerosis Society (NMSS) recently created and disseminated physical activity guidelines for persons with multiple sclerosis (MS) across the disease spectrum. Objective: This study aimed to assess perceptions of the updated NMSS Physical Activity Guidelines among wheelchair users with MS. Methods: One hundred thirty-four wheelchair users with MS participated in a cross-sectional study examining health behaviors. Outcomes were measured using an online questionnaire that included items related to demographic and clinical characteristics and a battery of questions regarding perceptions of the NMSS Physical Activity Guidelines based on Expanded Disability Status Scale groups 7.0-7.5 & 8.0-8.5. Results: Among the 134 participants, 77 participants (58%) did not meet the general recommendations, 43 participants sometimes meet the general recommendations (32%), and 14 participants (10%) reported meeting the general recommendations. Participants reported positive perceptions across modalities (i.e. Breathing, Flexibility, Upper Extremity, Lower Extremity, and Core Exercises); however Upper and Lower Extremity Exercises were rated as the most challenging based on inability to complete independently. Conclusion: Wheelchair users with MS in this study generally rated the NMSS Guidelines for Physical Activity as appropriate.

Physical activity and vascular comorbidity in Black and White persons with multiple sclerosis: A cross-sectional study.

BACKGROUND: Physical activity and sedentary behavior have been associated with vascular comorbidity in multiple sclerosis (MS), yet the associations have not been thoroughly investigated in MS subpopulations as a function of race. OBJECTIVES: This study examined if physical activity levels/sedentary time and vascular comorbidity differed between Black and White persons with MS, and further examined the associations between the variables within the two MS subpopulations. METHODS: Participants (n = 208) completed the comorbidity questionnaire in MS and wore accelerometers for seven days as a device-measure of physical activity levels/sedentary time. We examined the effect of race on physical activity levels/sedentary time and vascular comorbidity, controlling for covariates, using ANCOVA. We further performed bivariate correlations among variables in Black and White persons with MS separately. RESULTS: Only moderate-to-vigorous physical activity (MVPA) was significantly different between Black and White persons with MS, even after controlling for age, disease duration, marital status, education level, and income [F(1,177) = 9.01, p = .003, d = 0.16]. There was only a significant and moderate association between MVPA and vascular comorbidity in White persons with MS (r = -0.33). CONCLUSIONS: The findings indicate that MVPA is higher in White than Black persons with MS, and that more MVPA was associated with lower vascular comorbidity in White persons with MS. Physical activity behavior might be a potential target for managing vascular comorbidity in White persons with MS.

Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis.

BACKGROUND: There is interest in the application of behavioral interventions based on theory for increasing physical activity among adults with multiple sclerosis (MS). To date, researchers have applied theory such as Social Cognitive Theory (SCT) for identifying correlates of physical activity that can then inform the design and delivery of behavioral interventions. Such research often has been conducted in heterogeneous samples of persons with MS without a focus on those with a specific symptom, such as fatigue, that may be targeted by physical activity behavioral interventions. To that end, this study examined SCT variables (i.e., self-efficacy, barriers, outcome expectations, goal-setting, planning, social support, and functional limitations) as correlates of physical activity in persons with MS who self-reported elevated fatigue. METHODS: Persons with MS (N=210; aged 49.6[13.2] years) who ambulated with or without assistance participated in the study. Participants completed self-report measures of fatigue, physical activity, and SCT variables and wore an ActiGraph GT3X+ accelerometer on a belt around the waist for 7 days. The accelerometer data were processed and delineated into time spent in light and moderate-to-vigorous physical activity (MVPA) based on MS-specific cut-points. We generated groups of fatigued (n=134) and non-fatigued (n=76) persons with MS based on the cut-off score of 4 for the Fatigue Severity Scale. RESULTS: There were differences in physical activity and SCT variables between fatigued and non-fatigued persons with MS. Among those with fatigue, functional limitations (ρ=0.52), self-efficacy (ρ=0.31), and goal-setting (ρ=0.25) were associated with device-measured MVPA, and all SCT variables except outcome expectations were associated with self-reported physical activity. The regression analyses indicated self-efficacy, functional limitations, and goal-setting as significant correlates of MVPA in those with fatigue. CONCLUSION: Self-efficacy, goal-setting, and social support may be important targets of SCT-based behavioral interventions for increasing physical activity among persons with MS who have fatigue.