Godin Leisure-Time Exercise Questionnaire Research Articles

Patterns and predictors of naturally occurring change in depressive symptoms over a 30-month period in multiple sclerosis

Background: Depressive symptoms are common in multiple sclerosis (MS), yet there is little information about the pattern and predictors of changes in depressive symptoms over time. Objective: We examined changes in depressive symptoms over a 30-month period and the demographic, clinical and behavioral predictors of such changes in relapsing–remitting MS (RRMS). Methods: 269 persons with RRMS completed the Hospital Anxiety and Depression Scale (HADS) and a demographic/clinical scale, Godin Leisure-Time Exercise Questionnaire (GLTEQ) and Patient Determined Disease Steps (PDDS) scale every 6 months over a 30-month period. Data were analyzed using latent class growth modeling (LCGM). Results: LCGM identified a two-class model for changes in HADS depression scores over time. Class 1 involved lower initial status (i.e. fewer depressive symptoms) and linear decreases in depressive symptoms over time (i.e. improving HADS scores), whereas Class 2 involved higher initial status (i.e. more depressive symptoms) and linear increases in depressive symptoms over time (i.e. worsening HADS scores). LCGM further indicated that being older (OR = 2.46; p < .05), married (OR = 2.62; p < .05), employed (OR = 4.29; p < .005) and physically active (OR = 2.71; p < .05) predicted a greater likelihood of belonging to C1 than C2. Conclusions: Depressive symptoms change over time in persons with RRMS, and the pattern of change can be predicted by modifiable and non-modifiable factors.

Physical Activity in Adolescents following Treatment for Cancer: Influencing Factors

The purpose of this study was to examine physical activity levels and influencing individual and environmental factors in a group of adolescent survivors of cancer and a comparison group. Methods. The study was conducted using a “mixed methods” design. Quantitative data was collected from 48 adolescent survivors of cancer and 48 comparison adolescents using the Godin Leisure-Time Exercise Questionnaire, the Fatigue Scale—Adolescents, and the Amherst Health and Activity Study—Student Survey. Qualitative data was collected in individual semistructured interviews. Results. Reported leisure-time physical activity total scores were not significantly different between groups. Physical activity levels were positively correlated with adult social support factors in the group of adolescent survivors of cancer, but not in the comparison group. Time was the primary barrier to physical activity in both groups. Fatigue scores were higher for the comparison but were not associated with physical activity levels in either group. The qualitative data further supported these findings. Conclusions. Barriers to physical activity were common between adolescent survivors of cancer and a comparative group. Increased knowledge of the motivators and barriers to physical activity may help health care providers and families provide more effective health promotion strategies to adolescent survivors of pediatric cancer.

Physical activity and quality of life among university students: exploring self-efficacy, self-esteem, and affect as potential mediators

Physical activity (PA) has been shown to enhance quality of life (QOL) in older adults. Findings from these studies indicate that the relationship between PA and QOL is indirect and likely mediated by variables such as physical self-esteem, exercise self-efficacy, and affect. As PA varies greatly by age, the purpose of the current study is to extend this area of research to young adults and explore the complex relationship between PA and QOL in this target population. Data were collected via anonymous questionnaire from N = 590 undergraduate students. PA was assessed with the Godin Leisure Time Exercise Questionnaire, and QOL was assessed by the Satisfaction with Life Scale. Path analysis was used to test the relationship between PA and QOL, with mediators of exercise self-efficacy, physical self-esteem, and affect. The PA model (RMSEA = .03, CFI = .99) accounted for 25 % of the variance in QOL. PA had positive direct effects on exercise self-efficacy (β = .28, P < .001), physical self-esteem (β = .10, P < .001), positive affect (β = .10, P < .05), and negative affect (β = .08, P < .05). Physical self-esteem was found to be the most powerful mediating variable on QOL (β = .30, P < .001), followed by positive affect (β = .27, P < .001) and negative affect (β = .14, P < .001). Physical self-esteem and, to a lesser extent, positive affect emerged as integral components in the link between PA and QOL. Findings suggest that health education programs designed to promote regular PA and increase physical self-esteem may be effective in improving QOL in young adults.

An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study

ObjectivesExercise on referral schemes (ERS) are widely commissioned in the UK but there is little evidence of their association with physical activity levels. We sought to assess the Northumberland exercise...

Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis

Objective: Investigate the feasibility and potential efficacy of a customized print-based intervention to promote physical activity and symptom self-management in women with multiple sclerosis. Design: A randomly allocated two-group repeated measures design, with a delayed-treatment contact group serving as the control. Participants were randomized to receive the intervention immediately (n =14) or receive it at week 12 (n =16). Outcome measures were administered at weeks 1, 12, and 24. Setting: Community-based in metropolitan area. Subjects: Thirty women with multiple sclerosis. Intervention: Prescribing a home-exercise program and following up with customized pamphlets, which are matched to participants’ stage of readiness to change physical activity behavior and physical activity barriers (e.g. encouraging self-management of symptoms). Main Measures: Physical Activity and Disability Survey-revised, Godin Leisure-Time Exercise Questionnaire, SF-12, Symptoms of Multiple Sclerosis Scale, and 6-minute walk test. Results: Intent-to-treat analyses using mixed multivariate analysis of variance (MANOVA) were conducted on (1) physical activity levels and (2) health and function outcomes. The mixed MANOVAs for physical activity levels and health and function outcomes indicated significant improvements in the immediate group compared with the delayed group (i.e. condition by time interaction was significant, Wilks’ λ = 0.59, F2, 27 = 9.31, P = 0.001 and Wilks’ λ = 0.70, F4, 25 = 2.72, P = 0.052, respectively). The intervention had moderate to large effect sizes in improving physical activity levels (d = 0.63 to 0.89), perceptions of physical function (d = 0.63), and 6-minute walk test (d=0.86). Conclusion: This pilot study indicates that a customized print-based intervention shows promise in improving physical activity levels and health and function in women with multiple sclerosis.

Effects of Physical Activity on the Quality of Life in Taiwanese Lung Cancer Patients Receiving Active Treatment or Off Treatment

Lung cancer is the leading cause of cancer deaths in the world. Physical activity can enhance the quality of life (QOL) of cancer patients. However, the best timing according to cancer therapy to implement physical activities for lung cancer patients is not yet clear. The purpose of our study was to examine the relationship between physical activity and QOL in different cancer-treatment periods among lung cancer patients. This study used a cross-sectional design. Instruments included the Functional Assessment of Cancer Therapy-Lung Cancer and the Godin Leisure-Time Exercise Questionnaire. In total, 185 patients participated in this study, and results showed that only 25% of participants achieved recommended physical-activity guidelines. Of all patients, 50.3% engaged in light physical activity, such as walking. During active-treatment periods, lung cancer patients who engaged in light or moderate activity had significantly higher scores for the overall QOL than did those who were completely sedentary. However, during off-treatment periods, there were no significant differences in the overall QOL with different activity levels. The QOL may be improved by engaging in light or moderate physical activity during active-treatment periods among lung cancer patients. It is important for healthcare providers to consider promoting physical activity based on different cancer treatments to improve the QOL of Taiwanese lung cancer patients.

Marital Status and Motherhood: Implications for Physical Activity

Single motherhood has been associated with negative health consequences, such as increased risk for cardiovascular disease and depression, which might be accompanied by reduced levels of physical activity. This pilot study aimed to compare the magnitude of differences in physical activity between unmarried mothers, married mothers, and non-mothers. Participants (N = 66) in three equal-sized groups (n = 22) completed a battery of physical activity questions and wore an accelerometer for one week in March to May of 2012. Analyses of covariance controlling for group differences in demographic characteristics and Bonferroni post-hoc comparisons were conducted to detect differences in physical activity between groups. Compared to unmarried mothers, married mothers and non-mothers had significantly greater leisure time activity as measured by the Godin Leisure-Time Exercise Questionnaire (F(2,61) = 6.11, p = .004), overall activity in the previous year measured by the Modifiable Activity Questionnaire scores (F(2, 61) = 8.65, p = .001), and minutes spent in moderate-to-vigorous physical activity from the accelerometer (F(2,58) = 4.39, p = .02). No statistically significant differences were observed among groups for International Physical Activity Questionnaire scores or accelerometer activity and step counts. Overall, unmarried mothers were less physically active when compared to married mothers and non-mothers. Future studies should explore the correlates and health outcomes associated with physical activity among unmarried mothers.

