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Low levels of participation in vigorous physical activity in youth with multiple sclerosis and the associations with fatigue and depression
S.A. Grover1, D. Hopkins-Topp2, C.P. Sawicki1,3, R.W. Motl2, M. Finlayson4, J.E. Schneiderman5,6, C. Till7, B. Banwell8, E.A. Yeh1,3
1Departments of Neurology, Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada, 2Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States, 3Faculty of Medicine, University of Toronto, Toronto, 4Faculty of Health Sciences, Queen's University, Kingston, 5Physiology and Experimental Medicine, The Hospital for Sick Children, 6Faculty of Kinesiology and Physical Education, The University of Toronto, 7Department of Psychology, York University, Toronto, ON, Canada, 8Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
Background: Acquired demyelinating syndromes (ADS) occur in about 1/100,000 children. About 1/5 will eventually receive a diagnosis of multiple sclerosis (MS). Up to 3/4 of children with MS suffer from depression, fatigue, and/or cognitive impairment. Previous studies in healthy adolescents and adults with MS have shown physical activity (PA) to benefit cognition and psychosocial outcomes. Investigating PA may help in the development of non-pharmacologic interventions for symptom management in pediatric MS.
Goals: To investigate:
(1) PA levels in youth with monophasic ADS (mono-ADS) and MS in comparison to healthy controls (HC);
(2) The associations of PA levels in youth with MS wh experience fatigue and depression.
Methods: 74 consecutive patients were recruited from the Neuroinflammatory Clinic at the Hospital for Sick Children, Toronto, Canada (25 MS, 49 mono-ADS). 45 HC were recruited by flyers/word of mouth. Accelerometry (7 days), PA (Godin Leisure Time Exercise Questionnaire (GLTEQ)), fatigue (PedsQL MFS) and depression (CES-DC) questionnaires were completed by all participants. SickKids research ethics approval was obtained.
Results: MS participants (15.7±1.9 yo) were older than mono-ADS (13.7±2.6; p=0.001) and HC (14.4±2.4; p=0.03) participants. The proportion of females was not different across groups (p=0.14). Accelerometer data showed lower vigorous PA in the MS group (0.07±1.5 min/d) than in the mono-ADS (3.3±5.6 min/d; p=0.006) and HC (5.6±5.0 min/d; p=0.004) groups. On the GLTEQ, indicated MS patients compared with mono-ADS patients participated in lower levels of strenuous (17±18 vs. 30±21 METs, p=0.01) and total (42±29 vs. 63±32 METs, p=0.02) PA. Results remained after controlling for age. No differences were found in fatigue or depression between the groups. For the MS group, fatigue was correlated with depression (r=0.76) and vigorous PA was negatively correlated with fatigue (r=-0.53) and depression (r=-0.54).
Conclusions: Youth with MS participate in less vigorous/strenuous PA than their mono-ADS and HC counterparts. Those who participate in higher levels of vigorous PA report fewer depressive and fatigue symptoms. This study is limited by its cross-sectional nature, therefore, directionality of this association is unknown. Future investigations should focus on interventions that will help increase the amount of vigorous/strenuous PA as this may have the potential to ameliorate depression and fatigue in youth with MS.
S.A. Grover1, D. Hopkins-Topp2, C.P. Sawicki1,3, R.W. Motl2, M. Finlayson4, J.E. Schneiderman5,6, C. Till7, B. Banwell8, E.A. Yeh1,3
1Departments of Neurology, Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada, 2Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States, 3Faculty of Medicine, University of Toronto, Toronto, 4Faculty of Health Sciences, Queen's University, Kingston, 5Physiology and Experimental Medicine, The Hospital for Sick Children, 6Faculty of Kinesiology and Physical Education, The University of Toronto, 7Department of Psychology, York University, Toronto, ON, Canada, 8Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
Background: Acquired demyelinating syndromes (ADS) occur in about 1/100,000 children. About 1/5 will eventually receive a diagnosis of multiple sclerosis (MS). Up to 3/4 of children with MS suffer from depression, fatigue, and/or cognitive impairment. Previous studies in healthy adolescents and adults with MS have shown physical activity (PA) to benefit cognition and psychosocial outcomes. Investigating PA may help in the development of non-pharmacologic interventions for symptom management in pediatric MS.
Goals: To investigate:
(1) PA levels in youth with monophasic ADS (mono-ADS) and MS in comparison to healthy controls (HC);
(2) The associations of PA levels in youth with MS wh experience fatigue and depression.
Methods: 74 consecutive patients were recruited from the Neuroinflammatory Clinic at the Hospital for Sick Children, Toronto, Canada (25 MS, 49 mono-ADS). 45 HC were recruited by flyers/word of mouth. Accelerometry (7 days), PA (Godin Leisure Time Exercise Questionnaire (GLTEQ)), fatigue (PedsQL MFS) and depression (CES-DC) questionnaires were completed by all participants. SickKids research ethics approval was obtained.
Results: MS participants (15.7±1.9 yo) were older than mono-ADS (13.7±2.6; p=0.001) and HC (14.4±2.4; p=0.03) participants. The proportion of females was not different across groups (p=0.14). Accelerometer data showed lower vigorous PA in the MS group (0.07±1.5 min/d) than in the mono-ADS (3.3±5.6 min/d; p=0.006) and HC (5.6±5.0 min/d; p=0.004) groups. On the GLTEQ, indicated MS patients compared with mono-ADS patients participated in lower levels of strenuous (17±18 vs. 30±21 METs, p=0.01) and total (42±29 vs. 63±32 METs, p=0.02) PA. Results remained after controlling for age. No differences were found in fatigue or depression between the groups. For the MS group, fatigue was correlated with depression (r=0.76) and vigorous PA was negatively correlated with fatigue (r=-0.53) and depression (r=-0.54).
Conclusions: Youth with MS participate in less vigorous/strenuous PA than their mono-ADS and HC counterparts. Those who participate in higher levels of vigorous PA report fewer depressive and fatigue symptoms. This study is limited by its cross-sectional nature, therefore, directionality of this association is unknown. Future investigations should focus on interventions that will help increase the amount of vigorous/strenuous PA as this may have the potential to ameliorate depression and fatigue in youth with MS.