Benefits of Physical Activity for Depression and Fatigue in Multiple Sclerosis: A Longitudinal Analysis


      To examine the longitudinal relationship between physical activity and fatigue and depression among youth with demyelinating conditions.

      Study design

      From September 2013 to March 2017, we performed a longitudinal study of consecutive youth diagnosed at their first visit with pediatric onset multiple sclerosis (POMS) or monophasic acquired demyelinating syndromes (mono-ADS) at a neuroinflammatory disorders clinic in a tertiary children's hospital. Fatigue was determined at each visit by the Pediatric Quality of Life Multidimensional Fatigue Scale, depressive symptoms by the Center of Epidemiologic Studies Depression Children Rating Scale, and physical activity level by the Godin Leisure Time Exercise Questionnaire. Mixed linear models were used to examine the associations of moderate-to-vigorous physical activity (MVPA) with fatigue and depression over time, adjusting for age, time from incident demyelination, sex, number of relapses, relapse within 30 days, and disability.


      In 182 patients (48 POMS, age 15 ± 1.7 years, 35 female; and 134 mono-ADS, age 12 ± 3.6 years 67 female) with 538 visits (mean follow-up 3.6 ± 2.7 years and 4.2 ± 3.3 years, respectively), a trajectory of increased fatigue over time was observed in POMS (2.28 points/year, P = .008) and mono-ADS (1.33 points/year, P = .007) patients. Youth with POMS had more depressive symptoms (estimate = 11.4 points, P < .002) than mono-ADS. Depressive symptoms increased over time in female patients with POMS (estimate = 1.4 points/year, P < .02). MVPA was associated with lower depression (−0.09, P < .001) and general fatigue (0.13, P = .02) over time in POMS.


      Youth with POMS who have higher levels of MVPA demonstrate lesser depressive symptoms and lower fatigue over time. Our results may inform future interventions to manage mood and fatigue in POMS.



      EDSS (Expanded Disability Status Scale), Mono-ADS (Monophasic acquired demyelinating syndromes), MS (Multiple sclerosis), MVPA (Moderate-to-vigorous physical activity), PedsQL-MFS (Pediatric Quality of Life Multidimensional Fatigue Scale), POMS (Pediatric onset multiple sclerosis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Amato M.
        • Goretti B.
        • Ghezzi A.
        • Lori S.
        • Zipoli V.
        • Moiola L.
        • et al.
        Cognitive and psychosocial features in childhood and juvenile MS: two-year follow-up.
        Neurology. 2010; 75: 1134-1140
        • Carroll S.
        • Chalder T.
        • Hemingway C.
        • Heyman I.
        • Moss-Morris R.
        Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors.
        Dev Med Child Neurol. 2016; 58: 229-239
        • Parrish J.
        • Weinstock-Guttman B.
        • Smerbeck A.
        • Benedict R.
        • Yeh E.
        Fatigue and depression in children with demyelinating disorders.
        J Child Neurol. 2013; 28: 713-718
        • Grover S.A.
        • Sawicki C.
        • Kinnette-Hopkins D.
        • Finlayson M.
        • Schneiderman J.E.
        • Banwell B.
        • et al.
        Physical activity and its correlates in youth with multiple sclerosis.
        J Pediatr. 2016; 179: 197-203
        • Toussaint-Duyster L.C.
        • Wong Y.Y.M.
        • Van der Cammen-van Zijp M.H.
        • Van Pelt-Gravesteijn D.
        • Catsman- Berrevoets C.E.
        • Hintzen R.Q.
        • et al.
        Fatigue and physical functioning in children with multiple sclerosis and acute disseminated encephalomyelitis.
        Mult Scler. 2018; 24: 982-990
        • Grover S.A.
        • Aubert-Broche B.
        • Fetco D.
        • Collins D.L.
        • Arnold D.L.
        • Finlayson M.
        • et al.
        Lower physical activity is associated with higher disease burden in pediatric multiple sclerosis.
        Neurology. 2015; 85: 1663-1669
        • Lubans D.
        • Richards J.
        • Hillman C.
        • Faulkner G.
        • Beauchamp M.
        • Nilsson M.
        • et al.
        Physical activity for cognitive and mental health in youth: a systematic review of mechanisms.
        Pediatrics. 2016; 138
        • McPhie M.L.
        • Rawana J.S.
        The effect of physical activity on depression in adolescence and emerging adulthood: a growth-curve analysis.
        J Adolesc. 2015; 40: 83-92
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann Neurol. 2011; 69: 292-302
        • Krupp L.B.
        • Tardieu M.
        • Amato M.P.
        • Banwell B.
        • Chitnis T.
        • Dale R.C.
        • et al.
        International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune- mediated central nervous system demyelinating disorders: revisions to the 2007 definitions.
        Mult Scler. 2013; 19: 1261-1267
        • Faulstich M.E.
        • Carey M.P.
        • Ruggiero L.
        • Enyart P.
        • Gresham F.
        Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC).
        Am J Psychiatry. 1986; 143: 1024-1027
        • Weissman M.
        • Orvaschel H.
        • Padian N.
        Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports.
        J Nerv Ment Disord. 1980; 168: 736-740
        • Varni J.W.
        • Seid M.
        • Rode C.A.
        The PedsQL: measurement model for the pediatric quality of life inventory.
        Med Care. 1999; 37: 126-139
        • Godin G.
        The Godin-Shephard Leisure-Time Physical Activity Questionnaire.
        Health Fitness J Can. 2011; 4: 18-22
        • Kinnett-Hopkins D.
        • Grover S.A.
        • Yeh E.A.
        • Motl R.W.
        Physical activity in pediatric onset multiple sclerosis: Validating a questionnaire for clinical practice and research.
        Mult Scler Relat Disord. 2016; 10: 26-29
        • Kurtzke J.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Feinstein A.
        • Magalhaes S.
        • Richard J.-F.
        • Audet B.
        • Moore C.
        The link between multiple sclerosis and depression.
        Nat Rev Neurol. 2014; 10: 507-517
        • Beal C.C.
        • Stuifbergen A.K.
        • Brown A.
        Depression in multiple sclerosis: a longitudinal analysis.
        Arch Psychiatr Nurs. 2007; 21: 181-191
        • Ensari I.
        • Motl R.W.
        • McAuley E.
        • Mullen S.P.
        • Feinstein A.
        Patterns and predictors of naturally occurring change in depressive symptoms over a 30-month period in multiple sclerosis.
        Mult Scler. 2014; 20: 602-609
        • Marshall G.
        • Baron A.E.
        Linear discriminant models for unbalanced longitudinal data.
        Stat Med. 2000; 19: 1969-1981