Impact of rehabilitation on physical activity behavior in persons with multiple sclerosis

Background: People with multiple sclerosis(PwMS) are likely to be less physically active than the general population. It is unknown whether doing rehabilitation aimed at improving mobility changes physical activity behavior in pwMS. Methods: Inpatients(N=27) and outpatients(N=18) (EDSS 3.5-7.0; mean±standard deviation age:55.6±11.6 years) undergoing rehabilitation were recruited. Participants wore a Fitbit Versa tracker for one week at the beginning(T0) and one week at the end(T1) of their rehabilitation period, recording(primary outcomes) daily steps, minutes of light physical activity(LPA), and of moderate-vigorous physical activity(MVPA). Clinical assessment: Godin Leisure-Time Exercise Questionnaire(GLTEQ), 2-Min Walking Test(2MWT)(T0,T1), Fatigue Severity Scale(FSS), Self-Efficacy in Multiple Sclerosis scale(SEMS)(T0,T1,T2). Inpatients did 2-3 rehabilitation sessions a week, while outpatients did 2 sessions per day. Change scores of primary outcomes were analysed between groups with T-tests. Results: There were no differences in demographic and clinical characteristics between inpatients and outpatients, except in EDSS level (5.06 vs 5.88, p<0.05). At T0, the number of daily steps was 4441±2469 for inpatients and 4958±2629 for outpatients, well below recommended activity levels for PwMS. No significant changes were observed within-group(inpatients 4149±2440 steps; outpatients 4812±2390 steps T0-T1, p>0.05) or between-groups(p>0.5). Inpatients performed 7.16±15.0 minutes of moderate-vigorous activities daily and outpatients 17.8±14.1 minutes, with a statistical difference between groups at T0(p-value=0.027). At T1, no significant changes were observed within-group(inpatients:9.9±14.3; outpatients:13.7±16.6 minutes, p>0.05) or between-groups(p=0.1). GLTEQ(inpatients: 15.6±18.0; outpatients: 22.14±22.3 points), SEMS(inpatients: 40.9±9.2; outpatients: 40.9±10.8 points), 2MWT(inpatients: 86.5±33.0 m; outpatients: 103.5±45.3 m) and FSS(inpatients: 47.6±16.0; outpatients: 44.8±12.0) were similar between groups at T0(p>0.05) with no statistically different changes in either group at T1(p>0.05). Conclusion: PwMS are less physically active than the general population and even when following a rehabilitation program they do not increase their physical activity levels. Physical therapists should be encouraged to counsel pwMS on ways to increase daily physical activity as part of rehabilitation delivery.