Partners MS Center, Brigham and Women's Hospital, 60 Fenwood Rd., Boston, MA 02115, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States; Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States.
Partners MS Center, Brigham and Women's Hospital, 60 Fenwood Rd., Boston, MA 02115, United States.
Mult Scler Relat Disord. 2022 Sep;65:104006. doi: 10.1016/j.msard.2022.104006. Epub 2022 Jul 2.
Higher levels of total physical activity (PA) are associated with better health-related quality of life (HRQOL) in individuals with multiple sclerosis (MS). The benefits of PA across the activity continuum have not been well-studied. The goal of this study was to compare the associations between total PA, strenuous PA, moderate PA, and mild PA and HRQOL in a large cohort of individuals with MS using both generic and neurologic disease-specific questionnaires. Longitudinal changes in PA and HRQOL over two years were also examined METHODS: Subjects enrolled in SysteMS completed the Godin Leisure Time Exercise Questionnaire (GLTEQ) to measure PA. Subjects also completed generic (SF-36) and neurologic disease-specific (NeuroQoL) HRQOL measures. GLTEQ and HRQOL measures were administered at baseline and 24 months. The associations between the GLTEQ total leisure activity (TLA), strenuous PA, moderate PA and mild PA and scores on NeuroQoL and SF-36 were estimated using Spearman's correlation coefficient and partial Spearman's correlation coefficient adjusting for age, sex and Expanded Disability Status Scale (EDSS) measured by a provider. To further investigate the associations between mild PA and HRQOL measures, the associations between mild PA and HRQOL were estimated in participants who reported no moderate or strenuous PA in the last week. The changes in GLTEQ TLA scores and each component score were compared to the changes in NeuroQoL and SF-36 over 24 months using Spearman's correlation coefficient and partial Spearman's correlation coefficient adjusting for age, sex and EDSS.
Statistically significant weak correlations were observed between GLTEQ TLA and NeuroQoL and SF-36 domains, with higher levels of TLA being associated with better HRQOL outcomes. After adjusting for age, sex and EDSS, all correlations were attenuated. Strenuous and moderate levels of PA were similarly associated with many HRQOL outcomes, but mild PA was only weakly correlated with NeuroQoL Lower Extremity Function. There was limited change in PA over 24 months. In a subgroup of participants who reported mild PA, but no moderate or strenuous PA, there were no significant associations with NeuroQoL or SF-36 domains at baseline, but increases in mild PA over two years were moderately associated with improvement on NeuroQoL Upper Extremity Function and SF-36 Mental Health and Mental Component Summary.
There were weak associations between TLA and HRQOL across a wide range of HRQOL variables. In addition, both strenuous PA and moderate PA were weakly associated with many HRQOL outcomes, but mild PA was only associated with lower extremity function. Increases in mild PA in a subgroup of individuals who reported no strenuous or moderate PA at baseline were associated with improvements in HRQOL at 24 months. These findings suggest that programs aimed at increasing PA across the activity continuum may lead to improvements in multiple areas of HRQOL in individuals with MS.
多项研究表明，较高水平的总体身体活动（PA）与多发性硬化症（MS）患者的健康相关生活质量（HRQOL）呈正相关。但 across the activity continuum 的 PA 益处尚未得到很好的研究。本研究的目的是使用通用和神经疾病特异性问卷，比较 MS 患者大样本中总 PA、剧烈 PA、中度 PA 和轻度 PA 与 HRQOL 之间的关联。还检查了 2 年内 PA 和 HRQOL 的纵向变化。
参加 SysteMS 的受试者完成了 Godin 休闲时间运动问卷（GLTEQ）来测量 PA。受试者还完成了通用（SF-36）和神经疾病特异性（NeuroQoL）HRQOL 测量。GLTEQ 和 HRQOL 测量在基线和 24 个月时进行。使用 Spearman 相关系数和偏 Spearman 相关系数估计 GLTEQ 总休闲活动（TLA）、剧烈 PA、中度 PA 和轻度 PA 与 NeuroQoL 和 SF-36 得分之间的关联，并根据年龄、性别和由提供者测量的扩展残疾状况量表（EDSS）进行调整。为了进一步研究轻度 PA 与 HRQOL 测量之间的关联，在报告过去一周没有中度或剧烈 PA 的参与者中，估计了轻度 PA 与 HRQOL 之间的关联。使用 Spearman 相关系数和偏 Spearman 相关系数比较 24 个月内 GLTEQ TLA 评分和每个分量评分与 NeuroQoL 和 SF-36 的变化，根据年龄、性别和 EDSS 进行调整。
观察到 GLTEQ TLA 与 NeuroQoL 和 SF-36 域之间存在统计学上较弱的弱相关，TLA 水平较高与 HRQOL 结果较好相关。在调整年龄、性别和 EDSS 后，所有相关性均减弱。剧烈和中度 PA 水平与许多 HRQOL 结果相似相关，但轻度 PA 仅与 NeuroQoL 下肢功能弱相关。在 24 个月内，PA 变化有限。在报告轻度 PA 但无中度或剧烈 PA 的参与者亚组中，基线时与 NeuroQoL 或 SF-36 域无显著关联，但两年内轻度 PA 的增加与 NeuroQoL 上肢功能和 SF-36 心理健康和心理成分综合评分的改善中度相关。
TLA 与广泛的 HRQOL 变量之间存在弱关联。此外，剧烈 PA 和中度 PA 均与许多 HRQOL 结果弱相关，但轻度 PA 仅与下肢功能相关。在基线时报告无剧烈或中度 PA 的个体亚组中，轻度 PA 的增加与 24 个月时的 HRQOL 改善相关。这些发现表明，旨在 across the activity continuum 增加 PA 的计划可能会导致 MS 患者的多个 HRQOL 领域得到改善。
