Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis

Mult Scler. 2023 Mar;29(3):363-373. doi: 10.1177/13524585221143726. Epub 2022 Dec 27.


Background: Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown.

Objective: Evaluate the association of structural central nervous system pathology with ambulatory disability.

Methods: Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics.

Results: Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04).

Conclusion: These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.

Keywords: Fitbit; Multiple sclerosis; activity level; brain MRI; cervical MRI; remote monitoring; spinal cord gray matter area.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Atrophy / pathology
  • Brain / pathology
  • Cervical Cord* / pathology
  • Disability Evaluation
  • Disabled Persons*
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Motor Disorders*
  • Multiple Sclerosis* / pathology
  • Spinal Cord / pathology
  • Walking