Promoting physical activity through student life and academics

Objective: A physical activity passport (PAP) was developed to increase student’s physical activity through the collaboration of student life and academics. The purpose was to measure the effectiveness of the PAP. Design: The research design used was a quantitative, descriptive, quasi-experimental design with experimental and control groups. Setting: This study investigated a mid-sized southeastern university in the USA. Method: Two hundred and seventy-eight undergraduates (159 females, 116 males) sampled from 12 physical activity courses participated (109 freshmen, 71 sophomores, 53 juniors and 42 seniors). There were 144 in the PAP group and 134 in the non-PAP group. Participants filled out the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as well as a demographic questionnaire. Results: The results showed that those who participated in the PAP attended more than four times as many group fitness classes than did those who did not participate in the PAP. Furthermore, distinctive differences were found among students that might aid in future programming. Conclusion: Although results refuted the hypotheses, there were several future implications that could be drawn, most significantly the connection to future research involving self-determination theory.

Exercise Trajectories of Women from Entry to a 6-Month Cardiac Rehabilitation Program to One Year after Discharge

Background. Physical activity is associated with reduced mortality and morbidity. Cardiac rehabilitation (CR) is an effective intervention for patients with cardiovascular disease (CVD). Unfortunately, women are less likely to engage in, or sustain, regular physical activity. Objectives were to (1) describe women's guidelines-based levels of physical activity during and after CR and (2) determine the physical activity trajectories of women from entry to CR to one year after CR. Methods and Results. A prospective, longitudinal study of 203 women with CVD enrolled in a 6-month CR program. Physical activity was measured using the Godin Leisure Time Exercise Questionnaire (LSI), focusing on moderate-strenuous activity. Data were analyzed using latent class growth analysis (LCGA) and logistic regression. Mean scores on the LSI showed women to be “active” at all follow-up points. LCGA revealed a two-class model, respectively, called “inactive relapsers” and “moderately active relapsers.” Predictors of the “moderately active relapsers” class were employment status and diagnosis of myocardial infarction. Conclusions. Women achieved the recommended physical activity levels by the end of CR and sustained them until one year after CR. LCGA allowed us to determine the class trajectories associated with moderate-strenuous activity and, from these, to identify implications for targeted intervention.

Self-Reported Depression and Physical Activity in Adults With Mobility Impairments

ObjectiveTo test hypothesized associations between depression and physical activity among adults with multiple sclerosis (MS), spinal cord injury (SCI), muscular dystrophy (MD), and postpolio syndrome (PPS). DesignCross-sectional survey. SettingSurvey responses collected from individuals in the Washington state area (participants with SCI) and across the United States (participants with MS, MD, and PPS). ParticipantsConvenience sample of participants were surveyed (N=1676; MD, n=321; PPS, n=388; MS, n=556; SCI, n=411). InterventionsNot applicable. Main Outcome MeasuresThe Patient Health Questionnaire-9 (PHQ-9) assessing depressive symptoms and the International Physical Activity Questionnaire (IPAQ) and Godin Leisure Time Exercise Questionnaire (GLTEQ) assessing physical activity. ResultsThe average age was 56 years, 64% were women, 92% were white, 86% had a high school degree or higher, and 56% walked with an assistive device or had limited self-mobility. The IPAQ and GLTEQ explained a small but statistically significant and unique amount of the variance in PHQ-9 scores in all diagnostic groups, with no significant differences in the relation by condition, age, or mobility status (IPAQ R2=.004; GLTEQ R2=.02; both P<.02). ConclusionsBoth physical activity measures demonstrated a small but statistically significant association with depression in all 4 diagnostic groups. Research is needed to determine longitudinal relations and whether physical activity interventions could promote improved mood in adults with physical disabilities.

Testing and integrating self-determination theory and self-efficacy theory in a physical activity context.

