Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study

Anens et al. BMC Neurology (2017) 17:204 DOI 10.1186/s12883-017-0981-4 RESEARCH ARTICLE Open Access Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study Elisabeth Anens*, Lena Zetterberg, Charlotte Urell, Margareta Emtner and Karin Hellström Abstract Background: The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls selfefficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity. Methods: This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, selfefficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised. Results: Multiple regression analyzes showed that 59% (F(6,3) = 64.9, p = 0.000) of the variation in physical activity was explained by having less severe disease (β = −0.30), being employed (β = 0.26), having high falls self-efficacy (β = 0.20), having high self-efficacy for physical activity (β = 0.17), and enjoying physical activity (β = 0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity. Conclusions: Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences. Keywords: Exercise, Multiple sclerosis, Physical therapy, Rehabilitation, Self-efficacy Background In persons with MS (PwMS) the positive effects of physical activity (PA) are considerable. Reviews have shown positive effects on e.g. muscle strength, aerobic capacity, fatigue, quality of life and depression [1–5]. However, the benefit of exercise for populations with severe disability requires further investigation [3]. Despite the evidence of multiple health benefits in PwMS the level of PA is low [6]. * Correspondence: Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24 Uppsala, Sweden Knowledge about factors that correlate to PA is helpful in order to develop successful strategies to increase PA in PwMS. Previous studies show contradictory results regarding the influence of background factors on level of PA, such as age [7, 8], gender [8, 9], and having children living at home [7, 10]. A recent systematic review showed that employment status and educational level were consistent correlates of PA [11]. This review also showed that persons with greater disability are less physically active compared to those with a milder disease, but contradictory results were found regarding the influence of fatigue on PA [11]. Self-efficacy for PA, defined as the conviction that one can successfully execute the © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Anens et al. BMC Neurology (2017) 17:204 behavior required to produce a desired outcome [12] has shown to consistently facilitate PA [11]. Falls selfefficacy defined as the degree of efficacy (i.e. selfconfidence) to avoid a fall [13], enjoyment of PA, and social support for PA are not extensively studied in PwMS. A severe disease leads consistently to difficulties being physically active [6, 8, 9]. However, populations with more severe disability requires further investigation since MS participants in exercise interventions generally have a mild to moderate level of disability [3]. To get a better understanding of factors explaining PA in different subgroups and more useful results, it is of importance to investigate factors correlating to PA in PwMS with different disease severities. The aim of this study was to examine the multivariate association between PA and age, gender, employment, having children living at home, education, type of MS, disease severity, fatigue, self-efficacy for PA, falls selfefficacy, social support and enjoyment of PA in PwMS. Subgroup analyses with regard to disease severity were also performed. Methods Design This is a cross-sectional survey study. Participants Adults with a diagnosis of MS were recruited from the Swedish Multiple Sclerosis Registry (McDonald and/or Poser criteria). The register stratifies four types of MS; relapsing remitting, secondary progressive, primary progressive and progressive relapsing. Inclusion criteria were: having MS, age between 18 and 80 years, participants living in the county of Uppsala. All registered participants living in the county of Uppsala were invited to participate (502 subjects). Exclusion criteria were: not understanding Swedish (n = 1), not living independently (n = 1), having another neurological disease (n = 1), not being able to answer the survey (n = 1). Five participants were also excluded due to not having the required diagnosis. The final study cohort consisted of 287 subjects (response rate 58.2%). In total there were 84 men (29.3%) and 203 women (70.7%), giving a female-to-male ratio of 2.42:1. Mean age was 51.5 (SD 13.5) years. The female-to-male ratio for the 206 subjects who did not respond to the invitation was 2.38:1. Non-respondents were slightly younger, mean age 49.0 (SD 13.4) years, p = 0.048. Procedure A self-assessment questionnaire, an informatory letter, a consent form, and a stamped reply envelope were sent out by surface mail. The questionnaire was divided in two parts, with the second part sent out 2 weeks after a Page 2 of 7 reply with answers to the first part of the (...truncated)