{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:23:05Z","timestamp":1790695385350,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T00:00:00Z","timestamp":1592179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Fatigue is common in people with multiple sclerosis (MS). Activity pacing is a behavioral way to cope with fatigue and limited energy resources. However, little is known about how people with MS naturally pace activities to manage their fatigue and optimize daily activities. This study explored how activity pacing relates to fatigue and physical activity in people with MS. Participants were 80 individuals (60 females, 20 males) with a diagnosis of MS. The participants filled in questionnaires on their activity pacing, fatigue, physical activity, and health-related quality of life, 3\u20136 weeks before discharge from rehabilitation. The relationships between the variables were examined using hierarchical regression. After controlling for demographics, health-related quality of life, and perceived risk of overactivity, no associations were found between activity pacing and fatigue (\u03b2 = 0.20; t = 1.43, p = 0.16) or between activity pacing and physical activity (\u03b2 = \u22120.24; t = \u22121.61, p = 0.12). The lack of significant associations between activity pacing and fatigue or physical activity suggests that without interventions, there appears to be no clear strategy amongst people with MS to manage fatigue and improve physical activity. People with MS may benefit from interventions to manage fatigue and optimize engagement in physical activity.<\/jats:p>","DOI":"10.3390\/jfmk5020043","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T12:16:57Z","timestamp":1592223417000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Associations between Activity Pacing, Fatigue, and Physical Activity in Adults with Multiple Sclerosis: A Cross Sectional Study"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2509-4413","authenticated-orcid":false,"given":"Ulric S.","family":"Abonie","sequence":"first","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho PMB 31 Volta Region, Ghana"},{"name":"School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester CO4 3SQ, Essex, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Hoekstra","sequence":"additional","affiliation":[{"name":"Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"},{"name":"Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4066-1893","authenticated-orcid":false,"given":"Bregje L.","family":"Seves","sequence":"additional","affiliation":[{"name":"Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8472-334X","authenticated-orcid":false,"given":"Lucas H. V. van der","family":"Woude","sequence":"additional","affiliation":[{"name":"Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"},{"name":"Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rienk","family":"Dekker","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina J.","family":"Hettinga","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8SB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s00415-010-5684-3","article-title":"Fatigue, sleepiness, and physical activity in patients with multiple sclerosis","volume":"258","author":"Merkelbach","year":"2011","journal-title":"J. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta4270","article-title":"Treatments for fatigue in multiple sclerosis: A rapid and systematic review","volume":"4","author":"Branas","year":"2000","journal-title":"Health Technol. Assess."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1191\/1352458503ms904oa","article-title":"Fatigue associated with multiple sclerosis: Diagnosis, impact and management","volume":"9","author":"Bakshi","year":"2003","journal-title":"Mult. Scler."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1177\/135245850100700511","article-title":"Quality of life in multiple sclerosis: The impact of depression, fatigue and disability","volume":"7","author":"Amato","year":"2001","journal-title":"Mult. Scler."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00415-006-0431-5","article-title":"High concurrent presence of disability in multiple sclerosis","volume":"254","author":"Johansson","year":"2007","journal-title":"J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1080\/09638280600551476","article-title":"Validity of physical activity measures in ambulatory individuals with multiple sclerosis","volume":"28","author":"Motl","year":"2006","journal-title":"Disabil. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1191\/1352458505ms1188oa","article-title":"Physical activity and multiple sclerosis: A meta-analysis","volume":"11","author":"Motl","year":"2005","journal-title":"Mult. Scler."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1016\/j.apmr.2012.05.029","article-title":"Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: A systematic review and meta-analysis","volume":"93","author":"Andrews","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/01.NPT.0000281186.94382.90","article-title":"Effects of an aquatics exercise program on quality of life measures for individuals with progressive multiple sclerosis","volume":"28","author":"Roehrs","year":"2004","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_10","first-page":"144","article-title":"Exercise therapy for chronic fatigue syndrome","volume":"4","author":"Brurberg","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1682\/JRRD.2009.01.0007","article-title":"Can pacing self-management alter physical behaviour and symptom severity in chronic fatigue syndrome: A case series","volume":"46","author":"Nijs","year":"2009","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_12","unstructured":"National Institute for Health and Clinical Excellence (NICE) (2016, October 10). Clinical Guideline Chronic Fatigue Syndrome\/Myalgic Encephalomyelitis or Encephalopathy: Diagnosis and Management of CFS\/ME in Adults and Children. Available online: http:\/\/www.nice.org.uk\/nicemedia\/pdf\/CG53NICEGuideline.