Lower physical activity is associated with higher disease burden in pediatric multiple sclerosis.
OBJECTIVE
To evaluate the association between physical activity (PA) and multiple sclerosis (MS) disease activity, depression, and fatigue in a cohort of children with MS and monophasic acquired demyelinating syndrome (mono-ADS).


METHODS
In this cross-sectional study of consecutive patients attending a specialized pediatric MS clinic, we administered the PedsQL Multidimensional Fatigue Scale, Center for Epidemiological Studies Depression Scale, and Godin Leisure-Time Exercise Questionnaire. Quantitative MRI analysis was performed to obtain whole brain and T2 lesion volume in a subset of participants (n = 60).


RESULTS
A total of 110 patients (79 mono-ADS; 31 MS; 5-18 years; M:F 1:1.2) were included. Patients with MS reported less strenuous (33.21 ± 31.88 metabolic equivalents [METs] vs 15.97 ± 22.73 METs, p = 0.002) and total (44.48 ± 39.35 METs vs 67.28 ± 59.65 METs; p = 0.0291) PA than those with mono-ADS. Patients with MS who reported greater amounts of moderate PA METs had fewer sleep/rest fatigue symptoms (r = -0.4). Participation in strenuous PA was associated with smaller T2 lesion volumes (r = -0.66) and lower annualized relapse rate (r = -0.66). No associations were found between total brain volume and participation in PA.


CONCLUSIONS
Children with MS are less physically active than children with mono-ADS. Reasons for this are unclear, but may be related to ongoing disease activity, perceived limitations, or symptoms such as depression or fatigue. Children with MS reporting higher levels of strenuous PA had lower T2 lesion volumes and lower relapse rates, suggesting a potential protective effect of strenuous PA in this population. Further longitudinal studies are needed to establish the relationship of PA to MS symptoms and disease activity in this population.
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Stephanie A
SA
Grover
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Berengere
B
Aubert-Broche
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Dumitru
D
Fetco
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
D Louis
DL
Collins
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Douglas L
DL
Arnold
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Marcia
M
Finlayson
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Brenda L
BL
Banwell
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign.
Robert W
RW
Motl
From the Division of Neurology (S.A.G., E.A.Y.), Department of Pediatrics, Hospital for Sick Children, University of Toronto, and Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; Montreal Neurological Institute (B.A.-B., D.F., D.L.C., D.L.A.), McGill University; the School of Rehabilitation Therapy (M.F.), Faculty of Health Sciences, Queen's University, Kingston, Canada; the Division of Neurology (B.L.B.), the Children's Hospital of Philadelphia, PA; and the Department of Kinesiology and Community Health (R.W.M.), University of Illinois at Urbana-Champaign. ann.yeh@sickkids.ca.
E Ann
EA
Yeh
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*