Stemming from the need for theoretical integration, this study aimed at individually testing and integrating self-determination theory (SDT) and self-efficacy theory (SET) to predict physical activity. University students (n 225) completed questionnaires measuring constructs from SDT and SET as well as the Godin Leisure Time Exercise Questionnaire. Using path analysis, individual SDT and SET models and 2 hypothesised integrated models were tested. The preferred integrated model was selected on the basis of model fit indices. The selected integrated model was then compared with the individual theoretical models by examining the number of theoretical links that remained constant and the explained variance in the variables. Results revealed that the individual and integrated models were supported. The second integration model, which had self-determined motivation and confidence in equal agenic roles, had better model fit, 2 (7) 28.87, p .001, comparative fit index .95, root-mean-square error of approximation .12, standardized root mean residual .05, Akaike Information Criterion 84.87, and was preferred over the individual theoretical models. Overall, integrating 2 motivational theories in physical activity research is feasible, and more studies are needed to enhance our understanding of physical activity participation.

Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol

BackgroundChronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels.Methods/DesignA randomly-allocated, three-parallel group, time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a physical activity plus fatigue management intervention. All interventions will last 12 weeks and will be delivered entirely over the phone. Our hypothesis is that, in comparison to the contact-control condition, both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function, with the physical activity plus fatigue management intervention yielding significantly larger improvements. To test this hypothesis, outcome measures will be administered at Weeks 1, 12, and 24. Primary outcomes will be the Fatigue Impact Scale, the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and Actigraph accelerometers. Secondary outcomes will include the SF-12 Survey, Mental Health Inventory, Multiple Sclerosis Impact Scale, the Community Participation Indicator, and psychosocial constructs (e.g., self-efficacy).DiscussionThe proposed study is novel, in that it represents a multi-disciplinary effort to merge two promising lines of research on MS: fatigue management and physical activity promotion. Collectively, the proposed study will be the largest randomized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registrationNCT01572714

Evaluating the Effectiveness of a Physical Activity Referral Scheme Among Women

Evidence supports the effectiveness of interventions delivered in primary care to promote physical activity (PA). Specifically, approaches where physician counseling is coupled with other strategies (eg, referrals to community resources) have been recognized as the most promising. The purpose of this study was to compare the effectiveness of a PA prescription plus referral intervention versus a prescription only intervention delivered in primary care. Ten family physicians and their female patients (N = 35, mean age = 36 years) were randomly assigned to 1 of 3 conditions: prescription plus (n = 12), prescription only (n = 12), and usual care (n = 11). The prescription plus group received a PA prescription plus a referral to a community program, the prescription only group received only the PA prescription, and the usual care group received usual health care. The Godin Leisure-Time Exercise Questionnaire was used to measure PA. A significant increase on the PA score (P < .05, partial η(2) = .178) and on total weekly PA minutes (P < .05, partial η(2) = .179) was observed in both prescription groups after the intervention. There were no significant group differences (P > .05). No PA changes were observed in the usual care group. Findings from this pilot study suggest that brief PA counseling and a prescription delivered in primary care can be effective for promoting PA among women. Referring patients did not seem to enhance the effect on PA.

Exercisers' Identities and Exercise Dependence: The Mediating Effect of Exercise Commitment

The purpose of this study was to examine the associations of exercise identity, exercise commitment, exercise dependence, and, particularly, the mediating effects of exercise commitment on the relationship between exercise identity and exercise dependence. 253 Taiwanese regular exercisers completed measures, including the Exercise Dependence Scale-Revised, the Exercise Identity Scale, the Exercise Commitment Scale, and the Godin Leisure Time Exercise Questionnaire. Results showed that exercise identity, exercise dependence, and two types of exercise commitment were moderately to highly correlated. Furthermore, structural equation modelling indicated that a "have to" commitment partially mediated the relationship between exercise identity and exercise dependence. Based on the mediating role of a "have to" commitment, the findings are particularly informative to exercise instructors and for exercise program managers.

Associations between sitting time and quality of life in a population-based sample of kidney cancer survivors

BackgroundAdverse health effects of sedentary behaviour on cancer risk and health outcomes in cancer survivors have been reported but few studies have examined quality of life (QoL) and no study has focused on kidney cancer survivors (KCS). The purpose of this study was to estimate the prevalence of sitting time among KCS and to determine any associations with QoL. MethodsAll 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial Registry were mailed a survey that consisted of the modified domain-specific sitting time questionnaire, the Godin Leisure Time Exercise Questionnaire and several Functional Assessment of Cancer Therapy (FACT) QoL scales. Standard demographic and medical variables were also reported. ResultsCompleted surveys were received from 540 KCS. The mean hours of sitting time were 8.0 ± 4.7 for a work-day and 6.5 ± 3.8 for a non-work day. After adjustment for key covariates, analyses of covariance indicated that the only significant relationship was an unexpected positive association between sitting time on a work day and emotional well-being (p = 0.019). Moreover, the only variable to moderate these associations was age, with younger KCS under age 60 showing the expected negative associations between sitting time and physical and functional aspects of QoL. ConclusionKCS sit for a significant amount of time on work days and non-work days, however, there were few associations with QoL. Future observational studies and randomized controlled trials are warranted to examine sitting time and health outcomes among KCS.

