{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:53:27Z","timestamp":1772463207528,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2015,7,2]],"date-time":"2015-07-02T00:00:00Z","timestamp":1435795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Multiple sclerosis (MS) patients, in general, show reduced physical function, physical activity, and quality of life. Positive associations between physical activity and quality of life have been reported. In particular, we were interested in the relation between physical activity and mental health in MS patients without limitation of physical function, since limitations of physical function may influence both physical activity and quality of life. Assessment comprised the Baecke questionnaire on physical activity, the Short Form 36 Health Survey (SF-36), and Beck Depression Inventory (BDI). We ranked our sample according to physical activity into four groups and performed an ANOVA to analyze the relationship between levels of physical activity and health-related quality of life (HRQoL). Then we performed a subgroup analysis and included patients with unlimited walking distance and a score of less than 18 in the BDI. Most active vs. inactive patients were compared for the mental subscales of the SF-36 and depression scores. From 632 patients, 265 met inclusion criteria and hence quartiles were filled with 67 patients each. Active and inactive patients did not differ considerably in physical function. In contrast, mental subscales of the SF-36 were higher in active patients. Remarkable and significant differences were found regarding vitality, general health perception, social functioning and mental health, all in favor of physically active patients. Our study showed that higher physical activity is still associated with higher mental health scores even if limitations of physical function are accounted for. Therefore, we believe that physical activity and exercise have considerable health benefits for MS patients.<\/jats:p>","DOI":"10.3390\/ijms160714901","type":"journal-article","created":{"date-parts":[[2015,7,3]],"date-time":"2015-07-03T12:24:49Z","timestamp":1435926289000},"page":"14901-14911","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Mental Health in Multiple Sclerosis Patients without Limitation of Physical Function: The Role of Physical Activity"],"prefix":"10.3390","volume":"16","author":[{"given":"Alexander","family":"Tallner","sequence":"first","affiliation":[{"name":"Institute of Sport Science and Sport, University of Erlangen-N\u00fcrnberg, Gebbertstr. 123b,  91058 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Waschbisch","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Erlangen-N\u00fcrnberg, Schwabachanlage 6,  91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Hentschke","sequence":"additional","affiliation":[{"name":"Institute of Sport Science and Sport, University of Erlangen-N\u00fcrnberg, Gebbertstr. 123b,  91058 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Pfeifer","sequence":"additional","affiliation":[{"name":"Institute of Sport Science and Sport, University of Erlangen-N\u00fcrnberg, Gebbertstr. 123b,  91058 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathias","family":"M\u00e4urer","sequence":"additional","affiliation":[{"name":"Caritas Krankenhaus Bad Mergentheim gGmbH, Uhlandstr. 7, 97980 Bad Mergentheim, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2015,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1056\/NEJM200009283431307","article-title":"Multiple sclerosis","volume":"343","author":"Noseworthy","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/1352458507080464","article-title":"Effect of exercise training on quality of life in multiple sclerosis: A meta-analysis","volume":"14","author":"Motl","year":"2008","journal-title":"Mult. Scler."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"827","DOI":"10.2165\/00023210-200822100-00004","article-title":"Health-related quality of life in multiple sclerosis: Current evidence, measurement and effects of disease severity and treatment","volume":"22","author":"Rudick","year":"2008","journal-title":"CNS Drugs"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1600-0404.2011.01634.x","article-title":"Physical activity and multiple sclerosis: New insights regarding inactivity","volume":"126","author":"Sandroff","year":"2012","journal-title":"Acta Neurol. Scand."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/1545968308320641","article-title":"Effect of exercise training on walking mobility in multiple sclerosis: A meta-analysis","volume":"23","author":"Snook","year":"2008","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/1756285611430719","article-title":"Exercise and disease progression in multiple sclerosis: Can exercise slow down the progression of multiple sclerosis?","volume":"5","author":"Dalgas","year":"2012","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/1352458507079445","article-title":"Multiple sclerosis and physical exercise: Recommendations for the application of resistance-, endurance- and combined training","volume":"14","author":"Dalgas","year":"2007","journal-title":"Mult. Scler."},{"key":"ref_8","unstructured":"World Health Organization (2005). Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne, World Health Organization."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1023\/A:1020734901150","article-title":"Quality of life and multiple sclerosis: Comparison between people with multiple sclerosis and people from the general population","volume":"9","author":"McCabe","year":"2002","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/1352458506071170","article-title":"Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis","volume":"13","author":"Montel","year":"2007","journal-title":"Mult. Scler."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1191\/1352458504ms967oa","article-title":"A systematic approach to analyse health-related quality of life in multiple sclerosis: The GEDMA study","volume":"10","author":"Mitchell","year":"2004","journal-title":"Mult. Scler."},{"key":"ref_12","unstructured":"Bullinger, M., and Kirchberger, I. (1998). Der SF-36 Fragebogen zum Gesundheitszustand, G\u00f6ttingen Bern Toronto Seattle."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/S0022-510X(09)71295-X","article-title":"Health and quality of life in patients with relapsing multiple sclerosis: Making the intangible tangible","volume":"287","author":"Zwibel","year":"2009","journal-title":"J. Neurol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1080\/09638280310001608591","article-title":"A review about the impact of multiple sclerosis on health-related quality of life","volume":"25","author":"Morales","year":"2003","journal-title":"Disabil. