PhD Defence Ine Nieste
Supervisors: Prof. dr. Bert Op ’t Eijnde, Prof. dr. Hans H.C.M. Savelberg
Keywords: Multiple Sclerosis, physical activity, sedentary behaviour, cardiometabolic health
"The Physical Activity Continuum, Exercise-prescription and Cardiometabolic Health in Persons With Multiple Sclerosis: The Underexplored (Inter)relations and Care Implications"
The prevalence of non-communicable cardiometabolic diseases, such as type 2 diabetes mellitus and cardiovascular diseases, is rising among persons with Multiple Sclerosis (PwMS), similar to trends observed in the general population. These comorbidities significantly reduce the quality of life of PwMS, are associated with a worsening of disability, and largely contribute to all-cause mortality rates. Hence, it is highly warranted to explore strategies to mitigate or prevent the onset of these conditions.
Based on findings in the general population, it is known that insufficient physical activity - defined as not meeting the minimum international physical activity recommendations of more than 150 minutes of moderate-to-vigorous intensity physical activity (MVPA) per week - is a major contributor to the development of cardiometabolic diseases. The first scientific reports demonstrating positive associations between physical activity and cardiometabolic health in the general population already date back to the 1950s. In contrast, physical activity research in PwMS only began around the year 2000, due to the long-held belief that physical activity exacerbated MS disability. To date, the safety and symptomatic benefits of exercise for PwMS are evident, yet its cardiometabolic effects remain unclear. Furthermore, PwMS face multiple barriers to exercise and often engage in prolonged sedentary behaviours, which are now recognised as significant cardiometabolic disease risk factor independent of exercise participation. This dissertation explores how various physical activity behaviours can play a role for cardiometabolic health in MS care, investigates the effects of prescribed exercise on other components of the physical activity continuum, and explores other strategies than the traditional exercise-prescription paradigm to increase physical activity levels.
Taken together, it was found in the present dissertation that both light-intensity physical activity and MVPA exert significant beneficial cardiometabolic health effects in PwMS. Further research is now warranted to explore dose-response relationships and effective combinations, which will allow PwMS to choose a strategy that aligns with their individual needs and preferences. It was also found that when both sedentary behaviour and MVPA/exercise participation need to be improved simultaneously, both behaviours should be targeted. For this, a biphasic approach is proposed where the first part of the intervention focuses on reducing sedentary behaviour to induce a sustainable behaviour change. The findings of this dissertation show that multi-component interventions are most effective to address the multi-faced nature of sedentary behaviour in clinical populations. In a second phase, intervention components targeting MVPA or exercise participation can be added. Further research investigating the long-term effects of such interventions on physical activity behaviours, cardiometabolic health but also MS symptoms is warranted in order to inform the development of future physical activity recommendations for PwMS.
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