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Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis

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Abstract

Smoking is associated with increased multiple sclerosis (MS) risk. In addition, some studies have reported that smoking is associated with anxiety and depression. However, the associations between smoking, walking, and fatigue are needed to be investigated. The objective was to investigate the associations between cigarette smoking and walking, fatigue, depression symptom severity, and health-related quality of life in persons with MS. Two hundred seventy-nine persons with MS were evaluated in this cross-sectional study. Study outcomes were neurological disability level, walking speed, walking endurance, perceived walking impact of MS, fatigue, depression symptom severity, and health-related quality of life. There were 95 (34.1%) current smokers who had significantly higher fatigue (p = 0.003, 2 = 0.031) and depression (p = 0.044, 2 = 0.015), and lower health-related quality of life (p = 0.003, 2 = 0.031) after adjusting for age, gender, neurological disability level, and disease duration compared to non-smokers (n = 184). There was no significant difference between smokers and non-smokers in walking measures (p > 0.05). Smoking intensity was significantly correlated with age (r = 0.487), neurological disability level (r = 0.227), disease duration (r = 0.30), walking speed (r = 0.574), walking endurance (r =  − 0.461), perceived walking impact of MS (r = 0.684), fatigue (r = 0.370), health-related quality of life (r =  − 0.259), and depression (r = 0.269) in current smokers. Cigarette smokers with MS had significantly more fatigue and depression symptom severity and less health-related quality of life compared to non-smokers. Increased pack-years of cigarette smoking was associated with worse walking ability and health-related quality of life, and greater depression symptom severity and fatigue.

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References

  1. Olsson T, Barcellos LF, Alfredsson L (2017) Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 13(1):25–36. https://doi.org/10.1038/nrneurol.2016.187

    Article  CAS  PubMed  Google Scholar 

  2. Riise T, Nortvedt MW, Ascherio A (2003) Smoking is a risk factor for multiple sclerosis. Neurology 61(8):1122–1124. https://doi.org/10.1212/01.wnl.0000081305.66687.d2

    Article  PubMed  Google Scholar 

  3. Poorolajal J, Bahrami M, Karami M, Hooshmand E (2017) Effect of smoking on multiple sclerosis: a meta-analysis. J Public Health 39(2):312–320. https://doi.org/10.1093/pubmed/fdw030

    Article  Google Scholar 

  4. McKay KA, Jahanfar S, Duggan T, Tkachuk S, Tremlett H (2017) Factors associated with onset, relapses or progression in multiple sclerosis: a systematic review. Neurotoxicology 61:189–212. https://doi.org/10.1016/j.neuro.2016.03.020

    Article  PubMed  Google Scholar 

  5. Abdollahpour I, Nedjat S, Sahraian MA, Mansournia MA, Otahal P, van der Mei I (2017) Waterpipe smoking associated with multiple sclerosis: a population-based incident case-control study. Mult Scler 23(10):1328–1335. https://doi.org/10.1177/1352458516677867

    Article  PubMed  Google Scholar 

  6. Hedstrom AK, Hillert J, Olsson T, Alfredsson L (2013) Smoking and multiple sclerosis susceptibility. Eur J Epidemiol 28(11):867–874. https://doi.org/10.1007/s10654-013-9853-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Heydarpour P, Manouchehrinia A, Beiki O, Mousavi SE, Abdolalizadeh A, Lakeh MM, Sahraian MA (2018) Smoking and worsening disability in multiple sclerosis: a meta-analysis. Acta Neurol Scand 138(1):62–69. https://doi.org/10.1111/ane.12916

    Article  CAS  PubMed  Google Scholar 

  8. Manouchehrinia A, Tench CR, Maxted J, Bibani RH, Britton J, Constantinescu CS (2013) Tobacco smoking and disability progression in multiple sclerosis: United Kingdom cohort study. Brain 136(Pt 7):2298–2304. https://doi.org/10.1093/brain/awt139

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pittas F, Ponsonby AL, van der Mei IA, Taylor BV, Blizzard L, Groom P, Ukoumunne OC, Dwyer T (2009) Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis. J Neurol 256(4):577–585. https://doi.org/10.1007/s00415-009-0120-2

    Article  PubMed  Google Scholar 

  10. Hempel S, Graham GD, Fu N, Estrada E, Chen AY, Miake-Lye I, Miles JN, Shanman R, Shekelle PG, Beroes JM, Wallin MT (2017) A systematic review of modifiable risk factors in the progression of multiple sclerosis. Mult Scler 23(4):525–533. https://doi.org/10.1177/1352458517690270

