Physical activity and fatigue—what does this mean for exercise?

[ActiveMSers]

This is an interesting study and somewhat surprising. Does this mean we can't blame fatigue on physical activity (and exercise)? - Dave

The association between perceived fatigue and actual level of physical activity in multiple sclerosis

Marc B Rietberg1
Erwin EH van Wegen2
Bernard MJ Uitdehaag3
Gert Kwakkel2
1Research Institute MOVE, Department of Rehabilitation Medicine, Physical Therapy Section, VU University Medical Center, The Netherlands.
2Research Institute MOVE, Department of Rehabilitation Medicine, VU University Medical Center, The Netherlands.
3Department of Neurology and Department of Epidemiology and Biostatistics, VU University Medical Center, The Netherlands.
MB Rietberg (MSc), Department of Rehabilitation Medicine, Section Physical Therapy, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Email: m.rietberg@vumc.nl

Abstract

Background: Both fatigue and reduced physical activity are important consequences of multiple sclerosis (MS). However, their mutual association is poorly understood.
Objective: The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS.

Methods: Found associations were checked for confounding by age, Expanded Disability Status Scales (EDSS), disease duration, sub-type of MS, anxiety, and depression. Forty-three ambulatory patients with MS were recruited. Ambulatory physical activity was recorded for 24 hours. Fatigue was assessed with the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS) and the Checklist Individual Strength (CIS20R). Linear regression was applied after which potential confounding factors were introduced in a multivariate regression model.

Results: No significant associations between physical activity and fatigue scores were found, except for the MFIS sub-scale ‘physical activity’ (ßphysical_activity [ßpa] = −0.044; SE = 0.020). The association between physical activity and the FSS score was distorted by age, MS-type, anxiety and depression and the association between physical activity and the MFIS score by age and depression. The inverse association between MFIS sub-scale ‘physical activity’ and physical activity was significantly strengthened by adjusting for age (ßpa = − 0.052; SE = 0.019), sub-type of MS (ßpa = − 0.048; SE = 0.020), anxiety (ßpa = − 0.070; SE = 0.023) and depression (ßpa = − 0.083; SE = 0.023).

Conclusions: In MS, there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.

[AMFADVENTURES]

Wait a minute, did I read that right? 24 hours of recorded physical activity to measure the relationship of physical activity in MS to fatigue?????????????????? This looks like a very poorly designed study.

[Stella]

I don't understand that study. From my perspective, when I feel fatigue, I don't have the energy for the gym. So should I force myself and in turn will it give me more energy? Would be interesting to see if exercising gives MS'ers more energy.

[AMFADVENTURES]

I don't understand that study. From my perspective, when I feel fatigue, I don't have the energy for the gym. So should I force myself and in turn will it give me more energy? Would be interesting to see if exercising gives MS'ers more energy.

Hey Stella, Yeah, that study sort of flies in the face of everything else I've read. Although I can't put my finger on one right now, in most, if not all studies involving the effect of exercise on people with MS, fatigue relief was the number one result. I don't know that fatigue reduction necessarily means an increase in energy but seems like it would be a step in the right direction. I try to use the 20 minute rule on those low energy days, force myself to do 20 minutes of exercise, if things haven't improved after 20 minutes, I bail out. Most of the time things do improve though. Of course, there are those days it's just impossible to get out of the house.

Larry

[quietposter]

I have found that when I'm tired, really tired, and I push myself to do something/anything active, I feel better as a result. It could be as small as going for a brief walk with my dog to something as energetic as horseback riding or cycling. Some level of activity always seems to help mentally and physically when I'm in that exhausted state.

[ActiveMSers]

QP, I find the same thing is true when I exercise. When I'm beat, within 15 minutes of working out I start to feel better and get more energy.

I think what this study is saying is that people tend to report the same level of fatigue regardless of the amount of physical activity done during the day. (In other words, exercise shouldn't necessarily tire you out.) But I agree with AMF, there are lots of holes and no real conclusions in the research.