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Diet, Physical Activity, and Stress Among Wheelchair Users with Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors

Published:January 13, 2023DOI:https://doi.org/10.1016/j.apmr.2022.12.194
Diet, Physical Activity, and Stress Among Wheelchair Users with Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors
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      Abstract

      Objective

      This study examined individual and co-occurring behavioral risk factors (diet, exercise, and stress) in wheelchair users with multiple sclerosis (MS) and potential association with MS symptoms (i.e., fatigue, depression, anxiety, pain, sleep, and health-related quality of life [HRQOL]).

      Design

      Survey

      Setting

      General Community

      Participants

      One hundred twenty-three wheelchair users with MS completed this study.

      Interventions

      Not applicable

      Main Outcome Measures

      Participants were mailed instructions for accessing online questionnaires (demographic and clinical characteristics, Godin Leisure-Time Exercise Questionnaire, Perceived Stress Scale, Automated Self-Administered 24-Hour Dietary Assessment Tool, and MS symptoms).

      Results

      Standard cut-points were utilized to categorize behavioral risk factors and then identify the extent and distribution of these behaviors both individually and co-occurring. We then analyzed the associations between behavioral risk factors and MS symptoms using bivariate correlation analyses and Mann-Whitney U tests. The mean age of participants was 60.6±10.0 years, 76% identified as female, 82% had a progressive disease course, and the mean MS duration was 23.0±9.7 years. Seven participants were classified as having 0 negative health behaviors, 41 participants had 1 negative health behavior, 49 participants had 2 negative health behaviors, and 26 participants had 3 negative health behaviors. The number of negative health behaviors was significantly correlated with HRQOL (physical, r=.30; psychological, r=.47), sleep (r=.25), depressive symptoms (r=.36), and anxiety (r=.43). Mann-Whitney U tests indicated greater fatigue, depression, and anxiety as well as lower sleep quality and HRQOL among participants who reported 2 or 3 behavioral risk factors compared to 0 or 1 behavioral risk factor.

      Conclusions

      Future research should examine the design and implementation of multiple health behavior change interventions targeting co-occurring behavioral risk factors among wheelchair users with MS.

      Keywords

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      Article info

      Publication history

      Accepted: December 18, 2022
      Received in revised form: November 7, 2022
      Received: September 16, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Presentations: This study will be presented in an accepted poster presentation at the ACRM Annual Conference 2022.

      Funding: This research was funded in part, by a pilot grant program supported by the Consortium for Multiple Sclerosis Centers and EMD Serono Inc., and fellowship funding by the Eunice Kennedy Shriver National Institute of Child Health & Human Development [F32HD101214; F31HD101281]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

      Conflict of Interest: This research was funded in part, by a pilot grant program supported by the Consortium for Multiple Sclerosis Centers and EMD Serono Inc. awarded to Dr. Silveira. Dr. Cutter reports personal fees from Pythagoras Board membership, personal fees from Brainstorm Cell Therapeutics, personal fees from Teva Neuroscience, personal fees from EMD Serono, personal fees from Novartis, personal fees from CSL Behring, personal fees from Avexis Pharmaceuticals, personal fees from Genzyme, personal fees from Medimmune/Viela Bio, personal fees from Receptos/celgene, personal fees from Biolinerx, personal fees from Sanofi-Aventis, personal fees from Galmed, personal fees from Opko, personal fees from NHLBI, personal fees from NICHD, personal fees from Vivus, personal fees from Genentech, personal fees from Reata Pharmaceuticals, personal fees from GW Pharmaceuticals, personal fees from Roche, personal fees from Orphazyme, personal fees from Horizon Pharmaceuticals, personal fees from Merck/Pfizer, personal fees from Klein-Buendel, personal fees from TG Therapeutics, personal fees from Celgene/BMS, personal fees from Recursion Pharmaceuticals, personal fees from Antisense Therapeutics, personal fees from AMO Pharmaceuticals, personal fees from Astra Zeneca, personal fees from Regeneron, personal fees from Mitsubishi Tanabe Pharma, personal fees from Immunic, personal fees from Protalix Biotherapeutics, personal fees from Alexion, personal fees from Clinical Trial Solutions LLC, personal fees from Green Valley Pharmaceuticals, personal fees from Mapi Pharmaceuticals, personal fees from AI Therapeutics, personal fees from SAB Biotherapeutics, personal fees from Avexis, personal fees from Brainstorm Therapeutics, personal fees from Applied Therapeutics, outside the submitted work. The other authors have nothing to disclose.

      List of abbreviations: Multiple Sclerosis (MS); National Multiple Sclerosis Society (NMSS); Wellness Working Group (WWG); Randomized Controlled Trial (RCT); Health-Related Quality of Life (HRQOL); North American Research Committee on MS (NARCOMS); Automated Self-Administered 24-Hour (ASA24); Health Eating Index-2015 (HEI-2015); Godin Leisure-Time Exercise Questionnaire Health Contribution Score (GLTEQ HCS); Perceived Stress Scale (PSS); Fatigue Severity Scale (FSS); Hospital Anxiety and Depression Scale (HADS); McGill Pain Questionnaire (MPQ); Pittsburg Sleep Quality Index (PSQI); 29-Item Multiple Sclerosis Impact Scale (MSIS-29); Patient Determined Disease Steps (PDDS)

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2022.12.194

      Copyright

      © 2023 by the American Congress of Rehabilitation Medicine.

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