    Article  PubMed  Google Scholar 

  11. Hernan MA, Jick SS, Logroscino G, Olek MJ, Ascherio A, Jick H (2005) Cigarette smoking and the progression of multiple sclerosis. Brain 128(Pt 6):1461–1465. https://doi.org/10.1093/brain/awh471

    Article  PubMed  Google Scholar 

  12. Healy BC, Ali EN, Guttmann CR, Chitnis T, Glanz BI, Buckle G, Houtchens M, Stazzone L, Moodie J, Berger AM, Duan Y, Bakshi R, Khoury S, Weiner H, Ascherio A (2009) Smoking and disease progression in multiple sclerosis. Arch Neurol 66(7):858–864. https://doi.org/10.1001/archneurol.2009.122

    Article  PubMed  PubMed Central  Google Scholar 

  13. Van-der-Vuurst-de-Vries RM, Mescheriakova JY, Runia TF, Siepman TAM, Wokke BHA, Samijn JPA, Hintzen RQ (2018) Smoking at time of CIS increases the risk of clinically definite multiple sclerosis. J Neurol 265(5):1010–1015. https://doi.org/10.1007/s00415-018-8780-4

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kvistad S, Myhr KM, Holmoy T, Benth JS, Loken-Amsrud KI, Wergeland S, Beiske AG, Bjerve KS, Hovdal H, Lilleas F, Midgard R, Pedersen T, Bakke SJ, Torkildsen O (2016) No association of tobacco use and disease activity in multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 3(4):e260. https://doi.org/10.1212/NXI.0000000000000260

    Article  PubMed  PubMed Central  Google Scholar 

  15. Munger KL, Fitzgerald KC, Freedman MS, Hartung HP, Miller DH, Montalban X, Edan G, Barkhof F, Suarez G, Radue EW, Sandbrink R, Kappos L, Pohl C, Ascherio A (2015) No association of multiple sclerosis activity and progression with EBV or tobacco use in BENEFIT. Neurology 85(19):1694–1701. https://doi.org/10.1212/WNL.0000000000002099

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Petersen ER, Sondergaard HB, Laursen JH, Olsson AG, Bornsen L, Soelberg Sorensen P, Sellebjerg F, Bang Oturai A (2019) Smoking is associated with increased disease activity during natalizumab treatment in multiple sclerosis. Mult Scler 25(9):1298–1305. https://doi.org/10.1177/1352458518791753

    Article  CAS  PubMed  Google Scholar 

  17. Petersen ER, Oturai AB, Koch-Henriksen N, Magyari M, Sorensen PS, Sellebjerg F, Sondergaard HB (2018) Smoking affects the interferon beta treatment response in multiple sclerosis. Neurology 90(7):e593–e600. https://doi.org/10.1212/WNL.0000000000004949

    Article  CAS  PubMed  Google Scholar 

  18. Briggs FBS, Yu JC, Davis MF, Jiangyang J, Fu S, Parrotta E, Gunzler DD, Ontaneda D (2019) Multiple sclerosis risk factors contribute to onset heterogeneity. Mult Scler Relat Disord 28:11–16. https://doi.org/10.1016/j.msard.2018.12.007

    Article  PubMed  Google Scholar 

  19. McKay KA, Tremlett H, Fisk JD, Patten SB, Fiest K, Berrigan L, Marrie RA, Epidemiology CTit, Impact of Comorbidity on Multiple Score (2016) Adverse health behaviours are associated with depression and anxiety in multiple sclerosis: a prospective multisite study. Mult Scler 22(5):685–693. https://doi.org/10.1177/1352458515599073

    Article  PubMed  Google Scholar 

  20. Jelinek PL, Simpson S Jr, Brown CR, Jelinek GA, Marck CH, De Livera AM, O'Kearney E, Taylor KL, Neate SL, Weiland TJ (2019) Self-reported cognitive function in a large international cohort of people with multiple sclerosis: associations with lifestyle and other factors. Eur J Neurol 26(1):142–154. https://doi.org/10.1111/ene.13784

    Article  CAS  PubMed  Google Scholar 

  21. Ozcan ME, Ince B, Bingol A, Erturk S, Altinoz MA, Karadeli HH, Kocer A, Asil T (2014) Association between smoking and cognitive impairment in multiple sclerosis. Neuropsychiatr Dis Treat 10:1715–1719. https://doi.org/10.2147/Ndt.S68389

