Original article| Volume 96, ISSUE 1, P24-29, January 2015

Download started.


Is Physical Behavior Affected in Fatigued Persons With Multiple Sclerosis?

Published:September 17, 2014DOI:


      • Fatigued persons with multiple sclerosis are less physically active than healthy controls during the whole day.
      • Persons with multiple sclerosis are especially less active in the morning and evening.
      • Persons with multiple sclerosis spend more time sedentary and less time at higher-intensity physical activity than healthy controls.
      • Persons with multiple sclerosis have longer sedentary periods and shorter high-intensity periods.
      • Detailed measures may provide more insight into how multiple sclerosis affects physical behavior.



      To study physical behavior in detail in fatigued persons with multiple sclerosis (MS).


      Case-control explorative study.


      Outpatient rehabilitation department and participants' daily environment.


      Fatigued persons with MS (n=23) were selected from a randomized controlled trial. Cases were matched by age and sex to healthy, nonfatigued controls (n=23). Eligible persons with MS were severely fatigued (Checklist Individual Strength fatigue domain mean score, 43.2±6.6) and ambulatory (Expanded Disability Status Scale mean score, 2.5±1.5).


      Not applicable.

      Main Outcome Measures

      Measurements were performed using an accelerometer over 7 days. Outcomes included the following: amount of physical activity expressed in counts per day, counts per minute (CPM), and counts per day period (morning, afternoon, evening); duration of activity intensity categories (sedentary, light physical activity, moderate-to-vigorous physical activity [MVPA]); and distribution of MVPA and sedentary periods over the day.


      Persons with MS had fewer counts per day (mean difference, −156×103; 95% confidence interval [CI], −273×103 to −39×103; P=.010), had fewer CPM (mean difference, −135; 95% CI, −256 to −14; P=.030), and were less physically active in the morning (mean difference, −200; 95% CI, −389 to −11; P=.039) and evening (mean difference, −175; 95% CI, −336 to −14; P=.034) than controls. Persons with MS spent a higher percentage of their time sedentary (mean difference, 5.6; 95% CI, .1–11.1; P=.045) and spent less time at the higher MVPA intensity (mean difference, −2.4; 95% CI, −4.7 to −0.09; P=.042). They had fewer MVPA periods (mean difference, 29; 95% CI, −56.2 to −2.6; P=.032) and a different distribution of sedentary (mean difference, .033; 95% CI, .002 to .064; P=.039) and MVPA periods (mean difference, −.08; 95% CI, −.15 to −.01; P=.023).


      Detailed analyses of physical behavior showed that ambulatory fatigued persons with MS do differ from healthy controls not only in physical activity level, but also in other physical behavior dimensions (eg, day patterns, intensity, distribution).


      List of abbreviations:

      CI (confidence interval), CPM (counts per minute), MS (multiple sclerosis), MVPA (moderate-to-vigorous physical activity)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stuke K.
        • Flachenecker P.
        • Zettl U.K.
        • et al.
        Symptomatology of MS: results from the German MS Registry.
        J Neurol. 2009; 256: 1932-1935
        • Motl R.W.
        • Snook E.M.
        • Wynn D.R.
        • Vollmer T.
        Physical activity correlates with neurological impairment and disability in multiple sclerosis.
        J Nerv Ment Dis. 2008; 196: 492-495
        • Motl R.W.
        Physical activity and irreversible disability in multiple sclerosis.
        Exerc Sport Sci Rev. 2010; 38: 186-191
        • Bussmann J.B.
        • van den Berg-Emons R.J.
        To total amount of activity..... and beyond: perspectives on measuring physical behavior.
        Front Psychol. 2013; 4: 463
        • Minden S.L.
        • Frankel D.
        • Hadden L.
        • Perloffp J.
        • Srinath K.P.
        • Hoaglin D.C.
        The Sonya Slifka Longitudinal Multiple Sclerosis Study: methods and sample characteristics.
        Mult Scler. 2006; 12: 24-38
        • de Groot V.
        • Beckerman H.
        • Lankhorst G.J.
        • Polman C.H.
        • Bouter L.M.
        The initial course of daily functioning in multiple sclerosis: a three-year follow-up study.
        Mult Scler. 2005; 11: 713-718
        • de Groot V.
        • Beckerman H.
        • Twisk J.W.
        • et al.
        Vitality, perceived social support and disease activity determine the performance of social roles in recently diagnosed multiple sclerosis: a longitudinal analysis.
        J Rehabil Med. 2008; 40: 151-157
        • Motl R.W.
        • McAuley E.
        • Snook E.M.
        Physical activity and multiple sclerosis: a meta-analysis.
        Mult Scler. 2005; 11: 459-463
        • Sandroff B.M.
        • Dlugonski D.
        • Weikert M.
        • Suh Y.
        • Balantrapu S.
        • Motl R.W.
        Physical activity and multiple sclerosis: new insights regarding inactivity.
        Acta Neurol Scand. 2012; 126: 256-262
        • Ng A.V.
        • Kent-Braun J.A.
        Quantitation of lower physical activity in persons with multiple sclerosis.
        Med Sci Sports Exerc. 1997; 29: 517-523
        • Dlugonski D.
        • Pilutti L.A.
        • Sandroff B.M.
        • Suh Y.
        • Balantrapu S.
        • Motl R.W.
        Steps per day among persons with multiple sclerosis: variation by demographic, clinical, and device characteristics.
        Arch Phys Med Rehabil. 2013; 94: 1534-1539
        • Kos D.
        • Nagels G.
        • D'Hooghe M.B.
        • et al.
        Measuring activity patterns using actigraphy in multiple sclerosis.
        Chronobiol Int. 2007; 24: 345-356
        • Blikman L.J.
        • Huisstede B.M.
        • Kooijmans H.
        • Stam H.J.
        • Bussmann J.B.
        • van Meeteren J.
        Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2013; 94: 1360-1376
        • Evering R.M.
        • Tonis T.M.
        • Vollenbroek-Hutten M.M.
        Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: a case control study.
        J Psychosom Res. 2011; 71: 129-135
        • Arnardottir N.Y.
        • Koster A.
        • Van Domelen D.R.
        • et al.
        Objective measurements of daily physical activity patterns and sedentary behaviour in older adults: Age, Gene/Environment Susceptibility-Reykjavik Study.
        Age Ageing. 2013; 42: 222-229
        • Chastin S.F.
        • Ferriolli E.
        • Stephens N.A.
        • Fearon K.C.
        • Greig C.
        Relationship between sedentary behaviour, physical activity, muscle quality and body composition in healthy older adults.
        Age Ageing. 2012; 41: 111-114
        • Chastin S.F.
        • Baker K.
        • Jones D.
        • Burn D.
        • Granat M.H.
        • Rochester L.
        The pattern of habitual sedentary behavior is different in advanced Parkinson's disease.
        Mov Disord. 2010; 25: 2114-2120
        • Chastin S.F.
        • Granat M.H.
        Methods for objective measure, quantification and analysis of sedentary behaviour and inactivity.
        Gait Posture. 2010; 31: 82-86
        • Rietberg M.B.
        • van Wegen E.E.
        • Kollen B.J.
        • Kwakkel G.
        Do patients with multiple sclerosis show different daily physical activity patterns from healthy individuals?.
        Neurorehabil Neural Repair. 2014; 28: 516-523
        • Klaren R.E.
        • Motl R.W.
        • Dlugonski D.
        • Sandroff B.M.
        • Pilutti L.A.
        Objectively quantified physical activity in persons with multiple sclerosis.
        Arch Phys Med Rehabil. 2013; 94: 2342-2348
        • Beckerman H.
        • Blikman L.J.
        • Heine M.
        • et al.
        The effectiveness of aerobic training, cognitive behavioural therapy, and energy conservation management in treating MS-related fatigue: the design of the TREFAMS-ACE programme.
        Trials. 2013; 14: 250
        • Matthew C.E.
        Calibration of accelerometer output for adults.
        Med Sci Sports Exerc. 2005; 37: S512-S522
        • Motl R.W.
        • Snook E.M.
        • Agiovlasitis S.
        • Suh Y.
        Calibration of accelerometer output for ambulatory adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2009; 90: 1778-1784
        • van Weering M.G.
        • Vollenbroek-Hutten M.M.
        • Tonis T.M.
        • Hermens H.J.
        Daily physical activities in chronic lower back pain patients assessed with accelerometry.
        Eur J Pain. 2009; 13: 649-654
        • Carr L.J.
        • Mahar M.T.
        Accuracy of intensity and inclinometer output of three activity monitors for identification of sedentary behavior and light-intensity activity.
        J Obes. 2012; 2012: 460271
        • Kozey-Keadle S.
        • Libertine A.
        • Lyden K.
        • Staudenmayer J.
        • Freedson P.S.
        Validation of wearable monitors for assessing sedentary behavior.
        Med Sci Sports Exerc. 2011; 43: 1561-1567
        • Sasaki J.E.
        • John D.
        • Freedson P.S.
        Validation and comparison of ActiGraph activity monitors.
        J Sci Med Sport. 2011; 14: 411-416
        • Alghaeed Z.
        • Reilly J.J.
        • Chastin S.F.
        • Martin A.
        • Davies G.
        • Paton J.Y.
        The influence of minimum sitting period of the ActivPAL on the measurement of breaks in sitting in young children.
        PLoS One. 2013; 8: e71854
        • Lord S.
        • Chastin S.F.
        • McInnes L.
        • Little L.
        • Briggs P.
        • Rochester L.
        Exploring patterns of daily physical and sedentary behaviour in community-dwelling older adults.
        Age Ageing. 2011; 40: 205-210
        • Klassen L.
        • Schachter C.
        • Scudds R.
        An exploratory study of two measures of free-living physical activity for people with multiple sclerosis.
        Clin Rehabil. 2008; 22: 260-271
        • Weikert M.
        • Suh Y.
        • Lane A.
        • et al.
        Accelerometry is associated with walking mobility, not physical activity, in persons with multiple sclerosis.
        Med Eng Phys. 2012; 34: 590-597
        • Sandroff B.M.
        • Motl R.W.
        Comparison of ActiGraph activity monitors in persons with multiple sclerosis and controls.
        Disabil Rehabil. 2013; 35: 725-731
        • Chastin S.F.
        • Schwarz U.
        • Skelton D.A.
        Development of a consensus taxonomy of sedentary behaviors (SIT): report of Delphi Round 1.
        PLoS One. 2013; 8: e82313
        • Hamilton M.T.
        • Healy G.N.
        • Dunstan D.W.
        • Zderic T.W.
        • Owen N.
        Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior.
        Curr Cardiovasc Risk Rep. 2008; 2: 292-298