title: Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey.
abstract: BACKGROUND
  Multiple Sclerosis (MS) is a common neurodegenerative disease, which often has a devastating effect on physical and emotional wellbeing of people with MS (PwMS). Several studies have shown positive effects of physical activity (PA) on disability, health related quality of life (HRQOL), and other outcomes. However, many studies include only people with mild disability making it difficult to generalize findings to those with moderate or severe disability. This study investigated the associations between PA and HRQOL, relapse rate (RR), disability, and demographic variables in PwMS with varying disability.
  
  
  METHODS
  Through online platforms this large international survey recruited 2232 participants with MS who completed items regarding PA, MS and other health characteristics.
  
  
  RESULTS
  PwMS who were younger (p < .001), male (p = 0.006), and with lower body mass index (BMI) (p < .001) undertook more PA, which was associated with decreased disability (p < 0.001) and increased HRQOL measures (all p < 0.001). For the subsample of people with relapsing-remitting MS, PA was associated with a decreased RR (p = 0.009). Regression analyses showed that increased PA predicted clinically significant improvements in HRQOL while controlling for level of disability, age and gender. More specifically, increasing from low to moderate and to high PA increased estimated mean physical health composite from 47.7 to 56.0 to 59.9 respectively (25.6% change), mental health composite from 60.6 to 67.0 to 68.8 (13.5% change), energy subscale from 35.9 to 44.5 to 49.8 (38.7% change), social function subscale from 57.8 to 66.1 to 68.4 (18.3% change), and overall QOL subscale from 58.5 to 64.5 to 67.7 (15.7% change).
  
  
  CONCLUSIONS
  For PwMS, regardless of disability level, increased PA is related to better HRQOL in terms of energy, social functioning, mental and physical health. These are important findings that should be taken into consideration by clinicians treating PwMS.
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy 3065, VIC, Australia. claudia.marck@svhm.org.au.
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Marck
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Hadgkiss
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: Dania M
authors.initials: DM
authors.lastname: van der Meer
authors.forename: Naresh G
authors.initials: NG
authors.lastname: Pereira
authors.forename: George A
authors.initials: GA
authors.lastname: Jelinek
mesh_terms: D000328:Adult; D003625:Data Collection; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D011788:Quality of Life