    Article  PubMed  PubMed Central  Google Scholar 

  22. Weiland TJ, Hadgkiss EJ, Jelinek GA, Pereira NG, Marck CH, van der Meer DM (2014) The association of alcohol consumption and smoking with quality of life, disability and disease activity in an international sample of people with multiple sclerosis. J Neurol Sci 336(1–2):211–219. https://doi.org/10.1016/j.jns.2013.10.046

    Article  CAS  PubMed  Google Scholar 

  23. Briggs FB, Gunzler DD, Ontaneda D, Marrie RA (2017) Smokers with MS have greater decrements in quality of life and disability than non-smokers. Mult Scler 23(13):1772–1781. https://doi.org/10.1177/1352458516685169

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jawahar R, Oh U, Eaton C, Wright N, Tindle H, Lapane KL (2014) Association between smoking and health outcomes in postmenopausal women living with multiple sclerosis. Mult Scler Int 2014:686045. https://doi.org/10.1155/2014/686045

    Article  PubMed  PubMed Central  Google Scholar 

  25. Briggs FBS, Thompson NR, Conway DS (2019) Prognostic factors of disability in relapsing remitting multiple sclerosis. Mult Scler Relat Disord 30:9–16. https://doi.org/10.1016/j.msard.2019.01.045

    Article  PubMed  Google Scholar 

  26. Chamot E, Kister I, Cutter GR (2014) Item response theory-based measure of global disability in multiple sclerosis derived from the performance scales and related items. BMC Neurol 14(1):192. https://doi.org/10.1186/s12883-014-0192-1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302. https://doi.org/10.1002/ana.22366

    Article  PubMed  PubMed Central  Google Scholar 

  28. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191

    Article  Google Scholar 

  29. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452. https://doi.org/10.1212/wnl.33.11.1444

    Article  CAS  Google Scholar 

  30. Kieseier BC, Pozzilli C (2012) Assessing walking disability in multiple sclerosis. Mult Scler 18(7):914–924. https://doi.org/10.1177/1352458512444498

    Article  PubMed  Google Scholar 

  31. Fischer JS, Rudick RA, Cutter GR, Reingold SC (1999) The multiple sclerosis functional composite measure (MSFC): an integrated approach to MS clinical outcome assessment National MS Society Clinical Outcomes Assessment Task Force. Mult Scler 5(4):244–250. https://doi.org/10.1177/135245859900500409

    Article  CAS  PubMed  Google Scholar 

  32. Goldman MD, Marrie RA, Cohen JA (2008) Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler 14(3):383–390. https://doi.org/10.1177/1352458507082607

    Article  PubMed  Google Scholar 

  33. Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ (2003) Measuring the impact of MS on walking ability: the 12-Item MS Walking Scale (MSWS-12). Neurology 60(1):31–36. https://doi.org/10.1212/wnl.60.1.31

    Article  CAS  PubMed  Google Scholar 

  34. Dib H, Tamam Y, Terzi M, Hobart J (2017) Testing patient-reported outcome measurement equivalence in multinational clinical trials: an exemplar using the 12-item Multiple Sclerosis Walking Scale. Mult Scler J 3(3):2055217317728740. https://doi.org/10.1177/2055217317728740

    Article  Google Scholar 

  35. Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF (1994) Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 18(Suppl 1):S79–83. https://doi.org/10.1093/clinids/18.supplement_1.s79

    Article  PubMed  Google Scholar 

  36. Armutlu K, Keser I, Korkmaz N, Akbiyik DI, Sumbuloglu V, Guney Z, Karabudak R (2007) Psychometric study of Turkish version of Fatigue Impact Scale in multiple sclerosis patients. J Neurol Sci 255(1–2):64–68. https://doi.org/10.1016/j.jns.2007.01.073

    Article  PubMed  Google Scholar 

  37. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56(6):893–897. https://doi.org/10.1037//0022-006x.56.6.893

    Article  CAS  PubMed  Google Scholar 

  38. Sacco R, Santangelo G, Stamenova S, Bisecco A, Bonavita S, Lavorgna L, Trojano L, D'Ambrosio A, Tedeschi G, Gallo A (2016) Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis. Eur J Neurol 23(4):744–750. https://doi.org/10.1111/ene.12932

    Article  CAS  Google Scholar 

  39. Hisli N (1989) Beck depresyon envanterinin universite ogrencileri icin gecerliligi, guvenilirligi (A reliability and validity study of Beck Depression Inventory in a university student sample). J Psychol 7:3–13

