Fatigue May Improve With Physical Activity Among Patients With RRMS

Among individuals with relapsing-remitting multiple sclerosis (RRMS), lower fatigue levels were associated with reduced disability rates, improved physical condition, and increased daily living activity, according to study findings published in the journal Multiple Sclerosis and Related Disorders.

Fatigue is considered one of the most common symptoms in patients with MS. However, researchers acknowledge that measuring its effects on a day-to-day basis can be difficult. For the study, the researchers sought to assess the association between disability level, fatigue, and accelerometer-measured physical activity among patients with RRMS.

They conducted a prospective cross-sectional study, Correlation Between Daily Physical Activity and Disability, Fatigue, Cognition and Quality of Life in MS Patients (PAMS; ClinicalTrials.gov Identifier: NCT04115930), reporting on the relationship between disability, fatigue, and physical activity monitored by accelerometers in individuals with RRMS.

The degree of disability was assessed using the Expanded Disability Status Scale (EDSS). Subsequently, the patients were categorized into 2 groups based on their EDSS level: EDSS ≤ 2.5 (n=22) and EDSS > 2.5 (n=18). Additionally, the researchers utilized the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) questionnaires to measure fatigue levels of these participants.

All patients with RRMS underwent EDSS assessment, while all participants completed the MS Functional Composite (MSFC) test, a 6-minute walk test, and wore an accelerometer for 7 consecutive days.

A total of 94 patients were screened, of which 41 were included in the final analysis.

The control group consisted of 20 healthy volunteers who were matched in terms of age and gender.

Most of the individuals in both the RRMS and control groups were women.

Individuals in the control group were significantly younger (P <0.001), with lower body mass index and waist circumference compared to patients with RRMS (P =0.020 and P =0.008, respectively). These differences were also statistically significant between patients and the control group.

Compared with healthy control individuals, those with an EDSS level between 0 to 2.5 displayed higher levels of fatigue (P <.001), but lower levels compared with those with an EDSS level ranging from 3 to 5.5 (P <.001).

MSFC scores were markedly greater in the control group compared to the RRMS group (P <.001), and a significant difference (P=.004) was evident between the EDSS-low and EDSS-high groups, with higher MSFC scores in the EDSS-low group.

FSS scores were notably higher in the RRMS group than the control group and in the EDSS-high group compared with the EDSS-low group (P <0.001).

Similarly, MFIS scores were significantly elevated in the RRMS group compared with the control group and in the EDSS-high group compared with the EDSS-low group (P <0.001).

The researchers observed a correlation between fatigue and disability levels, (EDSS/FSS, r=0.750/P =.001; EDSS/MFIS, r=0.661/P =.001), as well as with the MSFC test within the patient group (MSFC/FSS, r = −0.350/P =.025; MSFC/MFIS, r = −0.423/P =.007).

Sleep exhibited correlations with disability, fatigue, sedentary time, total activity time steps, and 6-minute walk within the RRMS group, while no such correlations were observed in the control group.

The sit-up test demonstrated a moderate correlation with the 6- minute walk test in all groups, including the RRMS group (P <.001), control group (P =.002), EDSS-low group (P= .003), and EDSS-high group (P =.008).

Additionally, there was a strong correlation observed between total physical activity and step count across all groups, including the control group.

 Furthermore, in the control group, light physical activity exhibited correlations with the 6-minute walk test, sit-up test, total physical activity, and step count.

The primary limitation of the study stemmed from the limited and imbalanced study population across various EDSS groups.

The researchers concluded, “Furthermore, more specific research is required into patients’ disability and actual physical activity levels, taking the existing levels of patients’ disability into account.”