Diet, Physical Activity, and Stress Among Wheelchair Users with Multiple Sclerosis: Examining Behavioral Risk Factors

Research Objectives: To examine the distribution, prevalence, and correlates of health behaviors in a sample of wheelchair users with MS across the United States.

Design: Cross-sectional

Setting: General Community

Participants: One hundred twenty-five wheelchair users with MS were recruited through advertisements via the National MS Society, iConquerMS, and North American Research Committee on MS (NARCOMS) Registry. Participant inclusion criteria: (a) age 18 years or older, (b) diagnosis of MS, (c) use of a wheelchair for mobility ≥50% of the day, (d) Internet access, and (e) willingness to complete the study protocol.

Interventions: N/A

Main Outcome Measures: Participants were mailed a packet that included an accelerometer for measuring moderate-vigorous physical activity (MVPA) and instructions for accessing online questionnaires that included: demographic and clinical characteristics, the Perceived Stress Scale, and three dietary recalls using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool for calculating Health Eating Index scores. Standard cut-points were utilized to identify the extent and distribution of negative health behaviors both individually and co-occurring. We then analyzed the associations between health behaviors and wellness outcomes, including comorbid conditions, symptoms (fatigue, depression, anxiety, pain, and sleep quality), and health-related quality of life (HRQOL).

Results: The mean age among participants was 60.5±9.9, 76% identified as female, 82% progressive clinical course and mean MS duration 23.0±9.7. Twenty-seven participants were classified as 0 negative health behaviors (22%), 38 participants with 1 negative health behavior (31%), 46 participants with 2 negative health behaviors (38%), and 10 participants with all 3 negative health behaviors (8%). Number of negative health behaviors was significantly related to HRQOL (p=.43 physical; p=.48 psychological), sleep (p=.27), depression (p=.33), and anxiety (p=.38).

Conclusions: Seventy-eight percent of wheelchair users with MS report at least 1 negative health behavior and the number of negative health behaviors was related to poor HRQOL and worse symptoms (sleep, depression, and anxiety). Further research is needed examining the impact of behavioral interventions targeting diet, physical activity, and stress management for improving health and wellbeing among wheelchair users with MS.

Author(s) Disclosures: The authors declare no conflicts.