    Google Scholar 

  40. Simeoni M, Auquier P, Fernandez O, Flachenecker P, Stecchi S, Constantinescu C, Idiman E, Boyko A, Beiske A, Vollmer T, Triantafyllou N, O'Connor P, Barak Y, Biermann L, Cristiano E, Atweh S, Patrick D, Robitail S, Ammoury N, Beresniak A, Pelletier J, MusiQol Study Group (2008) Validation of the multiple sclerosis international quality of life questionnaire. Mult Scler 14(2):219–230. https://doi.org/10.1177/1352458507080733

    Article  PubMed  Google Scholar 

  41. Cohen J (1988) Statistical power analysis for the behavioural sciences. Erlbaum, In Hillsdale

    Google Scholar 

  42. Marrie RA, Cutter G, Tyry T, Campagnolo D, Vollmer T (2009) Smoking status over two years in patients with multiple sclerosis. Neuroepidemiology 32(1):72–79. https://doi.org/10.1159/000170910

    Article  PubMed  Google Scholar 

  43. Friend KB, Mernoff ST, Block P, Reeve G (2006) Smoking rates and smoking cessation among individuals with multiple sclerosis. Disabil Rehabil 28(18):1135–1141. https://doi.org/10.1080/09638280500533707

    Article  CAS  PubMed  Google Scholar 

  44. Ramanujam R, Hedstrom AK, Manouchehrinia A, Alfredsson L, Olsson T, Bottai M, Hillert J (2015) Effect of smoking cessation on multiple sclerosis prognosis. JAMA Neurol 72(10):1117–1123. https://doi.org/10.1001/jamaneurol.2015.1788

    Article  PubMed  Google Scholar 

  45. Tanasescu R, Constantinescu CS, Tench CR, Manouchehrinia A (2018) Smoking cessation and the reduction of disability progression in multiple sclerosis: a cohort study. Nicotine Tob Res 20(5):589–595. https://doi.org/10.1093/ntr/ntx084

    Article  PubMed  Google Scholar 

  46. World Health Organization (2018) Global health observatory data repository. https://apps.who.int/ghodata/. Accessed 13 Nov 2018

  47. Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A (2001) The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain 124(Pt 5):962–973. https://doi.org/10.1093/brain/124.5.962

    Article  CAS  PubMed  Google Scholar 

  48. Taylor KL, Simpson S Jr, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ (2018) Longitudinal associations of modifiable lifestyle factors with positive depression-screen over 2.5-years in an international cohort of people living with multiple sclerosis. Front Psychiatry 9:526–526. https://doi.org/10.3389/fpsyt.2018.00526

    Article  PubMed  PubMed Central  Google Scholar 

  49. Weiland TJ, Jelinek GA, Marck CH, Hadgkiss EJ, van der Meer DM, Pereira NG, Taylor KL (2015) Clinically significant fatigue: prevalence and associated factors in an international sample of adults with multiple sclerosis recruited via the internet. PLoS ONE 10(2):e0115541–e0115541. https://doi.org/10.1371/journal.pone.0115541

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Newland P, Flick L, Xian H, Thomas FP (2016) Symptom co-occurrences associated with smoking in individuals with relapsing-remitting multiple sclerosis. Int J MS Care 18(4):163–168. https://doi.org/10.7224/1537-2073.2014-028

    Article  PubMed  PubMed Central  Google Scholar 

  51. Solaro C, Gamberini G, Masuccio FG (2018) Depression in multiple sclerosis: epidemiology, aetiology, diagnosis and treatment. CNS Drugs 32(2):117–133. https://doi.org/10.1007/s40263-018-0489-5

    Article  PubMed  Google Scholar 

  52. Leong TI, Weiland TJ, Jelinek GA, Simpson S, Brown CR, Neate SL, Taylor KL, O'Kearney E, Milanzi E, De Livera AM (2018) Longitudinal associations of the healthy lifestyle index score with quality of life in people with multiple sclerosis: a prospective cohort study. Front Neurol 9:874. https://doi.org/10.3389/fneur.2018.00874

    Article  PubMed  PubMed Central  Google Scholar 

  53. Conway DS, Thompson NR, Cohen JA (2016) Influence of hypertension, diabetes, hyperlipidemia, and obstructive lung disease on multiple sclerosis disease course. Mult Scler J 23(2):277–285. https://doi.org/10.1177/1352458516650512

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Multiple Sclerosis Research Association.

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Kahraman, T., Ozdogar, A.T., Abasiyanik, Z. et al. Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis. Acta Neurol Belg 121, 1199–1206 (2021). https://doi.org/10.1007/s13760-020-01341-2

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