Potentially Modifiable Factors Associated With Physical Activity in Individuals With Multiple Sclerosis

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Multiple sclerosis (MS) is a multifocal inflammatory disease of the brain and spinal cord (Papini & König, 2015), associated with varying signs and symptoms including spasticity, pain, fatigue, depression, impaired mobility, and cognitive dysfunction (Tubaro et al., 2012). MS affects more than 2 million persons worldwide (Multiple Sclerosis International Federation, 2013) and is the most prevalent chronic neurological disease affecting young and middle‐aged adults in the United States (National Multiple Sclerosis Society, 2003). As such, individuals are affected for most of their lives, 80% living with the disease for over 35 years (Koch‐Henriksen, Brønnum‐Hansen, & Stenager, 1998). The severity of MS symptoms is variable and is associated with modifiable lifestyle behaviors that influence disability progression (D'Hooghe, Nagels, Bissay, & Keyser, 2010).
Although disease‐modifying therapies exist for MS, they are only partially effective (Papini & König, 2015), and symptom‐management strategies and physical rehabilitation remain important for managing the disease (Dalgas & Stenager, 2012). Physical activity is well‐tolerated (Mostert & Kesselring, 2002) and has been shown to induce significant improvements in the mental and physical functioning of people with MS (Bjarnadottir, Konradsdottir, Reynisdottir, & Olafsson, 2007; Dalgas, Stenager, & Ingemann‐Hansen, 2008; Motl & Pilutti, 2012). Despite its recognized importance, the prevalence of physical activity among individuals with MS is lower than in the general population (Motl, McAuley, & Snook, 2005). This is concerning, given that persons with MS are at increased risk for conditions related to sedentary lifestyles, including cardiovascular diseases, obesity, Type II diabetes, and osteoporosis (Dalgas et al., 2008).
In a recent review, authors identified a gap in knowledge regarding the factors associated with physical activity participation in persons with MS (Motl, Learmonth, Pilutti, Gappmaier, & Coote, 2015). In particular, research is needed to determine which factors (i.e., clinical, demographic) should be the target of interventions. Evidence from healthy adults or those with other chronic diseases is not fully applicable because MS signs and symptoms may fluctuate substantially over time and often reflect progressive worsening of disability.
Therefore, the primary aim of this study was to identify the clinical and demographic factors associated with meeting the recommended guidelines for physical activity in a sample of people with MS, with an emphasis on symptoms that have not been studied previously (i.e., bladder dysfunction, hand dysfunction), and factors that are potentially modifiable. In addition, we aimed to fill a gap in evidence about the relationship between health literacy levels and physical activity in MS. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Baker et al., 2007). Persons with chronic illnesses such as MS may be overwhelmed by information on prognosis, symptom management, and treatment for the disease when limited literacy skills prevent them from understanding and acting on the information provided (Chiovetti, 2006). Low health literacy is associated with obesity and smoking in persons with MS (Marrie, Salter, Tyry, Fox, & Cutter, 2014). Therefore, the secondary aim of this study was to determine whether health literacy was associated with meeting the recommended guidelines for physical activity in people with MS.

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