MS Fatigue Linked to 3 Different Patterns of Physical Activity, Study Finds

MS Fatigue Linked to 3 Different Patterns of Physical Activity, Study Finds

The relationship between fatigue and patterns of physical activity in people with multiple sclerosis (MS) is not straightforward. New findings show that, among MS patients with similar fatigue levels, there are three different types — or “clusters” — of physical behavior.

Clinicians should be aware of these behavioral types as they could be useful in developing personalized rehabilitation programs for individuals with MS, researchers say.

The study, “Three distinct physical behavior types in fatigued patients with multiple sclerosis,” was published in the Journal of NeuroEngineering and Rehabilitation.

Fatigue is a common symptom experienced by the majority — more than 80% — of MS patients. While it is believed to induce changes in people’s physical behavior, previous studies have described only a weak association between MS-related fatigue and physical activity patterns.

Researchers believe that, like the variability in symptoms, response to exercise is also highly heterogeneous in people with MS. So, a better understanding of how MS physical behavior varies could help healthcare professionals develop personalized interventions that could greatly improve MS management and patients’ quality of life.

To learn more, Dutch researchers analyzed data from the TREFAMS-ACE program, which included three clinical trials — ISRCTN82353628, ISRCTN69520623, and ISRCTN58583714. These trials evaluated the impact of different rehabilitation strategies — specifically aerobic training, cognitive behavioral therapy, and energy conservation management — on the outcomes of people with MS.

The team reviewed the clinical data of 212 adults with MS enrolled in the program (mean age of 47.9 years) who showed symptoms of severe fatigue, as determined by a score higher than 35 in the Checklist Individual Strength scale. All were still able to walk, and their disability score, as measured by Expanded Disability Status Scale (EDSS), was below 6 (indicating less severe disability). Most patients (73.1%) had relapsing-remitting MS.

Researchers used accelerometer signals to distinguish between sedentary, light, and moderate/vigorous physical activity — both in terms of amount and intensity, frequency and duration. They also recorded activity patterns during the day, to measure the MS patients’ physical behavior.

Accelerometer data revealed that these individuals could be grouped into three main groups, or clusters, that corresponded to three distinct subtypes of physical activity patterns.

“The most important finding was that patients with similar fatigue levels showed large differences in [physical behavior],” the researchers said.

“Patients who are willingly and mostly uninterruptedly sedentary, like patients in cluster 2, require a different approach compared to patients with similar [physical behavior] as healthy controls (cluster 3),” they added.

Th researchers found that some individuals — those grouped in cluster 1 — showed moderate sedentary activity. The majority of people, however, were classified as cluster 2. These patients had the highest rate of sedentary behavior. Indeed, cluster 2 was found to have 15% more sedentary behavior compared with the most active group of people, identified as cluster 3.

Physical activity daily patterns were also significantly different between cluster 1 and 2. While the morning and evening levels of activity were similar, during the afternoon the cluster 1 individuals were less sedentary than those in cluster 2.

Patients grouped in cluster 3 were the most active and also the youngest. They underwent a minimum of 41 minutes of moderate/intense physical activity per week. Among this group, sedentary behavior represented a mean of 54.2%, which is actually comparable with healthy people, who had 57.5% sedentary behavior. Supported by these findings, the team concluded that the physical behavior of those in cluster 3 is “not affected by MS-related fatigue.”

Overall, the team believes that physical behavior subtypes, “based on a unique set of physical behavior outcome measures,” could represent a promising strategy in the design of individually tailored interventions for physical behavior rehabilitation for people with MS.

Additional studies are warranted to further explore “the clinical feasibility of [physical behavior] subtypes in the design of interventions,” they suggested.

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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10 comments

  1. Liz says:

    Is this correlation or causation? Based on how I interpret this, there is an assumption that those who are mostly sedentary are more fatigued. What if those who are most active are simply pushing through their fatigue?

    • Kate O'Connor says:

      I cannot physically push through my pain Douglas because I get feint, dizzy & light headed & have to lay down after short bursts of activity. Pacing myself through each day & planning my days & weeks in advance has really helped me manage my commitments & still have lots of rest because of intense fatigue. It’s highly frustrating to not be able to keep up with my peers but I have had a lot of time to get used to this way of living life since my diagnosis many years ago (RRMS)! It takes time & lots of trial & error to find your own personal ‘zen’ but it is essential to reduce level of future disability where possible.

  2. Linda Fitch says:

    I don’t get the conclusions being drawn here. Of course, if you are less fatigued you would naturally be able to be more active. I know in my life prior to MS, I didn’t know the meaning of slowing down let alone sitting down. MS fatigue hit me like a train! Even if I fight through one day, I won’t be able get up the next no matter how much I berate myself.

  3. Anonymous says:

    An “intervention” for sufferers that would of course benefit them a lot more would be research geared toward a cure. It’s an obvious statement, yes. But when patients’ bodies are attacking their own central nervous systems, the focus should be on actual help in stopping downward spirals caused by disease progression.

    It is worrisome that so many research studies make it seem as if patients are merely getting lifestyle choices wrong, when in fact, they are physically deteriorating as they try their utmost to exercise and eat right.

    • carla. says:

      I agree with above. I was a very active person track in school very strong runner then all of a sudden bam hit me like a ton of bricks.Researchers can research all they want but with degeneration of the myelin sheath of the central nervous system proper diet and exercise don’t go hand in hand. I have also chronic fatigue I can be out walking and it suddenly hits find a place now to sit.so our life style choices cant be that wrong.maybe some reasearchers need more excersise.we have a constant battle we are fighting against our own immune system.

  4. Kelly Branchal says:

    Point One: Too many pop-ups trying to get my email address, which you already have!
    Point Two: The comments make more sense than the article.
    Point Three: I have three more points here than the article.
    Happy Tuesday!

  5. Rob Orr says:

    The findings state the obvious – MS patients suffer severe fatigue and increasingly struggle to remain physically active as MS progresses, and treatment programs should be targeted appropriately for the individual patient.

    What is perhaps ‘new’ information is that the self-report of fatigue level (as tested in study) was above the test cut-off for severe fatigue for *all* of the participants – in other words it seems the experience of severe fatigue does not correlate well with the actual level of physical activity of participants.

    My interpretation is that further research is therefore needed to explain what other personal/social/physical factors may play a role in determining each individual’s physical activity level. I would predict that if those factors could be identified, they would be very helpful in developing an individual treatment plan for each patient.

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