Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey

Elisabeth Anens 0 Margareta Emtner 0 1 Lena Zetterberg 0 Karin Hellstrm 0 0 Department of Neuroscience, Section for Physiotherapy, Uppsala University , Uppsala , Sweden 1 Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University , Uppsala , Sweden Background: There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods: The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey - Revised, Exercise Self-Efficacy Scale, Falls- Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results: Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions: Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active. - Background The incidence and prevalence of multiple sclerosis (MS) has increased over the past decades, particularly among women [1]. The prevalence in Sweden is currently 188.9/100 000 [2] and about 75% debut between 2040 years of age [3]. MS is a heterogeneous progressive neurological disorder with consequences such as muscle weakness, loss of balance, limited sensation, fatigue, and spasticity that can limit a persons ability to be physically active [3]. MS is a demyelinating disease of the central nervous system, and the demyelinated areas are characterized by inflammation [4]. Physical inactivity in subjects with MS can lead to deterioration in physical function and increased risk of secondary illness such as cardiovascular co-morbidities [5,6]. Physical activity can be defined as all bodily movement that derives from the contraction of the skeletal muscles and results in increased energy expenditure [7]. Subjects with MS are less physically active than the general population [8-10], and individuals with more severe disease are less physically active compared to those with a milder disease [11]. Persons with MS have lower accelerometer activity and step counts, and less time spent in moderate-to vigorous physical activity than matched controls [9]. Cardiorespiratory exercise capacity was up to 30% lower in persons with MS than in healthy controls [12]. There is strong evidence that physical activity has positive effects on physical and mental health and quality of life [13-15]. Positive effects of physical activity have also been demonstrated in people with MS e.g. muscle strength, aerobic capacity, mobility, fatigue level, walking, and quality of life [16-20]. An important facilitator for physical activity, selfefficacy for physical activity [21,22], has also been observed in subjects with MS [23-25] but not in all samples [11,26]. Self-efficacy is defined as the conviction that one can successfully execute the behavior required to produce a desired outcome and is a central concept in Social Cognitive Theory [27,28]. Another type of self-efficacy is fallrelated self-efficacy, defined as the degree of efficacy (i.e. self-confidence) to avoid a fall [29]. Fall-related selfefficacy is relevant in subjects with MS since falling and fear of falling is often reported [30-32]. Fatigue has also been found to be a barrier to physical activity in some studies [23,25] but not in all [11,33]. On the other hand, social support for physical activity can be a facilitator for physical activity in subjects with MS [34], however, contradictory results have been reported [11]. Studies regarding facilitators and barriers to physical activity in subjects with MS are still few and not consistent. In the general population it has been shown that men have a higher physical activity level than women [35]. Gender differences regarding factors associated with physical activity have also been shown, such as personal barriers that have been found to be more important to women than men [36-38]. A meta analysis [8] of physical activity in individuals with MS showed combined samples of women and men to be significantly less physically active compared to samples of women alone, indicating that men are less physically active. Jobin et al. [39] reviewed the literature and summarized gender-related issues in MS, showing that a benign course of the disease is more often associated with the female gender, and the progression is worse for men than for women when all disease courses are included. On the other hand men and women experience disabling fatigue with the same frequency, whereas studies investigating gender in social support in general show varying results [39]. Little research focus has been placed on gender in MS with regard to physical activity, despite the gender differences found in other populations. Aims The aim of the study was to examine physical activity, severity of disease, fatigue levels, self-efficacy for physical activity, fall-related self-efficacy and social support for physical activity, in a sample of subjects with MS, in addition to study gender differences. Methods The study has been performed as a cross-sectional cohort survey with a descriptive and comparative design. Study cohort Individuals between 1880 years with a diagnosis of MS were recruited from the Swedish Multiple Sclerosis Registry (http://www.msreg.net). The register specify four types of MS; relapsing remitting, secondary progressive, primary progressive or progressive relapsing. All registered subjects living in the county of Uppsala were invited to participate (502 subjects). Five subjects were excluded due to not having the required diagnosis. Other reasons for exclusion were not living independent (n = 1), not understand (...truncated)