How does Coronavirus Disease 2019 (COVID-19) "Sheltering in Place" Affect Ambulatory Activity in People with Multiple Sclerosis?
Valerie Block 1, Riley Bove 1, Jeffrey Gelfand 1, Bruce Cree1
1Neurology, University of California San Francisco

Test the hypothesis that average daily step count (STEPS) in people with multiple sclerosis (MS) would decrease due to the COVID-19 shelter-in-place order.


People with neurological conditions that impair mobility, such as multiple sclerosis (MS), have low levels of physical activity, with walking being their primary exercise. When the San Francisco Bay Area shelter-in-place order was announced in mid-March 2020 to decrease SARS-CoV-2 infections, the abrupt closure of fitness centers greatly limited exercise options. We leveraged an ongoing study utilizing wearable technology to understand the impact of the pandemic (shelter-in-place policy) on physical activity in people with MS.


STEPS was measured from a MS cohort using a wrist worn accelerometer (Fitbit Flex2). Amount, type and frequency of exercise, as well as fatigue (Modified Fatigue Index; MFIS-5) and mental health (Mental Health Inventory; MHl-5) were assessed via questionnaire. Descriptive statistics and pre-post comparisons were performed, and figures generated, using R studio.


A decrease in STEPS was observed during the week (p=0.024) and month (p=0.048) after, versus before, the shelter-in-place in 42 participants with valid STEPS data. Marked decrease in STEPS was observed for the week immediately post shelter-in-place; however, some recovered to near pre-shelter-in-place levels. As a group, this rebound was not significant. People who did not recover activity had lower baseline STEPS [3,404 (IQR: 2,136 – 5,470)] compared to those who rebounded [5,911 (IQR: 2,774 – 8,263)].


The data support the hypothesis that physical activity is reduced in people with MS due to shelter-in-place. Overall prolongation of reduced activity is troubling, particularly in a population where low activity is already pervasive. The findings highlight the increasing impact that wearables can have for tracking and promoting physical activity. In the future these can be used to more efficiently target and augment telehealth and telerehabilitation interventions in populations with chronic neurological disorders.