Sleep patterns, depression, physical activity levels, fatigue, and mental toughness in patients with multiple sclerosis (MS) : results from cross-sectional, longitudinal and intervention studies

Abstract

Worldwide, multiple sclerosis (MS) is the most common chronic autoimmune demyelinating and inflammatory disease of the central nervous system, with long term effects on both physical and mental functioning. Individuals with MS might suffer from various combinations of physical and mental issues such as physical weakness, spasticity, motor and sensory dysfunction, fatigue, depression, sleep complaints, pain, cognitive dysfunction, and psychosocial and behavioral problems; these symptoms limit the individual’s capacity to function and participate at social life. In this PhD dissertation, the candidate investigated the impact of physical activity (PA) programs on depression, fatigue, paresthesia, objective and subjective sleep and mental toughness in patients with multiple sclerosis. She could show that PA positively improved symptoms of depression, fatigue, and paresthesia. Further, after a PA intervention, patients’ sleep improved subjectively and objectively. Additionally, Mental toughness (MT) as a psychological construct describing the capacity of a person to be consistently successful in facing difficulties in life, remained unchanged. From a developmental point of view the author showed that MT is routed in childhood. More specifically, childhood characteristics such as higher prosocial behavior, more positive peer relationships, and lower internalizing and externalizing problems at age five, could predict higher mental toughness at the age of fourteen years. The candidate underscored that MT is rather a trait than state, and that MT remained stable after PA interventions. Finally, in a cross sectional and longitudinal study on the same sample recruited since disease onset, the author showed that patients with MS did not differ in their sleep patterns and PA levels, compared to healthy samples. Additionally, two years after disease onset, patients are still as physically active as at onset, with slight changes in the pattern of their activity: Vigorous PA decreased, moderate PA and walking increased. Further, sleep patterns remained stable within the first two years of the disease. The PhD candidate had seven published and one submitted papers related to her project. In four papers, she was the first author and in four papers she is co-author.