Abstract
Background
Physical activity is lower in people with multiple sclerosis (pwMS) compared to healthy
controls. Previous work focused on studying activity levels or activity volume, but
studies of daily-living rest-activity fragmentation patterns, circadian rhythms, and
fractal regulation in pwMS are limited. Based on findings in other cohorts, one could
suggest that these aspects of daily-living physical activity will provide additional
information about the health and well-being of pwMS. Therefore, here, we aimed to
(1) identify which fragmentation, fractal, and circadian amplitude measures differ
between pwMS and healthy controls, (2) evaluate the relationship between fragmentation,
fractal, and circadian amplitude measures and disease severity, and (3) begin to evaluate
the added value of those measures, as compared to more conventional measures of physical
activity (e.g., mean signal vector magnitude (SVM). A global measure of the overall
volume of physical activity).
Methods
132 people with relapsing-remitting MS (47±11 yrs, 69.7% female, Expanded Disability
Status Scale, EDSS, median (IQR): 3 (2–4)) and 90 healthy controls (46±11 yrs, 47.8%
female) were asked to wear a 3D accelerometer on their lower back for 7 days. Rest-activity
fragmentation, circadian amplitude, fractal regulation, and mean SVM metrics were
extracted. PwMS and healthy controls were compared using independent samples t-tests
and linear regression, including comparisons adjusted for mean SVM to control for
the effect of physical activity volume. Spearman correlations between measures and
logistic regressions were used to identify the clinical condition based on the measures
that differed significantly after adjusting for SVM. All analyses included adjustments
for demographic and clinical parameters (e.g., age, sex).
Results
Multiple measures of activity fragmentation significantly differed between pwMS and
healthy controls, reflecting a more fragmented active behavior in pwMS. PwMS had a
lower circadian rhythm amplitude, indicating a smaller amplitude in the circadian
changes of daily activity, and weaker temporal correlations as based on the fractal
analysis. When taking into account physical activity volume, one circadian amplitude
measure and one fractal measure remained significantly different in pwMS and controls.
Fragmentation measures and circadian amplitude measures were significantly associated
with disability level as measured by the EDSS; the association with circadian amplitude
remained significant, even after adjusting for the mean SVM.
Conclusion
The physical activity patterns of pwMS differ from those of healthy individuals in
rest-activity fragmentation, the amplitude of the circadian rhythm, and fractal regulation.
Measures describing these aspects of activity provide information that is not captured
in the total volume of physical activity and could, perhaps, augment the monitoring
of disease progression and evaluation of the response to interventions.
Keywords
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Article info
Publication history
Published online: August 17, 2022
Accepted:
August 12,
2022
Received:
July 28,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
