Interventions to manage fatigue through activity pacing and improve physical activity may benefit patients with multiple sclerosis (MS), according to study results published in the Journal of Functional Morphology and Kinesiology.

Study researchers sought to evaluate the associations between engagement in pacing, fatigue, and physical activity in people with MS. They conducted a cross-sectional study as part of a multicenter longitudinal study (Rehabilitation, Sports, and Active lifestyle [ReSpAct] Study) that focused on the nationwide implementation of an active lifestyle among patients with chronic diseases. A total of 80 patients (>18 years old) who had a MS diagnosis, received rehabilitation care or medicine, and participated in an active lifestyle program were included in the study. Patients had a mean age of 44 (Standard Deviation [SD], ±11) years and 75 percent were female (n=60).

Patients received either inpatient or outpatient rehabilitation and were evaluated at a baseline measurement (3 to 6 weeks before discharge) of activity pacing behaviors, fatigue, physical activity, and health-related quality of life (QoL) selected from the ReSpAct dataset. Patients completed questionnaires to determine the level of activity performed and the engagement in pacing, risk of overactivity, and fatigue. Background demographics included age, gender, body mass index (BMI), health-related QoL, and risk of overactivity.

A clinically significant Fatigue Severity Scale (FSS score >4) was assessed in 91.3 percent of patients (n=73). Though the variables were not strongly correlated with each other, fatigue and health-related QoL had the highest modest correlation (r=-0.41 [β=-0.341; t=-2.57, P =0.03]), followed by engagement in pacing and health-related QoL (r=-0.27), and engagement in pacing and fatigue (r=0.27 [β=0.198; t=1.43, P =0.16]). The correlations between pacing and physical activity (r=-0.25 [β=-0.242; t=-1.61, P =0.12) showed no associations between the two. None of the demographics connected to physical activity (P ≥0.05). Pacing and age (r=0.24) followed. Other bivariate correlations maintained a modest level (r≤±0.22).

Patient’s with MS demonstrated significant fatigue complaints, and a moderate negative association between fatigue and health-related QoL indicated high fatigue correlated to a low health-related QoL. Additionally, study researchers determined that the negative connection between pacing and health-related QoL indicated that high engagement in pacing correlated to a low health-related QoL.

Limitations included the size of study, the lack of information for MS type and disability, and the inability to generalize results to other populations. The process of self-reporting measures may have also been susceptible to bias due to underreporting or over-reporting.

The lack of association between pacing and fatigue and/or physical activity indicated the need for patients with MS to establish appropriate strategies in physical activity. Study researchers concluded that, ultimately, there “is a need to explore the potential of guiding and advising people with MS on activity pacing and develop therapeutic interventions.”


Abonie US, Hoekstra F, Seves BL, Woude LHVvd, Dekker R, Hettinga FJ. Associations between activity pacing, fatigue, and physical activity in adults with multiple sclerosis: a cross sectional study. J. funct. morphol. Published online June, 15 2020;5(2):43. doi:10.3390/jfmk5020043

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