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.2522\/ptj.20140405","article-title":"Assessing the psychometric properties of an activity pacing questionnaire for chronic pain and fatigue","volume":"95","author":"Antcliff","year":"2015","journal-title":"Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1080\/02640414.2020.1721254","article-title":"Optimising activity pacing to promote a physically active lifestyle in persons with a disability or chronic disease: A narrative review","volume":"38","author":"Abonie","year":"2020","journal-title":"J. Sports Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1080\/09638288.2018.1504994","article-title":"Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: A meta-analysis","volume":"42","author":"Abonie","year":"2020","journal-title":"Disabil. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1016\/j.pain.2014.09.028","article-title":"Activity pacing in daily life: A within-day analysis","volume":"155","author":"Murphy","year":"2014","journal-title":"Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5014\/ajot.62.3.329","article-title":"Measuring activity pacing in women with lower-extremity osteoarthritis: A pilot study","volume":"62","author":"Murphy","year":"2008","journal-title":"Am. J. Occup. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"326","DOI":"10.3389\/fpsyg.2012.00326","article-title":"The association between symptoms, pain coping strategies, and physical activity among people with symptomatic knee and hip osteoarthritis","volume":"3","author":"Murphy","year":"2012","journal-title":"Front. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e007591","DOI":"10.1136\/bmjopen-2015-007591","article-title":"Protocol of a longitudinal cohort study on physical activity behaviour in physically disabled patients participating in a rehabilitation counselling programme: ReSpAct","volume":"5","author":"Alingh","year":"2015","journal-title":"BMJ Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s13012-014-0127-7","article-title":"Design of a process evaluation of the implementation of a physical activity and sport stimulation program in Dutch rehabilitation setting: ReSpAct","volume":"9","author":"Hoekstra","year":"2014","journal-title":"Implement Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/S0895-4356(03)00220-8","article-title":"Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity","volume":"56","author":"Schuit","year":"2003","journal-title":"J. Clin. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11136-008-9418-2","article-title":"Updated US population standard for the Veterans RAND 12-item Health Survey (VR-12)","volume":"18","author":"Selim","year":"2009","journal-title":"Qual. Life Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jpainsymman.2007.08.019","article-title":"The measurement of fatigue in chronic illness: A systematic review of unidimensional and multidimensional fatigue measures","volume":"37","author":"Whitehead","year":"2009","journal-title":"J. Pain Symptom Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1468-1331.2010.03090.x","article-title":"Fatigue in multiple sclerosis: Associations with health-related quality of life and physical performance","volume":"18","author":"Smedal","year":"2011","journal-title":"Eur. J. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"R99","DOI":"10.1186\/ar4279","article-title":"Daily physical activity in ankylosing spondylitis: Validity and reliability of the IPAQ and SQUASH and the relation with clinical assessments","volume":"15","author":"Arends","year":"2013","journal-title":"Arthritis Res. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wagenmakers, R., van den Akker-Scheek, I., Groothoff, J.W., Zijlstra, W., Bulstra, S.K., Kootstra, J.W., Wendel-Vos, G.W., van Raaij, J.J., and Stevens, M. (2008). Reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-141"},{"key":"ref_28","unstructured":"Hays, R.D. (1998). RAND 36 Health Status Inventory, Harcourt Brace & Company."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-time short form health survey: Construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_30","unstructured":"IBM Corp (2015). IBM SPSS Statistics for Windows, IBM Corp. Version 23."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1249\/MSS.0000000000000929","article-title":"Translating fatigue to human performance","volume":"48","author":"Enoka","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/j.apmr.2016.04.019","article-title":"Real-time assessment of fatigue in patients with multiple sclerosis: How does it relate to commonly used self-report fatigue questionnaires?","volume":"97","author":"Heine","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/01.FCH.0000264411.20766.0c","article-title":"Physical activity and multiple sclerosis: Validity of self-report and objective measures","volume":"30","author":"Gosney","year":"2007","journal-title":"Fam. Commun. Health"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Weiland, T.J., Jelinek, G.A., Marck, C.H., Hadgkiss, E.J., van der Meer, D.M., Pereira, N.G., and Taylor, K.L. (2015). Clinically Significant Fatigue: Prevalence and Associated Factors in an International Sample of Adults with Multiple Sclerosis Recruited via the Internet. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0115541"},{"key":"ref_35","first-page":"580596","article-title":"Methodology of an International Study of People with Multiple Sclerosis Recruited through Web 2.0 Platforms: Demographics, Lifestyle, and Disease Characteristics","volume":"2013","author":"Hadgkiss","year":"2013","journal-title":"Neurol. Res. Int."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/5\/2\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:39:10Z","timestamp":1760175550000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/5\/2\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,15]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["jfmk5020043"],"URL":"https:\/\/doi.org\/10.3390\/jfmk5020043","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,15]]}}}