Acta Neurol Scand 2015: 131: 422–425 DOI: 10.1111/ane.12352
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Clinical Commentary
Descriptive epidemiology of physical activity rates in multiple sclerosis Motl RW, McAuley E, Sandroff BM, Hubbard EA. Descriptive epidemiology of physical activity rates in multiple sclerosis. Acta Neurol Scand 2015: 131: 422–425. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background – Persons with multiple sclerosis (MS) engage in substantially less overall physical activity than healthy controls, but there is little information on public health rates of physical activity necessary for health benefits. Purpose – This study examined the rates of insufficient, moderate, and sufficient physical activity in persons with MS compared with healthy controls. Method – Secondary analysis of data from participants with MS (n = 1521) and healthy controls (n = 162) who completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as part of a questionnaire battery in 14 previous investigations. Results – There were statistically significant differences in overall GLTEQ scores (F1,1666 = 96.8, P < 0.001, d = 0.83) and rates of physical activity (v2 (2, N = 1683) = 94.2, P < 0.001) between MS and control groups. The rates of insufficient, moderate, and sufficient physical activity in the MS group were 58.0%, 15.2%, and 26.8%, respectively. Those with MS were 2.5 times more likely to report insufficient physical activity and 2.3 times less likely to report sufficient physical activity than controls. Conclusion – The majority of persons with MS were insufficiently physically active, and this segment represents the largest opportunity for successful behavior change and accumulation of associated health benefits.
Introduction
Multiple sclerosis (MS) is a common, immunemediated and neurodegenerative disease of the central nervous system (CNS) that results in functional, symptomatic, and behavioral consequences. This disease has an estimated prevalence of 1 per 1000 adults in the United States (1) and often begins with acute periods of immune-mediated demyelination and transection of axons in the CNS, followed by later neurodegenerative processes resulting in axo-neuronal loss (2, 3). The disease pathophysiology and its location often result in walking and cognitive dysfunction and symptomatic fatigue and depression (4, 5). There are further behavioral manifestations of MS, particularly a reduction in overall 422
R. W. Motl, E. McAuley, B. M. Sandroff, E. A. Hubbard Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
Key words: multiple sclerosis; health; physical activity R. W. Motl, Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL 61801, USA Tel: 217 265-0886 fax: 217 244-0702 e-mail: [email protected] Accepted for publication October 21, 2014
physical activity levels (6) by nearly one standard deviation (SD) compared with healthy controls (7). To date, very little is known about rates of participation in different classifications of physical activity based on public health guidelines for physical activity volumes (e.g., insufficiently, moderately, or sufficiently active) and the associated degree of health benefits (e.g., minimal, some, or substantial benefits) (8). This study involved a secondary analysis of data for examining the rates of insufficient, moderate, and sufficient physical activity in persons with MS compared with controls. Such data will provide new insight regarding the rates of physical activity for public health benefits in MS (8) and possibly inform research and clinical goals for changing this health behavior.
Physical activity in multiple sclerosis Methods Participants
This study involved an analysis of previously deidentified data from 14 investigations of physical activity and its associations with symptoms, quality of life, and social-cognitive outcomes. MS participants were recruited from throughout the United States, but primarily within the Midwest and the state of Illinois. Participants were contacted through print and email flyers and advertisements on the National Multiple Sclerosis Society Web site. Persons with MS were enrolled based on the following common inclusion criteria: (a) diagnosis of MS; (b) relapse-free in the previous 30 days; and (c) ambulatory with or without assistance. Healthy controls were a sample of convenience recruited from the University community via email postings. The final samples included 1521 persons with MS and 162 healthy controls.
written informed consent. Participants were either sent questionnaires through the United States Postal Service (USPS) with a stamped, preaddressed return envelope or completed questionnaires during a baseline testing session in the laboratory. The questionnaires included the GLTEQ, sociodemographics scale, and other measures that varied across the studies. The sample with MS further completed the Patient-Determined Disease Steps (PDDS) scale (13). The PDDS is a validated, self-report scale for characterizing the disability status of the MS sample. If the questionnaires were received via USPS, the researchers verified completeness upon return, and missing data were collected over the phone. If the questionnaires were completed during a baseline testing session, the questionnaires were checked, and missing data were collected prior to the participant departing. Participants received compensation ranging between 10 and 25 USD. Data analyses
Physical activity measure
Physical activity was measured with the Godin Leisure-Time Exercise Questionnaire (GLTEQ) (9) as this scale has been validated against accelerometry and other outcomes in MS (10) and captured behavioral intervention effects (11). The GLTEQ measures the frequency of strenuous, moderate, and mild leisure-time physical activity performed for periods of 15 min or more over a usual week. Recently, new scoring has been suggested for generating an overall GLTEQ score that aligns with current recommendations for physical activity and the dose–response association between the volume of physical activity and associated health benefits (12). This new score is based on only strenuous and moderate physical activity and is computed by multiplying the frequencies of strenuous and moderate activities by nine and five metabolic equivalents (METs), respectively, and then adding the resultant scores. The total score ranges between 0 and 98 and is converted into one of three categories, namely insufficiently active (i.e., score
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Clinical Commentary
Descriptive epidemiology of physical activity rates in multiple sclerosis Motl RW, McAuley E, Sandroff BM, Hubbard EA. Descriptive epidemiology of physical activity rates in multiple sclerosis. Acta Neurol Scand 2015: 131: 422–425. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background – Persons with multiple sclerosis (MS) engage in substantially less overall physical activity than healthy controls, but there is little information on public health rates of physical activity necessary for health benefits. Purpose – This study examined the rates of insufficient, moderate, and sufficient physical activity in persons with MS compared with healthy controls. Method – Secondary analysis of data from participants with MS (n = 1521) and healthy controls (n = 162) who completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as part of a questionnaire battery in 14 previous investigations. Results – There were statistically significant differences in overall GLTEQ scores (F1,1666 = 96.8, P < 0.001, d = 0.83) and rates of physical activity (v2 (2, N = 1683) = 94.2, P < 0.001) between MS and control groups. The rates of insufficient, moderate, and sufficient physical activity in the MS group were 58.0%, 15.2%, and 26.8%, respectively. Those with MS were 2.5 times more likely to report insufficient physical activity and 2.3 times less likely to report sufficient physical activity than controls. Conclusion – The majority of persons with MS were insufficiently physically active, and this segment represents the largest opportunity for successful behavior change and accumulation of associated health benefits.
