Physical activity and the incidence of multiple sclerosis.
OBJECTIVE
To study whether physical activity during adulthood or early life is associated with multiple sclerosis (MS) incidence in 2 prospective cohorts of women.


METHODS
Women in the Nurses' Health Study (NHS) (n = 81,723; 1986-2004) and NHS II (n = 111,804; 1989-2009) reported recent physical activity at baseline and in selected follow-up questionnaires. Using this information, we calculated total metabolic equivalent hours of physical activity per week, a measure of energy expenditure. There were 341 confirmed MS cases with first symptoms after baseline. Participants also reported early-life activity. To estimate relative rates (RRs) and 95% confidence intervals (CIs), we used Cox proportional hazards models, adjusting for age, latitude of residence at age 15, ethnicity, smoking, supplemental vitamin D, and body mass index at age 18.


RESULTS
Compared with women in the lowest baseline physical activity quartile, women in the highest quartile had a 27% reduced rate of MS (RRpooled= 0.73, 95% CI 0.55-0.98; p-trend 0.08); this trend was not present in 6-year lagged analyses. Change in physical activity analyses suggested that women reduced activity before onset of MS symptoms. In NHS and NHS II, higher strenuous activity at ages 18-22 years was weakly associated with a decreased MS rate. However, in NHS II, total early-life activity at ages 12-22 was not associated with MS.


CONCLUSIONS
Though higher physical activity at baseline was weakly associated with lower MS risk, this may have been due to women reducing physical activity in response to subclinical MS.
From the Departments of Epidemiology (K.S.D., A.A.) and Nutrition (J.M., A.A., K.L.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center (K.S.D.), Channing Division of Network Medicine, Department of Medicine (A.A.), and Partners Multiple Sclerosis Center, Department of Neurology (T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Kirsten S
KS
Dorans
From the Departments of Epidemiology (K.S.D., A.A.) and Nutrition (J.M., A.A., K.L.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center (K.S.D.), Channing Division of Network Medicine, Department of Medicine (A.A.), and Partners Multiple Sclerosis Center, Department of Neurology (T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Jennifer
J
Massa
From the Departments of Epidemiology (K.S.D., A.A.) and Nutrition (J.M., A.A., K.L.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center (K.S.D.), Channing Division of Network Medicine, Department of Medicine (A.A.), and Partners Multiple Sclerosis Center, Department of Neurology (T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Tanuja
T
Chitnis
From the Departments of Epidemiology (K.S.D., A.A.) and Nutrition (J.M., A.A., K.L.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center (K.S.D.), Channing Division of Network Medicine, Department of Medicine (A.A.), and Partners Multiple Sclerosis Center, Department of Neurology (T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Alberto
A
Ascherio
From the Departments of Epidemiology (K.S.D., A.A.) and Nutrition (J.M., A.A., K.L.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center (K.S.D.), Channing Division of Network Medicine, Department of Medicine (A.A.), and Partners Multiple Sclerosis Center, Department of Neurology (T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA. kgorham@hsph.harvard.edu.
Kassandra L
KL
Munger
D000328:Adult; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012720:Severity of Illness Index
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