# Exercise as it relates to Disease/Can Exercise Really Help Multiple Sclerosis?

The following is a critique of the research paper Correlates of Physical Activity Among Individuals with Multiple Sclerosis: A cross sectional trial, published in 2006

## What is the background to this research?

Across the United States of America, there are approximately 400,000 known cases of Multiple Sclerosis (MS), leaving it as the leading neurological disease in younger and middle aged adults. MS is a disease that affects the central nervous system, which is made up of the brain, the spinal cord and the optic nerve. Research has found that females are two times more likely to have MS then males. MS is an unpredictable disease, as everyone's case is different. Although everyone will have functional limitations, only 50% of people will require a walking aid at a stage in their lives and only 10% of that population will need to be placed in a wheelchair
Although there is no found cue for MS, there are ways in which the symptoms can be reduced. Physical activity is defined as "bodily movement produced by contraction of skeletal muscles resulting in an increase in energy expenditure and is accumulated in leisure time physical activity, exercise, household chores, and occupational work". Research has found that physical activity has unique advantages for those who suffer from MS, as it helps to reduce fatigue symptoms, mobility, spasticity, pain and without the participation of regular physical activity, there are increased chances of relapse and worsen symptoms
The hypothesis behind this study is that self-efficiency will have a direct link to physical activity. Enjoyment, social support, disability will all be link to physical activity through self- efficiency. It’s important to understand the relationship between variables and psychical activity as physical activity is becoming a treatment for those who have been diagnosed with MS.

## Where is the research from?

The Authors of this study, Robert Molt, Erin Snook, Edward McaAuley, Jennifer Scott and Martha Douglass, were from Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign. All authors are co-authors on other published articles in the area of sport science.

## What kind of research was this?

This trial was a cross sectional research. Cross sectional trials give the authors an understanding of how MS can affect a population at any specific point in time.

## What did the research involve?

Subjects were recruited though the Greater Illinois, Indiana, and Gateway chapters of the National Multiple Sclerosis Society (NMSS), which has approximately 12,000 people diagnosed with MS. The targeted population were contacted though a support group and advertising. The researches asked for those who were interested to make contact. Those who were interested were then re-contacted and were given an explanation on how the study was going to work. During these phone calls a verbal consent and a brief screening was conducted. Those who passed met the criteria of the following: a. Definite diagnosis of MS b. No relapse in the past 30 days c. Need minimal assistance (walking with or without just a cane) After the criteria was and screening were finished, 196 subjects were moved on to participate in the research.
173 women and 23 males took part in the research. They were all sent a package that included a written consent form, a number of questionnaires and an accelerometer. The participants were asked to fill out all forms on the Sunday before commencing on the Monday. The accelerometer was to be worn from the time they woke up until they go to bed. Water based activities were excused. The time spent wearing the accelerometer was recorded in a logbook. The testing finished after 7 days and the participants were asked to send all of the documents back to postal address.
The researchers looked into how different factors changed the amount someone participated in physical activity. A social cognitive perspective was embraced and the physical activity influences of social support, enjoyment, disability and self-efficacy were all studied. They were looking to understand which were closely related to physical activity and which would have an influence on individuals with MS.

## What were the basic results?

Those who participated in this study were found to be less active compared to those in a separate similar study. Comparing the QLTEQ in table one between current study and compared study, it is clear that the participates in current study could recognise they started off less active. During the seven days the accelerometer again proved that those whom took part in this study were less active compared to those in compared study.
Table 1 :
| | Current Study | | | Compared Study |
| | Mean | SD | Range | Mean | SD | Range |
| GLTEQ | 29.6 | 28.3 | 0-198 | 56 | 57 | 0-271 |
| Accelerometer (counter per day) | 223,489 | 114,543 | 53,691-818,217 | 241,688 | 120,972 | 66,039-597,863 |
* SD = Standard Deviation
* GlTEQ = Godin Leisure Time Exercise Questionnaire
The data was analysed by covariance modelling and maximum likelihood estimation. The models were broken down into two steps. Step one involved testing the fit of measurements and the second step two involved testing if the models worked.
The models were assessed by using chi- square, root mean squared error approximation (RMSEA), standardised root mean squared residual (SRMSR) and comparative fit index (CFI). Each of these have a specific way of understanding how close the measure of fit is. These statistical measures were then used to help design the models and how the variables influenced physical activity
The hypothesised model of how the variables related to physical activity was that Enjoyment, Social support and Disability all related directly to Slef-efficany. Self-Efficacy was then the direct link to Physical activity. After completely several different tests with the statistical measurements, it was found that the original model wouldn’t fit the given results. The researches completed an additional testing that would state that statistically self-efficiency and enjoyment both have significant impacts on physical activity. There was direct relationships between Social Support and disability which then related them to Physical activity through either Enjoyment and or Self efficiency.

## What conclusions can we take from this research?

Based on the evidence provided, self-efficacy and enjoyment are both scientifically related to physical activity for those whom suffer from MS. The finding in this study aligns with the findings in a study which was investigating how physical activity creates a better quality of life for those with MS. Benito-León J, in their review they state that those who were more self-efficient, participated in more physical activity and as did other results in other studies

## Practical advice

While the optimal amount of physical activity is unknown for those who suffer from MS, maintaining a continuous schedule but ensuring the activity is self-efficient and enjoyable. Exercise treats the symptoms that arise with MS and slows the deformities happening with in the central nervous system. Before commencing any physical activity, participants should always consult with their general practitioner.

## Further information/resources

Understanding MS – an introduction for people living with MS
* https://www.msaustralia.org.au/sites/default/files/Understanding-MS-Aug2012(1).pdf

## References

* ↑ Motl RW, Snook EM, McAuley E, Scott JA, Douglass ML. Correlates of physical activity among individuals with multiple sclerosis. Annals of behavioral medicine. 2006 Oct 1;32(2):154.
* ↑ Motl RW, Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Annals of behavioral medicine. 2008 Feb 12;35(1):111-5.
* ↑ https://www.msaustralia.org.au/sites/default/files/Understanding-MS-Aug2012(1).pdf
* ↑ Motl RW, Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Annals of behavioral medicine. 2008 Feb 12;35(1):111-5.
* ↑ Motl RW, Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Annals of behavioral medicine. 2008 Feb 12;35(1):111-5.
* ↑ Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports. 1985 Mar;100(2):126.
* ↑ Schapiro RT. The symptomatic management of multiple sclerosis. Annals of Indian Academy of Neurology. 2009 Oct;12(4):291.
* ↑ Hemmett L, Holmes J, Barnes M, Russell N. What drives quality of life in multiple sclerosis?. Qjm. 2004 Oct 1;97(10):671-6.
* ↑ 7. Benito-León J, Manuel Morales J, Rivera-Navarro J, Mitchell AJ. A review about the impact of multiple sclerosis on health-related quality of life. Disability and rehabilitation. 2003 Dec 2;25(23):1291-303.
* ↑ (Motl RW, Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Annals of behavioral medicine. 2008 Feb 12;35(1):111-5
* ↑ Motl RW, Snook EM, McAuley E, Scott JA, Douglass ML. Correlates of physical activity among individuals with multiple sclerosis. Annals of behavioral medicine. 2006 Oct 1;32(2):154.