Neurological disability, as assessed by EDSS, was also found to be associated with higher levels of MS fatigue.
Michalina Rzepka, MBBS
Data from a recent study show that patients with multiple sclerosis (MS) that have lower physical activity and a higher degree of MS-related disability experience more severe fatigue than others. A greater severity of fatigue represents greater impairments to cognitive, psychosocial, and physical functioning.1
Patients were classified as fatigued based on Fatigue Severity Scale (FSS) scores. Fatigued patients had higher mean Expanded Disability Status Scale (EDSS) scores (3.0; standard deviation [SD], 2.6) than non-fatigued patients (2.2; SD, 1.4; P = .002). Intensity of physical activity was inversely correlated with higher scores of fatigue in FSS (r = –0.38; P <.001) and Modified Fatigue Impact Scale (MFIS; r = –0.33; P <.001).
Study author Michalina Rzepka, MBBS, department of neurology, Medical University of Silesia, in Katowice, Poland, and colleagues wrote that “fatigue, due to its high prevalence and significant impact on the quality of life, is a crucial problem among patients with MS. In clinical practice, we often observe insufficient effectiveness of pharmacological treatment. To effectively reduce the occurrence of fatigue, further research should be performed to understand its etiology. It is also important to identify other factors that can reduce fatigue.”
Rzepka and colleagues analyzed data from 100 patients with relapsing-remitting MS (RRMS) with an average age of 38.8 years (SD, 9.8; range, 19–65), 78 (78%) of which were women. The average FSS score was 31.3 (SD, 15.2) and 42 patients (42%) had scores greater than 36. The average MFIS score was 30.1 (SD, 17.0). The mean EDSS score was 2.5 (SD, 1.5). Low levels of physical activity were reported by 35% of patients; 20% reported moderate levels and 45% reported high levels of physical activity, according to the International Physical Activity Questionnaire (IPAQ) scores.
The authors found that the average level of physical activity measured with standard metabolic equivalents (MET) was significantly lower in patients with fatigue (1294; SD, 2317) than in those without (2860; SD, 3038; P < .001). Overall FSS scores were inversely correlated with levels of physical activity (r = −0.38; P < .001), and total MFIS score was also inversely correlated with physical activity (r = −0.33, P < .001), as well as physical (r = −0.36) and psychosocial subscales of the MFIS (r = −0.36, P < 0.001 for both). More physically active patients also had lower levels of fatigue in the MFIS cognitive score (r = −0.25; P = .012).
Rzepka and colleagues found that patients with fatigue had MS longer (9.6 years; SD, 5.2) than those without fatigue (7.1 years; SD, 5.2; P = .003). The impact of fatigue on a patient’s life, measured by MFIS total physical, psychosocial, and cognitive scores, was found to be positively correlated with duration of MS.
Less patients with highly active professions (62% of patients; 32% fatigued) were categorized as fatigued based on FSS score than patients without active professions (53% fatigued; P = .044). These patients also had overall lower MFIS total scores (27.5; SD, 17.4) than those who were non-active (34.3; SD. 15.7; P = .046).
“It seems that physical involvement associated with professional activities may represent protective measures for fatigue in MS patients or contribute to a decrease of its level, despite a long duration of illness. The specific impact of physical activity could contribute to the creation of new recommendations and thus to the improvement of a patient’s quality of life,” Rzepka and colleagues concluded.
A recent review conducted by Nazanin Razazian, MD, associate professor, department of neurology, Kermanshah University of Medical Sciences, and colleagues came to a similar conclusion. Razazian et al conducted a meta-analysis on 31 published clinical trials investigating physical activity in patients with MS and analyzed data from a total pool of 714 patients in intervention groups and 720 in control groups.2
The standardized mean difference between the intervention groups before the intervention was 23.8 (SD, 6.2) and 16.9 (SD, 3.2) after the intervention, which indicates that the physical exercise reduces fatigue in patients with MS.
Razazian and colleagues concluded that their review “reveal(s) and confirm(s) that physical exercise significantly reduces fatigue in patients with MS. As a result, a regular exercise program is strongly recommended to be part of a rehabilitation program for these patients.”