Physical activity monitoring to assess disability progression in multiple sclerosis

Abstract

Background Clinical outcome measurement in multiple sclerosis (MS) usually requires a physical visit. Remote activity monitoring (RAM) using wearable technology provides a rational alternative, especially desirable when distance is involved or in a pandemic setting. Objective To validate RAM in progressive MS using (1) traditional psychometric methods (2) brain atrophy. Methods 56 people with progressive MS participated in a longitudinal study over 2.5 years. An arm-worn RAM device measured activity over six days, every six months, and incorporated triaxial accelerometry and transcutaneous physiological variable measurement. Five RAM variables were assessed: physical activity duration, step count, active energy expenditure, metabolic equivalents and a composite RAM score incorporating all four variables. Other assessments every six months included EDSS, MSFC, MSIS-29, Chalder Fatigue Scale and Beck’s Depression Inventory. Annualized brain atrophy was measured using SIENA. Results RAM was tolerated well by people with MS; the device was worn 99.4% of the time. RAM had good convergent and divergent validity and was responsive, especially with respect to step count. Measurement of physical activity over one day was as responsive as six days. The composite RAM score positively correlated with brain volume loss. Conclusion Remote activity monitoring is a valid and acceptable outcome measure in MS.

Fitness, physical activity, and exercise in multiple sclerosis: a systematic review on current evidence for interactions with disease activity and progression

“…This is in line with evidence from preclinical animal models and human studies that support the beneficial effect of aerobic exercise on the hippocampus region [70,71]. Although these findings are important and provide a clear rationale to determine effects of changes in physical activity on clinical measures of disease progression and activity longitudinally, it remains elusive why only a limited number of studies integrated follow-up measurements [49,53,57,72]. A pilot study of Bahmani et al [49] showed that vigorous physical activity, assessed by questionnaire, decreased during the first 2 years of disease, although not being associated with changes in the EDSS.…”

The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review

“…These participants had a mean age ranging from 10.1 to 74.4 years and 56.42% (1380/2446) were female. Of the 30 studies, 2 (7%) targeted a pediatric population (aged<18 years [ 30 , 31 ], 21 (70%) studied adults with a mean age between 40 and 65 years [ 32 - 49 , 54 , 55 , 61 ], and 6 (20%) evaluated individuals aged >65 years [ 50 - 52 , 56 - 58 ]. Approximately 50% (15/30) of studies recruited participants from specialist tertiary clinics, with the remaining 50% (15/30) recruiting participants in the community (eg, primary care settings and rehabilitation centers).…”

Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping

“…Our findings built on a small body of prior work that explored the feasibility of passive sensing in people with MS and preliminary correlations between passively sensed behaviors and MS outcomes. For example, Newland et al [ 26 ] explored real-time depth sensors at home to identify gait disturbance and falls in 21 patients with MS. Other studies reported correlations between passively sensed physical activity and disability worsening in people with MS [ 27 , 62 , 63 ]. Chitnis et al [ 28 ] examined the gait, mobility, and sleep of 25 people with MS over 8 weeks using sensors mounted on their wrist, ankle, and sternum, and reported correlations among gait-related features (eg, turn angle and maximum angular velocity), sleep and activity, and disability outcomes.…”