I03 Evaluation of life time physical activity levels in Huntington's disease

Background Environmental factors may influence the onset and progression of neurodegenerative disorders, either directly or by interacting with genetic risk factors. Trembath and colleagues interviewed individuals with a formal clinical diagnosis of Huntington's disease (HD) and found that those who led a more passive lifestyle had an earlier age of onset than those who were less passive.1 Aims To establish the feasibility of using self-completion questionnaires to gather life time physical activity levels in a group of early stage and premanifest HD individuals from the TRACK-HD cohort so that this data could be compared to clinical outcomes in TRACK-HD study. Methods A self-report questionnaire was developed based on the Leisure Time Exercise Questionnaire by Godin et al.2 Activity levels were calculated across activities undertaken at home, at work and during recreation and for life stages from the teenage years, across each decade to the current age or age of disease onset. Life-time activity was categorised as strenuous, moderate or light, and activity scores were calculated from the frequency and duration of each activity. Results Retrospective data were collected from 277 participants (89 controls, 109 premanifest gene carriers, 79 HD Stage I/II) and the data used to distinguish the most and least physically active individuals. Modes of activity were also investigated. Conclusions Although retrospective data may be limited by recall bias, our data suggests that it is possible to use a general measure of life time physical activity levels. Such a life course perspective on physical activity may be a useful adjunct to the assessment of physical activity with more direct quantitative measures.

Correlates of physical activity in a population-based sample of kidney cancer survivors: an application of the theory of planned behavior

BackgroundOver half of kidney cancer survivors (KCS) are completely inactive and only a quarter are meeting physical activity (PA) guidelines. This highlights the need to identify and understand the determinants of PA in this understudied population. The purpose of this study is to determine the social cognitive correlates of PA intention and behavior in KCS using the Theory of Planned Behavior (TPB).MethodsAll 1,985 KCS diagnosed between 1996 and 2010 in Alberta, Canada were mailed a self-report survey that consisted of the Godin Leisure Time Exercise Questionnaire and standard TPB items for intention, planning, perceived behavioral control (PBC), affective and instrumental attitudes, and descriptive and injunctive norms. Standard demographic and medical variables were also collected.ResultsCompleted surveys were received from 703 of 1,654 (43%) eligible KCS. The TPB was tested using structural equation modelling and demonstrated an adequate-to-good fit to the data [χ² = 256.88, p < .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.06, 90% CI = 0.05-0.06].There were significant pathways to PA from PBC (ß = 0.18, p = 0.02), planning (ß = 0.22, p < 0.01), and intention (ß = 0.31, p < 0.01); and to planning from intention (ß = 0.81, p < 0.01). In addition, there were significant model pathways to intention from instrumental attitude (ß = 0.28, p = 0.03), descriptive norm (ß = 0.09, p = 0.01), and PBC (ß = 0.52, p < 0.01). Overall, the TPB accounted for 69%, 63%, and 42% of the variance in intention, planning and PA, respectively.ConclusionThe TPB appears to be a useful model for explaining PA in KCS. All TPB constructs except injunctive norm and affective attitude were useful for explaining intention with PBC emerging as the largest correlate. Developing PA interventions based on the TPB may be effective in promoting PA in KCS and may lead to important improvements in health.