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1046\/j.1468-1331.2002.00450.x","article-title":"Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients","volume":"9","author":"Morales","year":"2002","journal-title":"Eur. J. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jns.2009.11.004","article-title":"The association between cognitive impairment and quality of life in patients with early multiple sclerosis","volume":"290","author":"Glanz","year":"2010","journal-title":"J. Neurol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1177\/1352458508093619","article-title":"The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis","volume":"14","author":"Tepavcevic","year":"2008","journal-title":"Mult. Scler."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1177\/1352458508091260","article-title":"The impact of disabilities on quality of life in people with multiple sclerosis","volume":"14","author":"Wynia","year":"2008","journal-title":"Mult. Scler."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.jpainsymman.2009.11.312","article-title":"Symptom cluster and quality of life in multiple sclerosis","volume":"39","author":"Motl","year":"2010","journal-title":"J. Pain Symptom Manag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s10072-008-0009-3","article-title":"Coping strategies, psychological variables and their relationship with quality of life in multiple sclerosis","volume":"30","author":"Goretti","year":"2009","journal-title":"Neurol. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1002\/nur.20161","article-title":"Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis","volume":"29","author":"Motl","year":"2006","journal-title":"Res. Nurs. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.apmr.2006.04.003","article-title":"Exercise, functional limitations, and quality of life: A longitudinal study of persons with multiple sclerosis","volume":"87","author":"Stuifbergen","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1037\/0090-5550.52.4.463","article-title":"Are physical activity and symptoms correlates of functional limitations and disability in multiple sclerosis?","volume":"52","author":"Motl","year":"2007","journal-title":"Rehabil. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1177\/1352458508088916","article-title":"Patient perception of bodily functions in multiple sclerosis: Gait and visual function are the most valuable","volume":"14","author":"Heesen","year":"2008","journal-title":"Mult. Scler."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/1352458511415143","article-title":"Multiple sclerosis relapses are not associated with exercise","volume":"18","author":"Tallner","year":"2012","journal-title":"Mult. Scler."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"565","DOI":"10.2165\/11530770-000000000-00000","article-title":"Physical activity questionnaires for adults: A systematic review of measurement properties","volume":"40","author":"Chinapaw","year":"2010","journal-title":"Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1026\/0943-8149.12.4.139","article-title":"Der Zusammenhang von habitueller k\u00f6rperlicher Aktivit\u00e4t und Gesundheit: Dargestellt an zwei Feldstudien","volume":"12","author":"Wagner","year":"2004","journal-title":"Z. Gesundheitspsychol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tallner, A. (2012). K\u00f6rperliche Aktivit\u00e4t und k\u00f6rperliche Funktionsf\u00e4higkeit\u2014Erfassung und Wechselwirkung bei Personen mit Multipler Sklerose. [Ph.D Dissertation, Friedrich Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg].","DOI":"10.1055\/s-0032-1331357"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1191\/1352458502ms779oa","article-title":"Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis","volume":"8","author":"Mostert","year":"2002","journal-title":"Mult. Scler."},{"key":"ref_30","first-page":"383","article-title":"Ein Fragebogen zur Erfassung der habituellen k\u00f6rperlichen Aktivit\u00e4t verschiedener Bev\u00f6lkerungsgruppen","volume":"33","author":"Wagner","year":"2003","journal-title":"Sportwissenschaft"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1093\/ajcn\/36.5.936","article-title":"A short questionnaire for the measurement of habitual physical activity in epidemiological studies","volume":"36","author":"Baecke","year":"1982","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","unstructured":"Voight, D., Meck, S., and Klussmann, P.G. (2001). Festschrift f\u00fcr Dieter Voigt, LIT."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/0277-9536(95)00115-N","article-title":"German translation and psychometric testing of the SF-36 Health Survey: Preliminary results from the IQOLA project","volume":"41","author":"Bullinger","year":"1995","journal-title":"Soc. Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.jclinepi.2005.11.001","article-title":"Dimensional structure of the SF-36 in neurological patients","volume":"59","author":"Dallmeijer","year":"2006","journal-title":"J. Clin. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/jnnp.71.3.363","article-title":"The SF-36 in multiple sclerosis: Why basic assumptions must be tested","volume":"71","author":"Hobart","year":"2001","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_37","unstructured":"Hautzinger, M., Bailer, M., Worall, H., and Keller, F. (1995). Beck Depressionsinventar (BDI), Huber."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.dhjo.2009.04.001","article-title":"Transitional shifts in exercise behavior among women with multiple sclerosis","volume":"2","author":"Levy","year":"2009","journal-title":"Disabil. Health J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/j.1365-2648.2006.04054.x","article-title":"Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: A systematic review","volume":"56","author":"Neill","year":"2006","journal-title":"J. Adv. Nurs."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1212\/01.WNL.0000129534.88602.5C","article-title":"Randomized controlled trial of yoga and exercise in multiple sclerosis","volume":"62","author":"Oken","year":"2004","journal-title":"Neurology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.2165\/00007256-200434150-00005","article-title":"Exercise and multiple sclerosis","volume":"34","author":"White","year":"2004","journal-title":"Sports Med."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/16\/7\/14901\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:48:38Z","timestamp":1760215718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/16\/7\/14901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,2]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2015,7]]}},"alternative-id":["ijms160714901"],"URL":"https:\/\/doi.org\/10.3390\/ijms160714901","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,7,2]]}}}