Introduction
Multiple sclerosis (MS) is a common, immunemediated and neurodegenerative disease of the central nervous system (CNS) that results in functional, symptomatic, and behavioral consequences. This disease has an estimated prevalence of 1 per 1000 adults in the United States (1) and often begins with acute periods of immune-mediated demyelination and transection of axons in the CNS, followed by later neurodegenerative processes resulting in axo-neuronal loss (2, 3). The disease pathophysiology and its location often result in walking and cognitive dysfunction and symptomatic fatigue and depression (4, 5). There are further behavioral manifestations of MS, particularly a reduction in overall 422
R. W. Motl, E. McAuley, B. M. Sandroff, E. A. Hubbard Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
Key words: multiple sclerosis; health; physical activity R. W. Motl, Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL 61801, USA Tel: 217 265-0886 fax: 217 244-0702 e-mail: [email protected] Accepted for publication October 21, 2014
physical activity levels (6) by nearly one standard deviation (SD) compared with healthy controls (7). To date, very little is known about rates of participation in different classifications of physical activity based on public health guidelines for physical activity volumes (e.g., insufficiently, moderately, or sufficiently active) and the associated degree of health benefits (e.g., minimal, some, or substantial benefits) (8). This study involved a secondary analysis of data for examining the rates of insufficient, moderate, and sufficient physical activity in persons with MS compared with controls. Such data will provide new insight regarding the rates of physical activity for public health benefits in MS (8) and possibly inform research and clinical goals for changing this health behavior.
Physical activity in multiple sclerosis Methods Participants
This study involved an analysis of previously deidentified data from 14 investigations of physical activity and its associations with symptoms, quality of life, and social-cognitive outcomes. MS participants were recruited from throughout the United States, but primarily within the Midwest and the state of Illinois. Participants were contacted through print and email flyers and advertisements on the National Multiple Sclerosis Society Web site. Persons with MS were enrolled based on the following common inclusion criteria: (a) diagnosis of MS; (b) relapse-free in the previous 30 days; and (c) ambulatory with or without assistance. Healthy controls were a sample of convenience recruited from the University community via email postings. The final samples included 1521 persons with MS and 162 healthy controls.
written informed consent. Participants were either sent questionnaires through the United States Postal Service (USPS) with a stamped, preaddressed return envelope or completed questionnaires during a baseline testing session in the laboratory. The questionnaires included the GLTEQ, sociodemographics scale, and other measures that varied across the studies. The sample with MS further completed the Patient-Determined Disease Steps (PDDS) scale (13). The PDDS is a validated, self-report scale for characterizing the disability status of the MS sample. If the questionnaires were received via USPS, the researchers verified completeness upon return, and missing data were collected over the phone. If the questionnaires were completed during a baseline testing session, the questionnaires were checked, and missing data were collected prior to the participant departing. Participants received compensation ranging between 10 and 25 USD. Data analyses
Physical activity measure
Physical activity was measured with the Godin Leisure-Time Exercise Questionnaire (GLTEQ) (9) as this scale has been validated against accelerometry and other outcomes in MS (10) and captured behavioral intervention effects (11). The GLTEQ measures the frequency of strenuous, moderate, and mild leisure-time physical activity performed for periods of 15 min or more over a usual week. Recently, new scoring has been suggested for generating an overall GLTEQ score that aligns with current recommendations for physical activity and the dose–response association between the volume of physical activity and associated health benefits (12). This new score is based on only strenuous and moderate physical activity and is computed by multiplying the frequencies of strenuous and moderate activities by nine and five metabolic equivalents (METs), respectively, and then adding the resultant scores. The total score ranges between 0 and 98 and is converted into one of three categories, namely insufficiently active (i.e., score
