Sedentary behaviors more common among MS patients: 11 studies

People with multiple sclerosis (MS) engage in significantly more sedentary behaviors — activities like watching TV or using a computer or smartphone versus those requiring physical movement, such as exercise — than do individuals without the progressive disease, according to a pooled analysis of published studies.

This effect was particularly more pronounced in studies with a larger proportion of female MS patients, with the researchers noting that one study found “women spent more time in [sedentary behavior] and exhibited reduced light intensity activity with respect to men.”

However, factors such as body weight, disability levels, and MS duration did not substantially influence the findings, the data showed.

“Our findings may support the design of targeted behavioral change interventions for reducing [sedentary behavior] and improving health and function in the MS population,” the researchers wrote.

The study, “Systematic review and meta-analysis of sedentary behavior in persons with multiple sclerosis,” was published in the journal Multiple Sclerosis and Related Disorders.

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In MS, inflammation and damage to the brain and spinal cord result in various neurological symptoms, including walking difficulties, excessive fatigue, weakness, and muscle spasms or stiffness.

As a result, people with MS tend to be less active than those in the general population, which can predispose these patients toward sedentary behavior. Such behaviors may include watching television or playing video games, reading, playing cards, driving, or sitting at a computer or smartphone.

Among all people, more time engaged in sedentary behaviors has been associated with adverse health outcomes such as cardiovascular disease, obesity, and metabolic syndrome — characterized by high blood pressure, high blood fats, and insulin resistance — regardless of physical activity levels.

“However, much less is known about [sedentary behavior] in persons with MS,” the researchers wrote.

“To date, the notion of higher [sedentary behavior] levels in MS lacks empirical evidence derived from systematic investigation,” the team added.

To address this knowledge gap, scientists at the University of Illinois Chicago performed a systematic review and pooled analysis, also known as a meta-analysis, of published studies that compared sedentary behavior in people with and without MS.

“To our knowledge, this is the first systematic review that summarized the available evidence for [sedentary behavior] in MS,” the researchers wrote.

A total of 11 studies were identified in database searches. These covered a total of 1,403 MS patients and 449 controls, or people without MS. Most participants were women (80.8%), with mean ages between 36 and 65. Nearly all patients (87.6%) had relapsing-remitting multiple sclerosis or RRMS, the most common type of MS.

Sedentary behaviors were assessed primarily with wearable motion sensors, known as accelerometers, though some studies used self-reported questionnaires. Outcomes were reported as a percent sedentary time, sedentary time in minutes per day, sitting time, or lying time.

Individually, the majority of studies found a higher level of sedentary behaviors among MS patients. When the results from all the studies were pooled together, there was a small but statistically significant effect showing people with MS engaged in more sedentary behaviors than did the controls.

Still, the rates of sedentary behaviors among MS patients varied across assessments, particularly for overall sedentary time and lying time as measured by an accelerometer.

The team noted these variations likely were due to differences in wearable sensors, varying observation periods ranging from one to seven days, wear time criteria, and data processing methods.

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The sedentary behavior differences between people with MS and the healthy controls were more prominent when the patient group had a higher percentage of women.

To explain these results, the researchers suggested that women with MS may “encounter more barriers that limit participation in physical activity than [do] men.” Also, they noted that wrist-worn accelerometers may capture more upper-limb activities carried out by women during the day, such as household chores.

According to the team, “this result underscores the importance of considering sex as a factor in the assessment and evaluation of [sedentary behaviors] in MS research and clinical practice.”

The differences also were more significant when sedentary behavior was reported as percent sedentary time per day compared with sedentary and sitting times in minutes per day.

Participants’ body mass index or BMI, a measure of weight to height, did not substantially alter the difference in sedentary behavior between MS and non-MS individuals. Neither did disability status, MS duration, or the type of measurements (accelerometry vs. self-report) used in the study.

Our findings provide preliminary support for further investigations of [sedentary behaviors] in MS … [and may inform the] development of targeted, evidence-based interventions for reducing [sedentary behaviors] and accumulating consequential health benefits among persons with MS.

Overall, nearly all of the included studies were of good quality (91.4%), and there was a low risk of publication bias, which occurs when the outcome of a study biases the decision to publish.

“Our findings provide preliminary support for further investigations of [sedentary behaviors] in MS,” the researchers concluded, noting that “such knowledge will lay the foundations for future studies and allow involving [sedentary behavior] as a potential outcome in rehabilitation and clinical research.”

Ultimately, this study may benefit people with MS by informing the “development of targeted, evidence-based interventions for reducing [sedentary behaviors] and accumulating consequential health benefits among persons with MS,” the researchers concluded.