Accelerometer measured physical activity and sedentary time in individuals with multiple sclerosis versus age matched controls: A systematic review and meta-analysis

BACKGROUND

People with Multiple Sclerosis (PwMS) find it more difficult to engage in physical activity (PA) than healthy controls. Accelerometers can be used to measure sedentary time and free-living physical activity, understanding the differences between PwMS and controls can help inform changes such as interventions to promote a more active lifestyle. This in turn will help prevent secondary conditions and reduce symptom progression.

OBJECTIVE

To conduct a systematic review and meta-analysis on accelerometer measured sedentary behavior and physical activity between PwMS and healthy controls.

METHODS

A systematic search of five databases (PubMed, Web of Science, Ovid, Science Direct and CINAHIL) from inception until 22nd November 2019. Inclusion criteria was (1) included a group of participants with a definite diagnosis of multiple sclerosis of any type; (2) have 3 or more days of PA monitoring using accelerometers during free living conditions; (3) include age matched healthy controls; (4) assess adults over the age of 18; (5) reported data had to have been reported in a manner suitable for quantitative pooling including: percent of time spent sedentary, minutes per day of sedentary, light, moderate, vigorous activity (moderate and vigorous totaled together), steps per day or counts per day.

RESULTS

Initial search produced 9021 papers, after applying inclusion criteria 21 eligible papers were included in the study. One paper was a longitudinal study from which only baseline data was included. One paper was a reliability and validity study, with data for PwMS versus controls in the validity section. All other papers are cross sectional, with one being a pilot study and another a random control study. One paper used two devices in unison, only one set of data is included in the statistics. Outcome data was available for 1098 participants, 579 PwMS and 519 healthy controls. Significant differences were seen in all categories tested: (1) sedentary time (min/day), standard mean difference -0.286, P = 0.044, n = 4 studies; (2) relative sedentary time (%/day), standard mean difference -0.646, P = 0.000, n = 5 studies; (3) LPA (min/day), standard mean difference 0.337, P = 0.039, n = 5 studies; (4) relative LPA (%/day), standard mean difference 0.211, P = 0.152, n = studies; (5) MVPA (min/day), standard mean difference 0.801, P = 0.000, n = 8 studies; (6) relative MVPA (%/day), mean difference 0.914, P = 0.000, n = 5 studies; (7) step count, standard mean difference 0.894, P = 0.000, n = 8 studies; (8) activity count, standard mean difference 0.693, P = 0.000, n = 13 studies.

CONCLUSION

PwMS are more sedentary and engage in less LPA, MVPA, steps per day and accelerometer counts per day than healthy controls when measured using accelerometers during free-living conditions.

Depression in multiple sclerosis: Is one approach for its management enough?

BACKGROUND

Major depression disorder (MDD) and severe depression symptoms are highly prevalent in multiple sclerosis (MS). Depression can worsen symptoms of MS and is associated with significantly reduced quality of life and increased risk of suicide. Currently, there is no gold-standard, single treatment available for depression in MS. Pharmacotherapy, cognitive behavior therapy (CBT), and exercise training individually are moderately, yet incompletely, efficacious for managing depression in the general population and MS.

PURPOSE

This review provides an overview of evidence from meta-analyses and systematic reviews for current treatments of depression in persons with MS. This review further develops the rationale for using a combinatory treatment approach in persons with MS.

METHODS

We performed a narrative review of meta-analyses and systematic reviews regarding the current state of evidence for the three most common treatments of depression in persons with MS (i.e., antidepressant medication, cognitive-behavior therapy, and exercise training). We provide a concise assessment of the overall effect of these treatments on depression in the general population and then persons with MS. We further note short-comings of research on these treatments for depression.

CONCLUSION

There is no single, gold-standard treatment for depression in MS, and we proposed that combinatory treatments should be considered for the management of depression in MS. However, there is a paucity of evidence for the use of combinatory therapy on depression and its outcomes in persons with MS, and this supports direct examination of the feasibility and efficacy of such combinatory approaches for MDD in MS.

A cross-sectional study of alexithymia in patients with relapse remitting form of multiple sclerosis

Background:

Alexithymia is one's incapacity to identify, comprehend, and describe emotions. There is almost no literature data about the levels of alexithymia among patients with relapse remitting type of multiple sclerosis.

Aim:

The objective of the present study was to assess the levels of alexithymia in patients with relapse remitting type of multiple sclerosis in relation to their sociodemographic variables and clinical characteristics of the disease.

Methods:

This cross-sectional study included 106 consecutively assessed patients with relapse remitting type of multiple sclerosis. In addition to the data regarding disease duration, number of demyelinating relapses, and degree of neurological disability, assessed by the expanded disability scale score (EDSS), we used Toronto alexithymia scale (TAS), fatigue severity scale (FSS) and, Hamilton scale for the assessment of anxiety and depression and sociodemographic questionnaire.

Results:

Study included 74 female and 32 male patients, with a median age of 44 years, median disease duration 90 months, and median EDSS 4. About 29.55% of patients had alexithymia and borderline alexithymia was observed in 31.15% patients. Alexithymia correlated with anxiety and depression (P < 0.01) on all TAS subscales. Higher levels of neurological disability based on EDSS, severe fatigue based on FSS scores, and severe relapse remitting type of multiple sclerosis with more relapses and longer disease duration correlated with alexithymia (P < 0.01), depression (P < 0.01), and anxiety (P < 0.01). Higher rates of alexithymia were noticed in older, unemployed, single patients, and those having fewer children.

Conclusions:

Alexithymia was found in a relatively high percentage in patients with relapse remitting type of multiple sclerosis.