Background

Pre-existing chronic illness is associated with increased psychiatric distress due to the spread of COVID-19, specifically increased stress, anxiety and depression. This potentially placed individuals with MS in a uniquely vulnerable position to experience greater psychiatric symptomatology.

Objectives

To examine the impact of the COVID-19 pandemic on emotional symptomatology and quality of life in individuals with Progressive Multiple Sclerosis (PMS).

Methods

Data were obtained during a randomized clinical trial on rehabilitation taking place at 11 centers in North America and Europe (The CogEx Trial, ClinicalTrials.gov Identifier: NCT03679468). Participants included 131 individuals with PMS. Study procedures were interrupted in accordance with governmental restrictions as COVID-19 spread. During study closure, a COVID Impact Survey was administered via telephone or email to all participants, along with patient report outcome (PRO) measures of depressive and anxiety symptoms, quality of life and MS symptomatology that were previously administered pre-pandemic.

Results

The time between baseline PRO completion and lockdown survey completion varied (M=9.5 months, SD=4.1 months). 4% of respondents reported COVID-19 infection. No significant changes were noted in anxiety, quality of life, or the impact of MS symptomatology on daily life from baseline to lockdown. While total HADS depression scores increased significantly at follow up, this did not translate into more participants scoring above the HADS threshold for clinically significant depression. No significant relationships were noted between disease duration, processing speed ability or EDSS and changes in symptoms of depression or anxiety.

Most participants reported impact of the virus on their psychological well-being, with little impact on financial well-being. Perceived impact of the pandemic on physical and psychological well-being correlated significantly with the impact of MS symptomatology on daily life, as well as changes in depression.

Conclusions

Overall, in a sample confined exclusively to people with chronic progressive MS, little clinically significant change was noted in symptoms of depression or anxiety or quality of life during the pandemic lockdown.

Background

We have demonstrated an association between higher levels of physical activity and lower levels of disease activity, depression and fatigue in youth with Multiple Sclerosis (MS). Fitness level may also influence physical activity levels as well as health outcomes in these youth. Physical fitness has not been well studied in youth with MS. Further, the relationship between fitness, physical activity, disease activity and symptoms in youth with MS is unknown.

Objectives

1. To determine if there were differences in physical fitness between youth with Multiple Sclerosis and Healthy Controls (HC).

2. To examine relationships between physical fitness, physical activity level, fatigue, depression and disease activity in MS.

Methods

Youth with MS (n=19) and HC (n=21) completed a peak exercise test using a cycle ergometer protocol in order to establish cardiorespiratory-fitness (VO_2peak), walking endurance was determined by a two-minute walk test, and musculoskeletal strength by grip strength using a hand dynomometer. Questionnaires determined fatigue, depression, and physical activity level. Average weekly minutes of physical activity at sedentary, light, moderate and vigorous intensities were determined by Actigraph^(R) accelerometer. Tests of differences and correlational analyses were used to evaluate physical fitness.

Results

Youth with MS demonstrated a lower average cardiorespiratory fitness of 24.7 ml/kg/min (SD = 4.4 ml/kg/min) compared with 35.2 ml/kg/min (SD = 7.7 ml/kg/min) in age and sex matched controls (T = 4.6, DF 34, P<0.001, Cohen D=1.5). The average maximum workload capacity achieved on the cycle ergometer was on average 33 watts lower in youth with MS when compared with controls (U=221, DF =33, P=0.02, Cohen D=0.5). Walking endurance was lower in youth with MS who walked an average of 644 feet compared to 670 feet in healthy controls (T = 2.6, DF=32, P = 0.02, Cohen D = 0.88); Grip Strength, physical activity level, fatigue, and depression were not different between the two groups.

Youth with MS who exhibited lower cardiorespiratory fitness had more relapses (Spearman Rho = -0.52, p =0.04) and lower grip strength scores were also associated with more disability according to the EDSS (Spearman Rho = -0.6, p=0.03). Lower cognitive fatigue was associated with increased cardiorespiratory fitness profile in youth with MS (Spearman Rho = -0.5, p = 0.03). No other relationships were observed between VO_2peak, fatigue or depression in MS.

Conclusions

Youth with MS have lower levels of fitness, compared with HC. Higher levels of fitness were associated with lower disease activity and disability in youth with MS. Exercise interventions may be required to improve the low cardiorespiratory fitness levels found in youth with MS.