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Timing of Physical Activity Affects Its Benefit for Restless Legs Syndrome in Multiple Sclerosis

Evening physical activity was associated with lower restless legs syndrome severity, while more time spent in the morning on physical activity, specifically light physical activity, was associated with worse sleep quality.

According to a recently published study, restless legs syndrome (RLS) severity may be reduced in patients with multiple sclerosis (MS) through physical activity, particularly light physical activity (LPA) and evening steps shortly before bed. Higher morning and overall LPA were associated with worse sleep quality.1

Using Spearman rho correlations, more time spent in evening LPA (ρ = –0.42), more evening steps (ρ = ­–0.51), and more overall daily steps (ρ = –0.40) had moderate-to-strong associations with lower RLS severity. Additionally, regarding total weekly physical activity, more time spent in morning LPA (ρ = 0.34) and overall daily LPA (ρ = 0.33) had moderate associations with higher scores on Pittsburgh Sleep Quality Index (PSQI), or worse sleep quality.

RLS, a sensory-motor neurological disorder, has a prevalence rate of 26% in adults with MS.2 The presence and severity of RLS has been linked to the number and location of demyelinating spinal lesions, and has been negatively associated with symptoms of MS. Senior investigator Robert W. Motl, MD, professor of Kinesiology and Nutrition, University of Illinois Chicago, and colleagues aimed to examine the associations between physical activity and RLS severity in MS, as well as the time of day in which physical activity may be most beneficial.

A total of 39 participants, primarily female (77%) and Caucasian (87%), were included in the study. The International Restless Legs Syndrome Study Group Scale (IRLS) provided an overcome of overall RLS severity, while the 19-item PSQI provided an outcome of perceived sleep quality. Participants wore an ActiGraph GT3X+ accelerometer on a belt around the waist during waking hours for a 7-day period as a measure of psychical activity. The data from the accelerometers were processed with low frequency extension and quantified as average minutes per day of LPA and moderate-to-vigorous physical activity (MVPA), based on MS-specific cut-points.

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Of the cohort, participants had an average IRLS score of 16.4 and most (85%) participants classified as moderate-to-severe RLS. Similar to the total weekly output, on weekdays, more time spent in evening LPA (ρ = –0.39), more evening steps (ρ = ­–0.50) and more overall daily steps (ρ = –0.41) had moderate-to-strong associations with lower RLS severity. On weekend days, more time spent in evening LPA (ρ = ­–0.44), more time spent in MVPA (ρ = –0.42), more evening steps (ρ = –0.51), and more overall daily steps (ρ = –0.39) had moderate-to-strong associations with lower RLS severity. There were no other significant associations observed.

Higher PSQI scores, or worse sleep quality, were moderately associated with more time in morning LPA (ρ = –0.33), more evening MVPA (ρ = 0.32), and more overall daily LPA (ρ = –0.42) on weekdays. On weekend days, more morning MVPA (ρ = –0.42) was moderately associated with higher PSQI scores. Aside from those, there were no other significant associations.

"Future research might consider evaluating a specific cut-off for maximizing the benefit of physical activity (eg, step counts) in the management of RLS symptoms and sleep," Motl et al wrote. "There is no reason to believe our findings would not generalize outside of MS and our results are complimentary of a previous study in adults with RLS from the general population, yet future research should evaluate these relationships in the general population of adults with RLS."

1. Cederberg KL, Jeng B, Sasaki JE, et al. Does physical activity timing differentially correlate with symptoms of restless legs syndrome in adults with multiple sclerosis? Sleep Med. 2022;100:120-127. doi:10.1016/j.sleep.2022.08.001
2. Ning P, Hu F, Yang B, et al. Systematic review and meta-analysis of observational studies to understand the prevalence of restless legs syndrome in multiple sclerosis: an update. Sleep Med. 2018;50:97-104. doi:10.1016/j.sleep.2018.05.039.