Modifiable lifestyle factors associated with metabolic syndrome in patients with psoriasis

Psoriasis is a chronic inflammatory skin disease, which is associated with obesity and with cardiovascular morbidity and mortality. To evaluate modifiable lifestyle factors including stress level, physical activity and nutrition, which may be associated with metabolic syndrome in patients with psoriasis. In total, 65 patients with psoriasis and 52 control subjects from our university dermatology clinic were enrolled in this case-control pilot study. The study questionnaire included the Perceived Stress Scale (PSS), the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the Rapid Eating Assessment for patients (REAP). For subjects with psoriasis, the Psoriasis Area and Severity Index (PASI) was measured. Subjects with psoriasis (mean BMI 27.72) displayed a trend towards a higher BMI compared with controls (mean BMI 25.67). Subjects with psoriasis were not found to have an increased prevalence of self-reported metabolic syndrome-associated diseases including diabetes, heart disease, high cholesterol, hypertension or stroke compared with controls (P=0.25, P=0.46, P=0.96, P=0.26, and P=0.16, respectively). There was no significant difference in exercise or stress between patients with psoriasis and controls (P=0.06 and P=0.26, respectively). However, compared with controls, subjects with psoriasis (mean REAP score=2.23) did report poorer overall nutrition as assessed by the REAP score (mean=2.38, P<0.01). Among subjects with psoriasis, the factors of stress, smoking and systemic therapy were associated with increased PASI (r=0.13, r=3.47 and r=3.19, respectively). Our study suggests that poor dietary and exercise habits may be factors contributing to obesity and metabolic syndrome in patients with psoriasis. Further studies with larger numbers are needed to confirm these results.

Sociodemographic Patterns of Leisure-Time Physical Activity of Albertans 2000 to 2011

Background: Physical inactivity has been a significant health concern among the Canadian population over the last decade. Purpose: To study the trend in leisure-time physical activity (LTPA) of Albertans from 2000 to 2011 and to assesses the relationship between sociodemographic factors and LTPA. Methods: Cross-sectional design was used. Data were obtained in 2000 (n = 1200), 2002 (n = 1209), 2005 (n = 1208), 2006 (n=1207), 2008 (n=1313) and 2010 (n=1202) through representative random telephone surveys. The Godin Leisure-Time Exercise Questionnaire was used for all three surveys, in addition to questions about sociodemographic information (age, income, education, marital status). Men and women were considered active if they expended at least 38 or 35 metabolic equivalents (METs) per week, respectively. Results: From 2000 to 2005, the proportion of active Albertans increased from 54.2% to 60.2% whereas from 2006 to 2011 it decreased from 57.4% to 54.3%. Controlling for sex, logistic regression analyses showed that, compared to the youngest adults, the oldest adults were the least likely to be active (OR = 0.16 to 0.55) over the last decade. The highest quintile of income was the most likely to be active from 2000 to 2008 (OR = 1.96 to 2.28). Education was not related to LTPA. Conclusion: Older age remained a risk for inactivity over the decade and high income supported LTPA until 2008. Marital status inconsistently affected activity status in Albertans over the last decade. Education was not related to LTPA.

Cognitive reserve and patient-reported outcomes in multiple sclerosis

Background: Adaptation and compensation in the face of changing pathology may be better understood by considering the concept of cognitive reserve, which may protect against disability in multiple sclerosis (MS). Objectives: The present work investigates the relationship between cognitive reserve and demographic characteristics, health behaviors, and patient-reported outcomes (PROs). Methods: Cross-sectional data (n=1142) were drawn from the North American Research Committee on MS (NARCOMS) Registry, from whom additional survey data were collected. Cognitive reserve was measured using the Stern and Sole-Padulles measures, the O*NET occupational classification system, and the Godin Leisure-Time Exercise Questionnaire. PROs were assessed using generic (SF -12v2, Perceived Deficits Questionnaire, Ryff Psychological Well-Being, Diener Satisfaction with Life Scale) and disease-specific (Patient-Determined Disease Steps, Performance Scales) measures. Psychometric analysis created unidimensional cognitive reserve subscales. Regression models examined relationships between cognitive reserve, demographic characteristics, and PROs. Results: The cognitive reserve measures assessed distinct but related constructs. Individuals with high cognitive reserve were more likely to report lower levels of perceived disability and perceived cognitive deficits, and higher levels of physical health, mental health, and well-being. Both active and passive reserve are associated with better outcomes, independent of demographic factors, and these associations apply to both generic and disease-specific outcomes. Conclusions: This expanded measurement of cognitive reserve captures both the passive and active aspects of the construct, and there is a consistent and substantial relationship with PROs. Individuals with high passive and/or active reserve are healthier and experience higher levels of well-being.